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Acute Pain | Chronic Pain | General

Piroxicam in postoperative pain

Clinical bottom line:

Piroxicam is an effective analgesic. A single dose of 20 mg piroxicam had an NNT of 2.7 (2.1 to 3.8) for at least 50% pain relief over 4-6 hours in patients with moderate or severe pain compared with placebo. 40 mg had an NNT of 1.9 (1.2 to 4.3). However, this is based on a very small number of patients, and should be interpreted with caution. Piroxicam 20 mg is not associated with increased adverse effects in single dose administration.

Piroxicam is a non-steroidal anti-inflammatory drug (NSAID) which is used mainly in the treatment of rheumatic disorders. In 1995 there were over half a million prescriptions of piroxicam in the UK, accounting for about 3% of total NSAID prescriptions.

Systematic review

Edwards JE, Loke YK, Moore RA, McQuay HJ. Single dose piroxicam in acute postoperative pain: a quantitative systematic review. 1999 Cochrane Library, Database of Cochrane Reviews.

Inclusion criteria were randomised, double-blind, placebo controlled trials of piroxicam in postoperative pain; adult patients; baseline pain of moderate to severe intensity; oral and/or intramuscular administration; pain outcome at least four hours.

Mean TOTPAR and SPID values for each trial were converted to %maxTOTPAR and %maxSPID, and then the proportion of patients achieving at least 50%maxTOTPAR were calculated. This information was used to calculate numbers-needed-to-treat and relative benefit. Adverse effects frequency data were used to calculate numbers-needed-to-harm and relative risk.

Findings

No trials were found for intramuscular piroxicam.

Piroxicam 20 mg

Three trials comparing 141 piroxicam patients with 139 placebo patients were included. A single oral dose of piroxicam 20 mg was significantly more effective at relieving pain, with a number-needed-to-treat of 2.7 (2.1 to 3.8).

Piroxicam 40 mg

One trial comparing 15 piroxicam patients with 15 placebo patients was included. A single oral dose of piroxicam 40 mg was significantly more effective at relieving pain, with a number-needed-to-treat of 1.9 (1.2 to 4.3). However, this is based on a very small number of patients, and should be interpreted with caution.

Adverse effects

For any adverse effect, piroxicam 20 mg was associated with fewer adverse effects than placebo, with a number-needed-to-harm of -5 (-9 to -4). There were significantly less fever and significantly less non-fever (dizziness, nausea and vomiting analysed together) adverse effects with piroxicam.

There were insufficient data to analyse piroxicam 40 mg.

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