Oral Paracetamol Versus Combination Oral Analgesics for Acute Musculoskeletal Injuries

Gong, Jiayi; Colligan, Margaret; Kirkpatrick, Carl M.; Jones, P. G.

doi:10.1016/j.annemergmed.2019.05.030

Cited by 14 publications

(14 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The SPI supported by the SPID results in our study showed that ibuprofen 400 mg/paracetamol 1000 mg/codeine 60 mg did not provide general mean analgesic superiority compared to ibuprofen 400 mg/paracetamol 1000 mg in our mixed-sex study population suggesting that the ibuprofen/paracetamol component, and not the codeine component, provides the major analgesic effect. The results from our study and previous studies [2,6,7] may seem di cult to interpret since meta-analyses of acute pain studies show that paracetamol added to a NSAID increases analgesic e cacy compared to paracetamol alone, and codeine added to paracetamol, or ibuprofen shows a small, but proven analgesic advantage [20][21][22].…”

Section: Discussioncontrasting

confidence: 65%

“…All drugs used in this trial [2], including the active morphine derivatives of codeine, had relatively similar pharmacokinetic properties [3][4][5]. Studies that are more recent also showed no signi cant difference in pain relief between paracetamol 1000 mg, ibuprofen 400 mg and codeine 60 mg versus paracetamol 1000 mg and ibuprofen 400 on postsurgical dental impaction pain or versus paracetamol 1000 mg on acute musculoskeletal pain following injuries [6,7].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Analgesic effect of oral paracetamol 1000 mg/ibuprofen 400 mg, paracetamol 1000 mg/codeine 60 mg, paracetamol 1000 mg/ibuprofen 400 mg/codeine 60 mg, or placebo on acute postoperative pain: a single-dose, randomized, and double-blind study

Lyngstad

Skjelbred

Swanson

et al. 2023

Preprint

View full text Add to dashboard Cite

Purpose Combining analgesics with different mechanisms of action may increase the analgesic efficacy. The multidimensional pharmacodynamic profiles of ibuprofen 400 mg/paracetamol 1000 mg, ibuprofen 400 mg/paracetamol 1000 mg/codeine 60 mg, and paracetamol 1000 mg/codeine 60 mg and placebo were compared. Methods A randomized, double-blind, placebo-controlled, parallel-group, single-centre, outpatient, and single-dose study used 200 patients of both sexes and homogenous ethnicity after third molar surgery (mean age 24 years, range 19–30 years). Primary outcome was sum pain intensity over 6 h (SPI). Secondary outcomes were time to analgesic onset, duration of analgesia, time to rescue drug intake, number of patients taking rescue drug, sum pain intensity difference (SPID), maximum pain intensity difference, time to maximum pain intensity difference, number needed to treat, prevent remedication and harm values, adverse effects, and patient-reported outcome measure (PROM). Results Analgesia following ibuprofen and paracetamol combination with or without codeine was comparable. Both were better than paracetamol combined with codeine. Secondary variables supported this finding. Post hoc analysis of SPI and SPID revealed a sex/drug interaction trend in the codeine-containing groups where females experienced less analgesia. PROM showed a significant sex/drug interaction in the paracetamol and codeine group, but not in the other codeine-containing group. Especially females reported known and mild side effects in the codeine containing groups. Conclusion Codeine added to ibuprofen/paracetamol does not seem to add analgesia in a sex-mixed study population. Sex may be a confounding factor when testing weak opioid analgesics such as codeine. PROM seems to be more sensitive than traditional outcome measures. ClinicalTrials.gov June 2009 NCT00921700

show abstract

Section: Discussioncontrasting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Analgesic effect of oral paracetamol 1000 mg/ibuprofen 400 mg, paracetamol 1000 mg/codeine 60 mg, paracetamol 1000 mg/ibuprofen 400 mg/codeine 60 mg, or placebo on acute postoperative pain: a single-dose, randomized, and double-blind study

Lyngstad

Skjelbred

Swanson

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…4,5 Similarly, this combination was not better than paracetamol (acetaminophen) alone in ED patients with minor acute MSK injuries. 6 The ibuprofen/acetaminophen combination was found to be as effective as oxycodone/acetaminophen, hydrocodone/acetaminophen, and codeine/acetaminophen for short-term pain relief (up to 2 hours) in ED patients with acute MSK pain including fractures. 7 A head-to-head comparison of NSAID's (valdecoxib) to an opioid/acetaminophen combination demonstrated similar pain relief for short-term analgesia (up to 60 minutes) in ED patients with acute MSK.…”

