Analgesic efficacy of bromfenac, ibuprofen, and aspirin in postoperative oral surgery pain

Forbes, James A.; Beaver, William T.; Jones, Katherine F.; Edquist, Irene A.; Gongloff, Charles M.; Smith, Wendy K.; Smith, F. G.; Schwartz, Michael K.

doi:10.1038/clpt.1992.31

Cited by 40 publications

(10 citation statements)

References 2 publications

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“…The proportion of participants with at least 50% pain relief was 54% (1000/1842) for ibuprofen 400 mg, and 12% (152/1244) for placebo; the RB was 4.4 (3.8 to 5.2), and the NNT was 2.4 (2.2 to 2.6). Fourteen studies had fewer than 40 participants in both treatment arms (Ahlstrom 1993; Ehrich 1999; Forbes 1984;Forbes 1990; Forbes 1991b; Forbes 1992; Hersch 1993b; Laska 1986; McQuay 1996; Nørholt 1998; Schwartz 2007; Seymour 1991 (study 1); Seymour 1991 (study 2); Seymour 1996) (Analysis 4.5.2). The proportion of participants with at least 50% pain relief was 60% (280/463) for ibuprofen 400 mg, and 14% (56/393) for placebo; the RB was 4.1 (3.2 to 5.2), and the NNT was 2.2 (1.9 to 2.5).…”

Section: Resultsmentioning

confidence: 99%

Single dose oral ibuprofen for acute postoperative pain in adults

Derry

Derry²,

Moore³

et al. 2009

Cochrane Database of Systematic Reviews

116

113

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Background This review updates a 1999 Cochrane review showing that ibuprofen at various doses was effective in postoperative pain in single dose studies designed to demonstrate analgesic efficacy. New studies have since been published. Ibuprofen is one of the most widely used non-steroidal anti-inflammatory (NSAID) analgesics both by prescription and as an over-the-counter medicine. Ibuprofen is used for acute and chronic painful conditions. Objectives To assess analgesic efficacy of ibuprofen in single oral doses for moderate and severe postoperative pain in adults. Search methods We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to May 2009. Selection criteria Randomised, double blind, placebo-controlled trials of single dose orally administered ibuprofen (any formulation) in adults with moderate to severe acute postoperative pain. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Pain relief or pain intensity data were extracted and converted into the dichotomous outcome of number of participants with at least 50% pain relief over 4 to 6 hours, from which relative risk and number-needed-to-treat-to-benefit (NNT) were calculated. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals were collected. Main results Seventy-two studies compared ibuprofen and placebo (9186 participants). Studies were predominantly of high reporting quality, and the bulk of the information concerned ibuprofen 200 mg and 400 mg. For at least 50% pain relief compared with placebo the NNT for ibuprofen 200 mg (2690 participants) was 2.7 (2.5 to 3.0) and for ibuprofen 400 mg (6475 participants) it was 2.5 (2.4 to 2.6). The proportion with at least 50% pain relief was 46% with 200 mg and 54% with 400 mg. Remedication within 6 hours was less frequent with higher doses, with 48% remedicating with 200 mg and 42% with 400 mg. The median time to remedication was 4.7 hours with 200 mg and 5.4 hours with 400 mg. Sensitivity analysis indicated that pain model and ibuprofen formulation may both affect the result, with dental impaction models and soluble ibuprofen salts producing better efficacy estimates. Adverse events were uncommon, and not different from placebo. Authors’ conclusions The very substantial amount of high quality evidence demonstrates that ibuprofen is an effective analgesic in treating postoperative pain. NNTs for 200 mg and 400 mg ibuprofen did not change significantly from the previous review even when a substantial amount of new information was added. New information is provided on remedication.

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Section: Resultsmentioning

confidence: 99%

Single dose oral ibuprofen for acute postoperative pain in adults

Derry

Derry²,

Moore³

et al. 2009

Cochrane Database of Systematic Reviews

116

113

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“…In fact, a useful combination of two drugs could simply have additive or even subadditive analgesia as long as there is less additivity for side effects [40]. For example, there appears to be a ceiling effect for many analgesics (e.g., NSAIDs, acetaminophen and TCAs) [41,42]. In cases where two drugs, with different toxicities, both work at common sites or mechanisms (e.g., an NSAID and acetaminophen), the combination of equianalgesic doses will be subadditive due to the analgesic ceiling, but advantageous due to nonoverlapping adverse effects.…”

Section: Human Studiesmentioning

confidence: 99%

Combination pharmacotherapy for neuropathic pain: current evidence and future directions

Gilron¹,

Max²

2005

Expert Review of Neurotherapeutics

105

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Current drugs reduce neuropathic pain and improve mood and quality of life. However, as single agents they are limited by incomplete efficacy and dose-limiting adverse effects. Recent experimental and clinical data support the potential of combination pharmacotherapy for neuropathic pain. Therapeutic benefits may include greater efficacy, lower doses and fewer adverse effects. Due to potential adverse, as well as beneficial, drug interactions, safety and efficacy of specific combinations must be empirically evaluated. Techniques such as isobolographic analysis, response-surface modeling and other model-free tests have been used in order to characterize analgesic interactions as antagonistic, additive or synergistic. Whether synergistic or not, a clinically useful combination could simply have additive or even subadditive analgesia, provided that there is less additivity for side effects. Despite widespread clinical use, there are surprisingly few published observations on combination therapy for neuropathic pain. This review discusses future directions and proposes research strategies aimed at bridging current knowledge gaps, including safety, compliance and cost-effectiveness; discovering optimal drug combinations and dose ratios; comparing concurrent with sequential combination therapy; and combining more than two drugs. Continued close integration of basic and clinical sciences is crucial in further harnessing the potential of combination pharmacotherapy in neuropathic pain.

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“…Aspirin, discovered over 100 years ago, is an analgesic, anti‐pyretic and anti‐inflammatory agent. Aspirin tablets are marketed in standard strengths of 300 or 500 mg. Not only for the management of common episodic headache disorders such as tension‐type headache (1–3) or migraine (4–8), but also for dental pain (9, 10), sore throat (11), primary dysmenorrhoea (12) and fever associated with mild viral infection (13), there is very good evidence of the efficacy of aspirin in single doses of up to 1000 mg. We observe, however, in clinical practice and published reports (14), that paracetamol is often preferred for acute pain treatment. Yet the evidence of efficacy of paracetamol in headache is much less sound and contradictory (1, 15, 16).…”

Section: Introductionmentioning

confidence: 99%