Pain measures and cut‐offs – ‘no worse than mild pain’ as a simple, universal outcome

Moore, R Andrew; Straube, Sebastian; Aldington, Dominic

doi:10.1111/anae.12148

Cited by 321 publications

(153 citation statements)

References 76 publications

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“…There is empirical evidence that what patients desire in most pain conditions is fast and effective relief [50]. The IHSpreferred outcome of being pain-free 2 hours after dosing captures that.…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review of patients' views indicated that the evidence we have is that a low pain state, no worse than mild pain, is consistently rated highly by patients in clinical trials when validated against other outcomes, such as reduced depression, improved sleep, better functioning, higher quality of life, and improved ability to work [50]. Migraine patients want pain to be significantly reduced, quickly, without recurrence, and ideally without adverse effects [43].…”

Section: Outcomes In Clinical Trialsmentioning

confidence: 95%

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Evidence for efficacy of acute treatment of episodic tension-type headache: Methodological critique of randomised trials for oral treatments

Moore

Derry

Wiffen

et al. 2014

Pain

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The International Headache Society (IHS) provides guidance on the conduct of trials for acute treatment of episodic tension-type headache (TTH), a common disorder with considerable disability. Electronic and other searches identified randomised, double-blind trials of oral drugs treating episodic TTH with moderate or severe pain at baseline, or that tested drugs at first pain onset. The aims were to review methods, quality, and outcomes reported (in particular the IHS-recommended primary efficacy parameter pain-free after 2 hours), and to assess efficacy by meta-analysis. We identified 58 reports: 55 from previous reviews and searches, 2 unpublished reports, and 1 clinical trial report with results. We included 40 reports of 55 randomised trials involving 12,143 patients. Reporting quality was generally good, with potential risk of bias from incomplete outcome reporting and small size; the 23 largest trials involved 82% of patients. Few trials reported IHS outcomes. The number needed to treat values for being pain-free at 2 hours compared with placebo were 8.7 (95% confidence interval [CI] 6.2 to 15) for paracetamol 1000 mg, 8.9 (95% CI 5.9 to 18) for ibuprofen 400mg, and 9.8 (95% CI 5.1 to 146) for ketoprofen 25mg. Lower (better) number needed to treat values were calculated for outcomes of mild or no pain at 2 hours, and patient global assessment. These were similar to values for these drugs in migraine. No other drugs had evaluable results for these patient-centred outcomes. There was no evidence that any one outcome was better than others. The evidence available for treatment efficacy is small in comparison to the size of the clinical problem.

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Section: Discussionmentioning

confidence: 99%

Section: Outcomes In Clinical Trialsmentioning

confidence: 95%

Evidence for efficacy of acute treatment of episodic tension-type headache: Methodological critique of randomised trials for oral treatments

Moore

Derry

Wiffen

et al. 2014

Pain

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“…Furthermore, good resources on the impact of pain on work 7 , costs 8 , and the patient experience 9 are already available in the literature. Nonetheless, it is important to continue to have up-to-date and precise estimates of these effects from multiple sources as a means of further understanding the complex nature of the relationship between pain severity and health outcomes.…”

Section: Introductionmentioning

confidence: 99%

Examining the association between pain severity and quality-of-life, work-productivity loss, and healthcare resource use among European adults diagnosed with pain

