Article

Single dose oral analgesics for acute postoperative pain in adults

Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics), University of Oxford, Pain Research Unit, Churchill Hospital, Oxford, Oxfordshire, UK, OX3 7LJ.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 09/2011; 9(9):CD008659. DOI: 10.1002/14651858.CD008659.pub2
Source: PubMed

ABSTRACT

All analgesic drugs (painkillers) are tested in standardised clinical studies of people with established pain following surgery, and often after removal of third molar (wisdom) teeth. In all these studies the participants have to have at least moderate pain in order for there to be a sensitive measure of pain-relieving properties. The Cochrane Library has 35 reviews of oral analgesic interventions, with 38 different drugs, at various doses involving 45,000 participants in about 350 studies. This overview sought to bring all this information together, and to report the results for those drugs with reliable evidence about how well they work or any harm they may do in single oral doses. For some drugs there were no published trials, for some inadequate amounts of information, and for some adequate information but with results that would have been overturned by just a few unpublished studies with no effect. None of these could be regarded as reliable. However, amongst the data there were still 46 drug/dose combinations with reliable evidence. No drug produced high levels of pain relief in all participants. The range of results with single-dose analgesics in participants with moderate or severe acute pain was from 70% achieving good pain relief with the best drug to about 30% with the worst drug. The period over which pain was relieved also varied, from about two hours to about 20 hours. Typically adverse event rates were no higher with analgesic drugs than with placebo, except often with opioids (for example, codeine, oxycodone) where more participants experienced them. Commonly used analgesic drugs at the recommended or licensed doses produce good pain relief in some, but not all, patients with pain. The reasons for this are varied, but patients in pain should not be surprised if drugs they are given do not work for them. Alternatives analgesic drugs or procedures should be found that do work.

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    • "Table 1shows that among combined drugs of ASA with acetaminophen and caffeine at least cost for treatment (6.02 UAH) Requires tsitramon tablets number 6 PJSC " Monpfarm " Ukraine, which is appropriate to recommend to streamline pharmacotherapy. Diener HC, Pfaffenrath V., Pageler L., Peil H., Aicher B. (2005) in a multicenter, randomized, double-blind, placebo-controlled, parallel-group study found that the fixed combination of ASA with acetaminophen and caffeine is more effective for headache treatment (73% of patients do not feel pain after 30 minutes) than placebo, individual substances and dual combination (66%)61626364. Cost-efficiencess ratio for Citramon tabl. "

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    • "Although the mechanisms of analgesic action of NFP are not well understood, they are similar to those of triple neurotransmitter (serotonin, norepinephrine , and dopamine) reuptake inhibitors and anti- convulsants[4]. It has been used mainly as an analgesic drug for nociceptive pain, as well as a treatment for the prevention of postoperative shivering and hiccups5678. Based on NFP's mechanisms of analgesic action, it is more suitable for the treatment of neuropathic pain. "
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    ABSTRACT: Neuropathic pain, including paresthesia/dysesthesia in the lower extremities, always develops and remains for at least one month, to variable degrees, after percutaneous endoscopic lumbar discectomy (PELD). The recently discovered dual analgesic mechanisms of action, similar to those of antidepressants and anticonvulsants, enable nefopam (NFP) to treat neuropathic pain. This study was performed to determine whether NFP might reduce the neuropathic pain component of postoperative pain.
    Full-text · Article · Jan 2016 · The Korean journal of pain
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    • "Table 1shows that among combined drugs of ASA with acetaminophen and caffeine at least cost for treatment (6.02 UAH) Requires tsitramon tablets number 6 PJSC " Monpfarm " Ukraine, which is appropriate to recommend to streamline pharmacotherapy. Diener HC, Pfaffenrath V., Pageler L., Peil H., Aicher B. (2005) in a multicenter, randomized, double-blind, placebo-controlled, parallel-group study found that the fixed combination of ASA with acetaminophen and caffeine is more effective for headache treatment (73% of patients do not feel pain after 30 minutes) than placebo, individual substances and dual combination (66%)61626364. Cost-efficiencess ratio for Citramon tabl. "
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    ABSTRACT: The pharmaceutical market of Ukraine in January 2015 was registered 71 drug based acetylsalicylic acid (ASA), for which 52% combined. The most common combinations of ASA with acetaminophen and caffeine (45.9%), magnesium hydroxide (18.9%), bisoprolol (10.8%), ascorbic acid (8.1%), clopidogrel (5.4%). Comparing markets combined drugs ASA of Ukraine, the Russian Federation, 28 EU countries, Norway, Switzerland, India, Syria, Australia and the USA identified the active pharmaceutical ingredients, combined with ASA in a single dosage form. The analysis of questionnaires 40 pharmacists pharmacies Ternopil, Khmelnytsky and Kyiv regions of Ukraine noted that the biggest demand is mono-drugs ASA, Citramon, Askofen and Cardiomagnyl. Methods of pharmacoeconomic studies proved efficient use Upsaryn UPSA with vitamin C tabl. spike. tuba in box number 20 BMS (France), Citramon tablets number 6 PJSC “Monfarm” (Ukraine) and Cardiomagnyl tabl. film-coated shell 75 mg in bottle number 100 Nycomed Austria (Austria). On the basis of six State Forms of drugs in Ukraine (2009-2014) was found that the combination of drugs based on ASA is recommended to use of ascorbic acid (Aspiryn® C, Asprovit C, Upsarin UPSA with vitamin C), dipyridamole (Agrenox®), magnesium hydroxide (Cardiomagnyl, Cardiomagnyl Forte). Some of the standard combination of ASA (combination of paracetamol and caffeine) are not in form. For optimize State Form of drugs by improving health system in Ukraine can be useful pharmacoeconomic analysis of combination therapies with the current official system to note the combination of ASA with statins, esomeprazole, isosorbide.
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