Ketorolac and ibuprofen are not pharmacologic equivalent (dose for dose it is different) and therapeutically ketorolac is more potent. With the widespread narcotic abuse epidemic in the U.S.A., this drug should not have been limited by big pharma and insurance companies to IV or IM first dose. It is a very orally well absorb and effective medicine for moderate to severe pain that could have prevented a lot of clinicians from issuing narcotic analgesics. The problem is when it came out, clinicians did not study the medicine's profile and know the drug well before prescribing it. It was rx'ed wantonly and the effect of wanton prescription writing by clinicians who does not know the drug well led to adverse effects that the FDA and pharma indicated it for IM/IV use only for first dose in the hopes that clinicians will opt for the pricier IM/IV form (do you know why healthcare cost is skyrocketing) and not use the cheaper oral form first. If you study the drug's profile, it does not make sense. The problem is when a warning comes out, pharmacists get scared to in filling the prescription without even knowing its safety profile and the reason it got a warning. In the hands of a skilled and well-studied and diligent clinician, this is heaven-sent in preventing the narcotic abuse epidemic problem that is going on. This is also an argument for a good clinician-pharmacist relationship so that the pharmacist can be confident about the physician who is prescribing it and not worry that it will be abused. I have used it to treat refractory migraine when they do not respond to sumatriptan alone, chronic intermittent slip disc pain, trigeminal nerve zoster pain, etc...… Again, knowledgeable skilled clinicians know how to use the oral form, its nuances and can communicate well to patients on how to use it only on prn basis and not continuous >5-7 day RTC dosing (patient profile considered also in using this medication). In today's managed care setting with 5 minute visits, some clinicians may not be well served using this medicine but thoughtful good clinicians can!
For more info: see decisional summary on ketorolac by the FDA.