Narcotic receptor blockade and its effect on the analgesic response to placebo and ibuprofen after oral surgery

Hersh, Elliot V.; Ochs, Howard; Quinn, Peter D.; MacAfee, Kenneth; Cooper, Stephen A.

doi:10.1016/0030-4220(93)90219-t

Cited by 19 publications

(19 citation statements)

References 26 publications

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“…Eleven studies had 40 or more participants in both treatment arms (Black 2002; Forbes 1991a; Hersch 1993b; Jain 1986; Kiersch 1993; Medve 2001; Mehlisch 2002; Nelson 1994; Schou 1998;Seymour 2000; Wahl 1997) (Analysis 3.5.1). The proportion of participants with at least 50% pain relief was 49% (553/1126) for ibuprofen 200 mg, and 10% (80/827) for placebo; the RB was 4.6 (3.7 to 5.6), and the NNT was 2.5 (2.3 to 2.8).…”

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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“…Naloxone has been shown to partially antagonize ketamine and nitrous oxide analgesia. The analgesic response of the NSAID ibuprofen has been shown to be unaffected by naltrexone compared with codeine or placebo 12 . The MAC of potent volatile anaesthetics is unaffected by naloxone and probably also by naltrexone.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative High-Dose Remifentanil in a Patient on Naltrexone Therapy

Schwab

Wright

2000

Anaesth Intensive Care

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“…Although there is a population of patients with chronic pain and substance use disorders that are likely to receive both and could have elevated the incidence of the combination, the prescription of TCAs and opioid blockers was prescribed no more or less often than chance. Analgesic options not blocked by naloxone are available to prescribers with supporting studies in dental patients on ibuprofen 122 and in animals for aspirin 63 and gabapentin. 73 , 123…”

Section: Efficacy Limiting Interaction Supported By Animal Studiesmentioning

confidence: 99%

Relative prevalence of 10 types of pharmacodynamic interactions in psychiatric treatment

Zarkowski

2019

Int J Psychiatry Med

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Objective To assess the relative prevalence and factors affecting the prescription of medication combinations with a theoretical efficacy limiting pharmacodynamic interaction, defined as two medications with opposing indications and side effects or antagonistic action at the primary receptor of mechanism of action. Method One hundred sixteen combinations were identified for 10 types of pharmacodynamic interactions. PubMed was searched for each combination to assess the quality of evidence either supporting clinical use or verifying reduced efficacy. Micromedex was searched to determine the presence of warnings to prescribers of reduced efficacy. The prevalence in clinical practice was determined by computer review of the Genoa Healthcare database for all prescribers at 10 participating community mental health centers. The expected prevalence was calculated as the product of the probability of each medication prescribed alone and was compared with the actual prevalence of the combination using the test of proportions. Results The frequency of prescription of eight combinations met the Bonferroni corrected level of significance of p < 0.001. Four were combinations of amphetamine and D2 antagonists and each were prescribed less often than chance, p = 0.0001 consistent with epidemiological studies and multiple animal studies verifying an efficacy limiting interaction. Despite epidemiological studies indicating increased risk of accidents, alprazolam and amphetamine were prescribed more often than chance, p = 0.0001. Micromedex generated warnings for efficacy limiting interactions for five other combinations, but with no subsequent change in prescription frequency. Conclusions Neither presence of medical evidence nor warnings from Micromedex consistently affect the prescription of combinations with pharmacodynamic efficacy limiting interactions.

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Narcotic receptor blockade and its effect on the analgesic response to placebo and ibuprofen after oral surgery

Cited by 19 publications

References 26 publications

Single dose oral ibuprofen for acute postoperative pain in adults

Single dose oral ibuprofen for acute postoperative pain in adults

Intraoperative High-Dose Remifentanil in a Patient on Naltrexone Therapy

Relative prevalence of 10 types of pharmacodynamic interactions in psychiatric treatment

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