Oxford league table of analgesics in acute pain

[Guest guest]

While I'm on a roll wtih the bandolier site.

It seems like pain control, narcotic seekers, etc, pops up frequently on the lists.

Here is a review that is interesting...to me at least.

I'd always heard that Codeine was a poor pain killer...this table certainly agrees with that feeling.

Although the table above it says the Paracetamol (similar to tylenol as I recall) and Codeine does well...wonder if that is the paracetamol doing all the heavy lifting for pain control in that circumstance.

Locke, MD

http://www.jr2.ox.ac.uk/bandolier/booth/painpag/Acutrev/Analgesics/Leagtab.html

http://www.jr2.ox.ac.uk/bandolier/booth/painpag/Acutrev/Analgesics/Acutepain2007.pdf

Figure 1: 2007 League table of number needed to treat (NNT) for at least 50% pain relief over 4-6 hours in patients with moderate to severe pain, all oral analgesics except IM morphine

Table 1: The Oxford league table of analgesic efficacy (commonly used and newer analgesic doses)

The 2007 Oxford league table of analgesic efficacy(at least 3 trials or 200 patients)

Numbers needed to treat are calculated for the proportion of patients with at least 50% pain relief over 4-6 hours compared with placebo in randomised, double-blind, single-dose studies in patients with moderate to severe pain. Drugs were oral, unless specified, and doses are milligrams. Shaded rows are intramuscular administration

Analgesic and dose (mg)

Number of patients in comparison

Percent with at least 50% pain relief

NNT

Lower confidence interval

Higher confidence interval

Etoricoxib 180/240

248

77

1.5

1.3

1.7

Etoricoxib 120

500

70

1.6

1.5

1.8

Diclofenac 100

545

69

1.8

1.6

2.1

Celecoxib 400

298

52

2.1

1.8

2.5

Paracetamol 1000 + Codeine 60

197

57

2.2

1.7

2.9

Rofecoxib 50

675

54

2.3

2.0

2.6

Aspirin 1200

279

61

2.4

1.9

3.2

Ibuprofen 400

5456

55

2.5

2.4

2.7

Oxycodone IR 10 + Paracetamol 650

315

66

2.6

2.0

3.5

Diclofenac 25

502

53

2.6

2.2

3.3

Ketorolac 10

790

50

2.6

2.3

3.1

Naproxen 400/440

197

51

2.7

2.1

4.0

Piroxicam 20

280

63

2.7

2.1

3.8

Lumiracoxib 400

370

48

2.7

2.2

3.5

Naproxen 500/550

784

52

2.7

2.3

3.3

Diclofenac 50

1296

57

2.7

2.4

3.1

Ibuprofen 200

3248

48

2.7

2.5

2.9

Pethidine 100 (intramuscular)

364

54

2.9

2.3

3.9

Tramadol 150

561

48

2.9

2.4

3.6

Morphine 10 (intramuscular)

946

50

2.9

2.6

3.6

Naproxen 200/220

202

45

3.4

2.4

5.8

Ketorolac 30 (intramuscular)

359

53

3.4

2.5

4.9

Paracetamol 500

561

61

3.5

2.2

13.3

Celecoxib 200

805

40

3.5

2.9

4.4

Ibuprofen 100

495

36

3.7

2.9

4.9

Paracetamol 1000

2759

46

3.8

3.4

4.4

Paracetamol 600/650 + Codeine 60

1123

42

4.2

3.4

5.3

Paracetamol 650 + Dextropropoxyphene (65 mg hydrochloride or 100 mg napsylate)

963

38

4.4

3.5

5.6

Aspirin 600/650

5061

38

4.4

4.0

4.9

Paracetamol 600/650

1886

38

4.6

3.9

5.5

Ibuprofen 50

316

32

4.7

3.3

8.0

Tramadol 100

882

30

4.8

3.8

6.1

Tramadol 75

563

32

5.3

3.9

8.2

Aspirin 650 + Codeine 60

598

25

5.3

4.1

7.4

Paracetamol 300 + Codeine 30

379

26

5.7

4.0

9.8

Tramadol 50

770

19

8.3

6.0

13.0

Codeine 60

1305

15

16.7

11.0

48.0

Placebo

>10,000

18

N/A

N/A

N/A