Doctors working in accident and emergency departments are finding it increasingly difficult to provide cost effective care for patients. In the management of patients with painful limb injuries the use of less expensive strong analgesia may seem appropriate. On p 1247 Rainer et al show, however, that when additional emergency department and hospital costs are taken into account, the more expensive ketorolac is no more expensive than morphine. If emergency department and pharmacy costs are considered separately from total hospital costs, then ketorolac is cheaper, gives equal pain relief, is associated with less severe and fewer adverse effects, shortens patients' stay in the emergency department, and is associated with greater patient satisfaction.