Comparative efficacy of therapeutics for traumatic musculoskeletal pain in the emergency setting: A network meta-analysis

Yin, Bangshao; Wang, Xiaokai; He, Caiyun

doi:10.1016/j.ajem.2020.10.038

Cited by 8 publications

(9 citation statements)

References 24 publications

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“…Many recent studies showed that NSAIDs or acetaminophen are as good as or better than opioids for the treatment of acute pain 18–25 . Due to the opioid crisis and the postulate that short‐term opioids are ineffective and associated with a high risk of abuse, some health care professionals have stopped using opioids in the ED 55 .…”

Section: Discussionmentioning

confidence: 99%

“…Many recent studies showed that NSAIDs or acetaminophen are as good as or better than opioids for the treatment of acute pain. [18][19][20][21][22][23][24][25] F I G U R E 4 Forest plot of opioid efficacy for codeine versus other opioids.…”

Section: Opioid Prescribing Guidelinesmentioning

confidence: 99%

“…For acute musculoskeletal injuries seen in the ED, opioids do not seem to offer a better benefit-harm ratio in relieving pain than NSAIDs. [22][23][24] Others have found that opioids are not superior to NSAIDs or acetaminophen at reducing acute pain in a prehospital setting. 25 However, another literature review on musculoskeletal pain in the ED reported that "No interventions were more effective at decreasing pain intensity than opioids at 60 min."…”

Section: Introductionmentioning

confidence: 99%

“…The efficacy of opioids administered during an ED visit has also been well studied. For acute musculoskeletal injuries seen in the ED, opioids do not seem to offer a better benefit–harm ratio in relieving pain than NSAIDs 22–24 . Others have found that opioids are not superior to NSAIDs or acetaminophen at reducing acute pain in a prehospital setting 25 .…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of prescribed opioids for acute pain after being discharged from the emergency department: A systematic review and meta‐analysis

Daoust,

Paquet,

Marquis

et al. 2023

Academic Emergency Medicine

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BackgroundOpioids are often prescribed for acute pain to patients discharged from the emergency department (ED), but there is a paucity of data on their short‐term use. The purpose of this study was to synthesize the evidence regarding the efficacy of prescribed opioids compared to nonopioid analgesics for acute pain relief in ED‐discharged patients.MethodsMEDLINE, EMBASE, CINAHL, PsycINFO, CENTRAL, and gray literature databases were searched from inception to January 2023. Two independent reviewers selected randomized controlled trials investigating the efficacy of prescribed opioids for ED‐discharged patients, extracted data, and assessed risk of bias. Authors were contacted for missing data and to identify additional studies. The primary outcome was the difference in pain intensity scores or pain relief. All meta‐analyses used a random‐effect model and a sensitivity analysis compared patients treated with codeine versus those treated with other opioids.ResultsFrom 5419 initially screened citations, 46 full texts were evaluated and six studies enrolling 1161 patients were included. Risk of bias was low for five studies. There was no statistically significant difference in pain intensity scores or pain relief between opioids versus nonopioid analgesics (standardized mean difference [SMD] 0.12; 95% confidence interval [CI] −0.10 to 0.34). Contrary to children, adult patients treated with opioid had better pain relief (SMD 0.28, 95% CI 0.13–0.42) compared to nonopioids. In another sensitivity analysis excluding studies using codeine, opioids were more effective than nonopioids (SMD 0.30, 95% CI 0.15–0.45). However, there were more adverse events associated with opioids (odds ratio 2.64, 95% CI 2.04–3.42).ConclusionsFor ED‐discharged patients with acute musculoskeletal pain, opioids do not seem to be more effective than nonopioid analgesics. However, this absence of efficacy seems to be driven by codeine, as opioids other than codeine are more effective than nonopioids (mostly NSAIDs). Further prospective studies on the efficacy of short‐term opioid use after ED discharge (excluding codeine), measuring patient‐centered outcomes, adverse events, and potential misuse, are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Opioid Prescribing Guidelinesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of prescribed opioids for acute pain after being discharged from the emergency department: A systematic review and meta‐analysis

Daoust,

Paquet,

Marquis

et al. 2023

Academic Emergency Medicine

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“…According to a systematic review and meta-analysis by Pathan et al ( 37 ), the efficacy of NSAIDs is equivalent to opioids for the management of renal colic and they can be used as a suitable alternative for the management of colicky pain in the ED. Another recent study by Yin et al ( 38 ) has shown that NSAIDs are most suitable for the management of musculoskeletal pain. Despite their efficacy, there have been concerns regarding the use of NSAIDS for severe pain and the associated side effects of these drugs.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Intravenous Lidocaine for Pain Relief in the Emergency Department: A Systematic Review and Meta-Analysis

Zhong

Mao

et al. 2022

Front. Med.

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ObjectiveTo compare the efficacy of intravenous (IV) lidocaine with standard analgesics (NSAIDS, opioids) for pain control due to any cause in the emergency department.MethodsThe electronic databases of PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar were explored from 1st January 2000 to 30th March 2021 and randomized controlled trials (RCTs) comparing IV lidocaine with a control group of standard analgesics were included.ResultsTwelve RCTs including 1,351 patients were included. The cause of pain included abdominal pain, renal or biliary colic, traumatic pain, radicular low back pain, critical limb ischemia, migraine, tension-type headache, and pain of unknown origin. On pooled analysis, we found no statistically significant difference in pain scores between IV lidocaine and control group at 15 min (MD: −0.24 95% CI: −1.08, 0.61 I2 = 81% p = 0.59), 30 min (MD: −0.24 95% CI: −1.03, 0.55 I2 = 86% p = 0.55), 45 min (MD: 0.31 95% CI: −0.66, 1.29 I2 = 66% p = 0.53), and 60 min (MD: 0.59 95% CI: −0.26, 1.44 I2 = 75% p = 0.18). There was no statistically significant difference in the need for rescue analgesics between the two groups (OR: 1.45 95% CI: 0.82, 2.56 I2 = 41% p = 0.20), but on subgroup analysis, the need for rescue analgesics was significantly higher with IV lidocaine in studies on abdominal pain but not for musculoskeletal pain. On meta-analysis, there was no statistically significant difference in the incidence of side-effects between the two study groups (OR: 1.09 95% CI: 0.59, 2.02 I2 = 48% p = 0.78).ConclusionIV lidocaine can be considered as an alternative analgesic for pain control in the ED. However, its efficacy may not be higher than standard analgesics. Further RCTs with a large sample size are needed to corroborate the current conclusions.

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Paracetamol is acetaminophen, not an NSAID

Krebs

2022

The American Journal of Emergency Medicine

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Comparative efficacy of therapeutics for traumatic musculoskeletal pain in the emergency setting: A network meta-analysis

Cited by 8 publications

References 24 publications

Efficacy of prescribed opioids for acute pain after being discharged from the emergency department: A systematic review and meta‐analysis

Efficacy of prescribed opioids for acute pain after being discharged from the emergency department: A systematic review and meta‐analysis

Efficacy of Intravenous Lidocaine for Pain Relief in the Emergency Department: A Systematic Review and Meta-Analysis

Paracetamol is acetaminophen, not an NSAID

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