Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review

Aj, de Craen; G, Di Giulio; Je, Lampe-Schoenmaeckers; Ag, Kessels; Kleijnen, Jos

doi:10.1136/bmj.313.7053.321

Cited by 115 publications

(53 citation statements)

References 27 publications

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“…[9][10][11][12][13][14][15] However, this study has shown marked differences in the efficacy of pain control. Diflunisal was quicker and more effective in controlling pain compared to Panadeine, and maintained its efficacy throughout the study period.…”

Section: Discussionmentioning

confidence: 96%

“…8 Panadeine, a compound analgesic agent containing paracetamol and codeine, has been used after minor oral surgery for over 30 years. 9,10 Likewise, Diflunisal, a nonsteroidal anti-inflammatory drug (NSAID) with proven analgesic properties is a widely used agent. 11,12 One of the newer generation of NSAIDs to become employed in the control of postoperative pain following wisdom tooth removal has been Etodolac.…”

mentioning

confidence: 99%

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A study of the comparative efficacy of three common analgeisics in the control of pain after third molar surgery under local anaesthesia

Comfort

Tse²,

Tsang

et al. 2002

Australian Dental Journal

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Background:The aim of this study was to evaluate the comparative efficacy of three commonly used analgesics (Panadeine, Diflunisal and Etodolac) in the control of pain after third molar surgery under local anaesthesia. Methods: A randomized control study. Outcome of primary efficacy was judged by overall assessment of the area under the curve of graphs for pain intensity, measured from serial visual analogue scales over a 24-hour period. Other measures of efficacy included the number (per cent) of patients who took 'additional' analgesics and the incidence of adverse effects occurring in each treatment group over the study period. Results: The three drugs were effective in the control of post-operative pain (p<0.01). Variations in pain intensity and the use of additional medication between the treatment groups were observed over the study period. The Diflunisal group experienced less pain than the Panadeine or Etodolac group (p<0.01). Furthermore, a lesser number of those in the Diflunisal group used additional medication compared to the other two groups (p<0.01). The incidence of side effects from all three drugs was low. Conclusion: Diflunisal is superior in the control of pain following third molar surgery under local anaesthesia than either Panadeine or Etodolac, and has few side effects.

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Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 99%

A study of the comparative efficacy of three common analgeisics in the control of pain after third molar surgery under local anaesthesia

Comfort

Tse²,

Tsang

et al. 2002

Australian Dental Journal

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“…However, the superiority of those combinations over aspirin alone is equivocal. In two recent meta-analyses codeine was shown to exert some statistically although perhaps not clinically significant additional analgesic effect to that of paracetamol alone (2,3). Caffeine had no adjuvant analgesic effect (3).…”

Section: Introductionmentioning

confidence: 98%

Do codeine and caffeine enhance the analgesic effect of aspirin?-A systematic overview

Zhang

1997

Journal of Clinical Pharmacy and Therapeutics

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SUMMARYObjective: To assess whether codeine and caffeine enhance the analgesic effect of aspirin in postoperative pain. Method: Systematic overview of the literature and meta-analysis of published randomized controlled trials (RCTs). Results: Codeine 60 mg leads t o a small increase in the analgesic effect of 6 5 0 -m g of aspirin when total pain relief score (TOTPAR%) is used as an efficacy end-point. This increased effect was not seen when sum of pain intensity (SPID%) and proportion of patients responding with moderate t o excellent pain relief were used as outcome measures. Caffeine did not enhance the analgesic effect of aspirin. Conclusion: Codeine 6 0 m g may produce a small increase in the analgesic effect of aspirin 6 5 0 mg.However, this effect is not clinically meaningful. Caffeine has n o adjuvant analgesic effect. At overthe-counter (OTC) doses, caffeine and codeine are not useful in aspirin formulations.

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“…This dose is associated with severe constipation. 31 Codeine has a ceiling dose effect, above which further dose increases will not increase analgesia.…”

Section: Opioid Analgesiamentioning

confidence: 99%

Pharmacological Management of Pain in Older People

Katz

2007

Pharmacy Practice and Res

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The prevalence of pain increases with advancing age. Pain is often undiagnosed or under-treated in older patients, particularly those with cognitive impairment, communication problems or residents of aged-care facilities. The most definitive approach to the management of pain is to treat the underlying cause. As this is often not feasible in the elderly, the emphasis then shifts to symptom control. Pharmacological approaches form the mainstay of therapy. They are convenient and often cost-effective, and may be used alone, or in combination with physical and psychological therapies.

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Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review

Cited by 115 publications

References 27 publications

A study of the comparative efficacy of three common analgeisics in the control of pain after third molar surgery under local anaesthesia

A study of the comparative efficacy of three common analgeisics in the control of pain after third molar surgery under local anaesthesia

Do codeine and caffeine enhance the analgesic effect of aspirin?-A systematic overview

Pharmacological Management of Pain in Older People

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