dose of codeine plus combination therapies is a aspirin or paracetamol, major gap in knowledge. despite conducting While the doses of codeine searches of PubMed for may be small in individual any other non-Cochrane doses, this possibly reviews or randomised represents substantial trials with low dose population consumption, codeine combinations. and we need to know that Within a review of there is some benefit in ibuprofen plus codeine terms of analgesic efficacy in (Derry et al 2015 individuals as a balance to – reviewed above), the possible harm to the authors found information community.” on one trial of an OTC This paper identifies a lack of combination product but evidence for the analgesic concluded that the amount efficacy of low-dose codeine of information was too containing products. small to make the estimate of efficacy reliable. Stephens, G., et al. (2016) Frequent episodic Primary: Pain free at At least one arm Cochrane review. The review included two Paracetamol (acetaminophen) tension-type headache 2 using any paracetamol studies which used 23 studies, 8079 for trial treatment of episodic (TTH) standard method of (various doses) paracetamol/codeine participants tension-type headache in pain assessment and alone or in combinations one with – adults. Cochrane Database of without rescue combination with paracetamol 600mg + For the outcome of being Systematic Reviews DOI: medication another active oral codeine 60mg (Friedman pain free at two hours the treatment 1987) and one with NNT for paracetamol 1000 Secondary: A range of paracetamol 300mg + mg compared with placebo measures vs codeine 30mg (Gatoulis was 22 (95% confidence 2012). The reviewers noted at trial one arm interval (CI) 15 to 40) in that these studies did not given placebo eight studies (5890 provide sufficient data to do participants; high quality any analyses. +/- evidence), with no significant difference from The Friedman is for active control placebo at one hour. The high dose codeine; the NNT was 10 (7.9 to 14) for
dose of codeine plus aspirin or paracetamol, despite conducting searches of PubMed for any other non-Cochrane reviews or randomised trials with low dose codeine combinations. Within a review of ibuprofen plus codeine (Derry et al 2015 – reviewed above), the authors found information on one trial of an OTC combination product but concluded that the amount of information was too small to make the estimate of efficacy reliable. combination therapies is a major gap in knowledge. While the doses of codeine may be small in individual doses, this possibly represents substantial population consumption, and we need to know that there is some benefit in terms of analgesic efficacy in individuals as a balance to possible harm to the community.” This paper identifies a lack of evidence for the analgesic efficacy of low-dose codeine containing products. Stephens, G., et al. (2016) Paracetamol (acetaminophen) for treatment of episodic tension-type headache in adults. Cochrane Database of Systematic Reviews DOI: Frequent episodic tension-type headache (TTH) Primary: Pain free at 2 using any standard method of pain assessment and without rescue medication Secondary: A range of measures At least one arm paracetamol (various doses) alone or in combination with another active oral treatment vs at one arm given placebo +/- active control Cochrane review. 23 studies, 8079 participants For the outcome of being pain free at two hours the NNT for paracetamol 1000 mg compared with placebo was 22 (95% confidence interval (CI) 15 to 40) in eight studies (5890 participants; high quality evidence), with no significant difference from placebo at one hour. The NNT was 10 (7.9 to 14) for The review included two studies which used paracetamol/codeine combinations – one with paracetamol 600mg + codeine 60mg (Friedman 1987) and one with paracetamol 300mg + codeine 30mg (Gatoulis 2012). The reviewers noted that these studies did not provide sufficient data to do any analyses. The Friedman is for high dose codeine; the trial trial