Witt

Kenworthy

Isherwood

et al. 2016

Journal of Medical Economics

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Objective: The goal of this research was to quantify the association between pain severity and several health outcomes in a large sample of patients diagnosed with some form of pain. Methods: Responses from patients who had been diagnosed with some form of pain (n ¼ 14,459) were drawn from the 2013 EU National Health and Wellness Survey (NHWS; n ¼ 62,000). Respondents reported their subjective pain severity in the past week on a numerical rating scale (0-10) as well as the Medical Outcomes Study Short Form (SF-36), Work Productivity and Activity Impairment Questionnaire (WPAI), and healthcare resource utilization in the past 6 months (healthcare professional (HCP) visits, emergency room (ER) visits, and hospitalizations). Associations between pain severity and health outcomes were examined via a series of regression models controlling for a set of demographic and health-related covariates. Results: After controlling for demographics and comorbidities, pain severity in the past week was shown to be significantly negatively associated with Health Utilities (b ¼ À0.022, p < 0.001) and positively associated with overall WPAI scores (b ¼ 0.18, p < 0.001) and healthcare resource use (Hospitalizations: b ¼ 0.13, p < 0.001; ER Visits: b ¼ 0.14, p < 0.001; HCP Visits: b ¼ 0.08, p < 0.001). The nature of these relationships (linear, curvilinear, etc.) is also explored. Limitations: This study was a self-report cross-sectional study which may have biased the results and does not allow for causal inferences to be made. Finally, the regression models run were limited to available covariates and, hence, some potentially important covariates may not have been included in these models. Conclusions: The findings suggest that reducing pain severity could result in an increase in patients' quality-of-life and work productivity, and a decrease in healthcare resource use. The equations, linking pain and outcomes, were presented in an accessible format so they could be readily applied in healthcare decision-making. ARTICLE HISTORY

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“…A systematic review of patients' views indicated that patients with pain want either to have large reduction in their pain (≥50% from baseline), or to be in a low pain state, namely no worse than mild pain (Moore et al, 2013b). Migraine patients want pain to be significantly reduced quickly What's already known about this topic?…”

Section: Discussionmentioning

confidence: 99%

Overview review: Comparative efficacy of oral ibuprofen and paracetamol (acetaminophen) across acute and chronic pain conditions

Moore

Derry

Wiffen

et al. 2014

European Journal of Pain

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100

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Background: Ibuprofen and paracetamol have long been used as analgesics in a range of acute, intermittent and chronic pain conditions. Paracetamol is often the first line analgesic recommended, without consensus about which is the better analgesic. Methods: An overview review of systematic reviews and meta-analyses directly compares ibuprofen and paracetamol at standard doses in particular painful conditions, or uses indirect comparisons against placebo. Electronic searches for systematic reviews were sought published since 1995 using outcomes approximating to ≥50% pain intensity reduction. Painful conditions were acute post-operative pain, dysmenorrhoea, tension-type headache (TTH), migraine, osteoarthritis and rheumatoid arthritis, back pain, cancer and paediatric pain. There was no systematic assessment of harm. Results: Sixteen systematic reviews and four individual patient data meta-analyses were included. Ibuprofen was consistently superior to paracetamol at conventional doses in a range of painful conditions. Two direct comparisons favoured ibuprofen (acute pain, osteoarthritis). Three of four indirect comparisons favoured ibuprofen (acute pain, migraine, osteoarthritis); one showed no difference (TTH), although there were methodological problems. In five pain conditions (dysmenorrhoea, paediatric pain, cancer pain, back pain and rheumatoid arthritis), there were limited data on paracetamol and ibuprofen. Conclusions: At standard doses in different painful conditions, ibuprofen was usually superior producing more patients with the degree of pain relief that patients feel worthwhile. Neither of the drugs will be effective for everyone, and both are needed. This overview questions the practice of routinely using paracetamol as a first line analgesic because there is no good evidence for efficacy of paracetamol in many pain conditions.

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Pain measures and cut‐offs – ‘no worse than mild pain’ as a simple, universal outcome

Cited by 321 publications

References 76 publications

Evidence for efficacy of acute treatment of episodic tension-type headache: Methodological critique of randomised trials for oral treatments

Evidence for efficacy of acute treatment of episodic tension-type headache: Methodological critique of randomised trials for oral treatments

Examining the association between pain severity and quality-of-life, work-productivity loss, and healthcare resource use among European adults diagnosed with pain

Overview review: Comparative efficacy of oral ibuprofen and paracetamol (acetaminophen) across acute and chronic pain conditions

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