Caffeine as an analgesic adjuvant for acute pain in adults
Derry CJ, Derry S, Moore RA
The Cochrane database of systematic reviews · 94 citas
Etiquetas de revisión
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Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Marcadores de salud y funcionamiento
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 2014-12-11 · Cochrane Database Syst Rev · vol. 2019 · número 5 · pág. CD009281
- Editorial
- Elsevier BV
- Citado
- 188 citas · más que el 99% de estudios similares · 16.1× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 59 trabajos
- Acceso
- Lectura gratuita
- Áreas de investigación
- Anesthesia and Pain Management · Pain Management and Opioid Use · Pain Mechanisms and Treatments
- Palabras clave
- caffeine, adjuvant analgesics, acute pain, paracetamol, ibuprofen, aspirin, postoperative pain, headache, postpartum pain, dental pain, analgesic efficacy, adverse events, number needed to treat, postoperative analgesia, postpartum analgesia
- MeSH
- humans, headache, dysmenorrhea, acetaminophen, diclofenac, ibuprofen, caffeine, analgesics, chemotherapy, adjuvant, postpartum period, pregnancy, drug synergism, adolescent, adult, aged, middle aged, female, male, randomized controlled trials as topic, acute pain, ortho-aminobenzoates, postoperative pain
3 autores
- Christopher J Derry🇬🇧Churchill Hospital; University of Oxford
- Sheena Derry
- R Andrew Moore🇬🇧University of Oxford
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
This is an updated version of the original Cochrane review published in Issue 3, 2012. Caffeine has been added to common analgesics such as paracetamol, ibuprofen, and aspirin, in the belief that it enhances analgesic efficacy. Evidence to support this belief is limited and often based on invalid comparisons.
Objectives
To assess the relative efficacy of a single dose of an analgesic plus caffeine against the same dose of the analgesic alone, without restriction on the analgesic used or the pain condition studied. We also assessed serious adverse events.
Search methods
We searched CENTRAL, MEDLINE, and EMBASE from inception to 28 August 2014, the Oxford Pain Relief Database, and also carried out Internet searches and contacted pharmaceutical companies known to have carried out trials that have not been published.
Selection criteria
We included randomised, double-blind studies that compared a single dose of analgesic plus caffeine with the same dose of the analgesic alone in the treatment of acute pain.
Data collection and analysis
Two review authors independently assessed the eligibility and quality of studies, and extracted data. Any disagreements or uncertainties were settled by discussion with a third review author. We sought any validated measure of analgesic efficacy, but particularly the number of participants experiencing at least 50% of the maximum possible pain relief over four to six hours, participants reporting a global evaluation of treatment of very good or excellent, or headache relief after two hours. We pooled comparable data to look for a statistically significant difference, and calculated numbers needed to treat to benefit (NNT) with caffeine. We also looked for any numerical superiority associated with the addition of caffeine, and information about any serious adverse events.
Main results
We identified no new studies with available results for this update. The earlier review included 20 studies (7238 participants) in valid comparisons, but because we used different outcomes for some headache studies, the number of participants in the analyses of the effects of caffeine is now 4262 when previously it was 5243. The studies were generally of good methodological quality, using standard designs and mostly standard scales of pain measurement, although many of those treating postoperative pain were small.Most studies used paracetamol or ibuprofen, with 100 mg to 130 mg caffeine, and the most common pain conditions studied were postoperative dental pain, postpartum pain, and headache. There was a small but statistically significant benefit with caffeine used at doses of 100 mg or more, which was not dependent on the pain condition or type of analgesic. About 5% to 10% more participants achieve a good level of pain relief (at least 50% of the maximum over four to six hours) with the addition of caffeine, giving a NNT of about 14 (high quality evidence).Most comparisons individually demonstrated numerical superiority with caffeine, but not statistical superiority. One serious adverse event was reported with caffeine, but was considered unrelated to any study medication.We know of the existence of around 25 additional studies with almost 12,500 participants for which data for analysis were not obtainable. The additional analgesic effect of caffeine remained statistically significant but clinically less important even if all the known missing data had no effect; the bulk of the unobtainable data are reported to have similar results as this review.
Authors' conclusions
The addition of caffeine (≥ 100 mg) to a standard dose of commonly used analgesics provides a small but important increase in the proportion of participants who experience a good level of pain relief.
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