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Oxford Pain Internet Site


This month, on July 14 th , Bandolier is opening the Oxford Pain Internet Site . The content is different from the usual Bandolier story which gives a view on a systematic review or trial. Instead the site provides formal summaries of systematic reviews looking at pain outcomes. Each précis has a clinical bottom line at the top, followed by a commentary taking about five minutes to read if you want more information. There are NNTs and L'Abbé plots when they can be calculated or drawn, with references for further reading to other, similar, reviews, as well as links to related pages on the site. An example follows, a systematic review of antidepressants in neuropathic pain .

There is also the Oxford League Table of analgesic effectiveness. This shows the relative efficacy of single-dose analgesics in acute pain, using the number needed to treat for at least 50% pain relief over 4 to 6 hours compared with placebo for patients with moderate or severe pain. The NNTs have been obtained from randomised, double-blind trials, all of which have used standard pain efficacy measures in standard pain models (mostly after molar extraction or in postoperative pain). So there is a standard method, in patients with the same condition, using standard outcomes obtained by standard scales and using the same standard comparator, placebo.

Information is available for 18 drugs used at some 50 different doses. The full information is on the Pain Internet Site , but a summary of the NNTs for the most common analgesics is shown in the Figure and in the Table, which also has confidence intervals and numbers of patients. Oral NSAIDs perform as well as intramuscular opioids and oral combinations of simple analgesics and opioids.

 

NNTs for at least 50% pain relief obtained from randomised, single-dose, double-blind trials using standard pain efficacy measures in standard pain models, using standard methods, in patients with the same condition, using standard outcomes obtained by standard scales and using the same standard comparator, placebo.

 

Drug or combination Route NNT (95% CI) Number of patients in comparison
Paracetamol 1000 + Codeine 60 Oral 1.9 (1.5 to 2.6) 127
Diclofenac 50 Oral 2.3 (2.0 to 2.7) 636
Ibuprofen 400 Oral 2.7 (2.5 to 3.0) 2898
Morphine 10 Intramuscular 2.9 (2.6 to 3.6) 946
Pethidine 100 Intramuscular 2.9 (2.3 to 3.9) 364
Paracetamol 600/650 + Codeine 60 Oral 3.1(2.6 to 3.9) 816
Aspirin 600/650 Oral 4.4 (4.0 to 4.9) 5061
Paracetamol 650 + Dextropropoxyphene (65 hydrochloride or 100 napsylate) Oral 4.4 (3.5 to 5.6) 963
Paracetamol 1000 Oral 4.6 (3.9 to 5.4) 2283
Aspirin 650 + Codeine 60 Oral 5.3 (4.1 to 7.4) 598
Tramadol 75 Oral 5.3 (3.9 to 8.2) 563

 

Of course, this is not the complete picture. Adverse effects, cost and the requirements of individuals and institutions are also part of the decision-making process. Some information on adverse effects, in both acute and chronic use is also presented .


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