Section: What Is the Optimal Analgesic Treatment For Msk Pain?mentioning

confidence: 98%

Pain management in the emergency department: a clinical review

Motov

Vlasica²,

Middlebrook³

et al. 2021

Clin Exp Emerg Med

View full text Add to dashboard Cite

Pain is one of the most common reasons for patients to visit the emergency department. The ever-growing research on emergency department analgesia has challenged the current practices with respect to the optimal analgesic regimen for acute musculoskeletal pain, safe and judicious opioid prescribing, appropriate utilization of non-opioid therapeutics, and non-pharmacological treatment modalities. This clinical review is set to provide evidence-based answers to these challenging questions.

show abstract

“…Paracetamol provides important baseline analgesia; it is the agent of first choice for long-term use in a variety of mild to moderate chronic pain states. 35 A randomised controlled study found no additional benefit with the addition of opioids or a nonsteroidal anti-inflammatory agent over oral paracetamol alone 36 in acute pain situations. Consequently, paracetamol should not be omitted, especially in patients about to undergo an invasive procedure and, even more so, in those prescribed this agent to manage long-term pain.…”

Section: Open Accessmentioning

confidence: 99%

Impact of a policy to improve the management of oral medications when patients are fasting before a procedure: an interrupted time series analysis

Braat

Lim

et al. 2022

BMJ Open Qual

View full text Add to dashboard Cite

BackgroundManaging medications inappropriately when patients have oral intake restrictions can cause patient harm. This study evaluated the impact of a medication policy separating fasting from nil by mouth with respect to giving oral medications in patients fasting before a diagnostic or interventional procedure.MethodsThe policy stipulated that ‘fasting’ means oral medications should be given with a sip of water up to 1 hour before a procedure, unless there is a clinical reason to withhold, while ‘nil by mouth’ means nothing to be given orally, including medications.The policy was implemented in Surgical areas in February 2015 and Medical areas in March 2015 at a tertiary referral hospital in Melbourne, Australia, and included bedside signs, clinical champions and education sessions.The study was conducted in 2020. Admission and medication records were matched for non-elective procedure patients from January 2014 to May 2016. The monthly proportion of doses omitted inappropriately and overall omissions pre/post-policy implementation were compared using segmented regression.ResultsPre-implementation, the proportion of doses withheld inappropriately and total omissions in medical areas were 18.1% and 28.0%, respectively. Post-implementation, an absolute reduction of 13.4% (95% CI 9.0% to 17.7%) and 11.1% (95% CI 2.6% to 19.6%), respectively, was seen. Post-implementation linear trend showed a 0.3% (95% CI 0.0% to 0.6%) increase in inappropriate omissions but not overall omissions.In Surgical areas, pre-implementation proportions for inappropriate and overall omissions were lower than Medical areas’. Post-implementation, there was an absolute decrease in doses withheld inappropriately (8.3%, 95% CI 0.8% to 15.7%, from 11.9% pre-implementation) but not total omissions.ConclusionsDistinguishing fasting from nil by mouth appeared to provide clarity for some staff: a reduction in inappropriate omissions was seen post-implementation. Although the small increase in post-implementation linear trend for inappropriate omissions in Medical areas suggests sustainability issues, total omissions were sustained. The policy’s concepts require verification beyond our institution.

show abstract

Oral Paracetamol Versus Combination Oral Analgesics for Acute Musculoskeletal Injuries

Cited by 14 publications

References 17 publications

Analgesic effect of oral paracetamol 1000 mg/ibuprofen 400 mg, paracetamol 1000 mg/codeine 60 mg, paracetamol 1000 mg/ibuprofen 400 mg/codeine 60 mg, or placebo on acute postoperative pain: a single-dose, randomized, and double-blind study

Analgesic effect of oral paracetamol 1000 mg/ibuprofen 400 mg, paracetamol 1000 mg/codeine 60 mg, paracetamol 1000 mg/ibuprofen 400 mg/codeine 60 mg, or placebo on acute postoperative pain: a single-dose, randomized, and double-blind study

Pain management in the emergency department: a clinical review

Impact of a policy to improve the management of oral medications when patients are fasting before a procedure: an interrupted time series analysis

Contact Info

Product

Resources

About