When Cameron Nagel was born at 34 weeks, his medical journey began with immediate resuscitation and a three-week stay in the neonatal intensive care unit. By the time he was three, he had logged a long list of diagnoses. Now a veteran of the health-care system with more than 70 surgeries and nearly 700 days spent in hospital beds, Cameron and his mother, Dana, have seen firsthand how pediatric care has evolved. "We went from holding kids down for certain procedures to coming up with a coping plan or having a distraction — all of those things that help your child so that it's not such a traumatic experience," Dana recalls. But the most profound shift they’ve seen is toward giving patients more of a voice in their care. It was this philosophy — putting family preferences and patient experiences at the centre of medicine — that inspired Dana and Cameron, now 16, to volunteer as patient partners in research at the Stollery Children’s Hospital. They worked with Dr. Samina Ali, professor of pediatrics and emergency medicine at the University of Alberta and chair of Pediatric Emergency Research Canada, whose research program focuses on better treatment of children’s pain. The No OUCH trial Ali led a landmark Canadian study that is transforming how emergency rooms manage acute pain in children. Backed by the clinical research services of the Women and Children's Health Research Institute (WCHRI) at the U of A, the No OUCH trial set out to answer a critical question: do children sent home from the emergency department with broken or sprained limbs actually benefit from oral opioids? Historically, clinicians and parents faced a difficult balancing act, particularly given the ongoing complexities of the opioid crisis. To address widespread parental anxieties, Ali’s team deployed an innovative study design. They embedded two trials within a single study — one involving oral opioids and one without — giving families the autonomy to choose the path that felt safest for them. It was one of the largest randomized clinical trials ever conducted on pediatric pain in Canada, and evaluated 699 children aged six to 17 across six pediatric emergency departments in Alberta, Manitoba and Ontario. The participants all had musculoskeletal injuries such as broken arms and sprained ankles and had moderate to severe pain, but did not need surgery or hospital admission. Challenging the role of opioids The results were definitive: ibuprofen alone provided the same level of pain relief as ibuprofen paired with acetaminophen or ibuprofen paired with hydromorphone, a potent oral opioid. While pain scores dropped universally an hour after peak medication effect, children given oral opioids were four to five times more likely to suffer adverse reactions such as dizziness, fatigue, nausea and vomiting. "We don’t like to give children medications they don’t need, so if these medicines add no benefit to pain relief, then there is no reason to give them,” Ali explains. “For me, this puts to rest the idea that oral opioids have a role in the treatment of children with acute pain and musculoskeletal injury in the emergency department who are being sent home." Ali says more research is needed on the so-called “3P approach” to pain management, which blends pharmacological treatments with physical therapies (like ice and heat) and psychological support (such as distraction and child life teams). This holistic model mirrors the standards that earned the Stollery Children’s Hospital a prestigious ChildKind International certification for its commitment to treating children’s pain, making it one of only 22 hospitals worldwide to achieve this standard. A framework for family-centred care The trial’s success underscores WCHRI’s capacity to anchor large, multi-site clinical trials. By providing the infrastructure needed for high-quality study design, rigorous implementation and data coordination, WCHRI enables researchers to generate evidence that can alter clinical practice on a large scale. Ali expects the findings to lead to changes in the national clinical practice guidelines put out by TREKK (Translating Emergency Knowledge for Kids) and the Canadian Paediatric Society, to which she contributes. The study also highlights why a dedicated, standalone children’s hospital is so vital in Edmonton, allowing clinicians to focus entirely on children's unique medical and emotional needs. For patient partners like the Nagels, seeing research translate into real-world changes in care makes their arduous journey feel meaningful. “Knowing that the people coming after us will maybe have an easier time — it completely warms my heart. It just makes it feel like maybe all of this was worth it.” Story by Kerry Powell with files from Gillian Rutherford and Erik Einsiedel WCHRI’s integrated research services support every stage of pediatric, perinatal and women’s health research, from planning, ethics approval and recruitment, to data management, documentation and closeout. As of spring 2026, the clinical trials support team was managing 100 active trials. The No OUCH study is part of the international Innovative Pediatric Clinical Trials (iPCT) partnership co-led by U of A pediatrics professor Lawrence Richer, associate dean of research for the College of Health Sciences. The research was supported by the Canadian Institutes of Health Research and the Stollery Children’s Hospital Foundation through WCHRI.
Photos by William Au Full-spectrum research support
