Secondary outcomes: placebo/no women, contributed data paracetamol 1000mg (50 adverse events; days treatment); to the analysis. women) with a combination in hospital; of submaximal dose of opioids vs non Authors considered only 4 readmission to paracetamol 800 mg + opioids, of the 8 trials were of high hospital. codeine 60mg (50 women), quality. All trials were and placebo (25 women). opioids vs small. combinations and The abstract of this There was insufficient indicates that, in patients non-opioids vs evidence to establish with strong baseline pain, combinations analgesic effects. statistically highly significant differences were were more side documented in efficacy effects, including nausea, variables between the active vomiting and drowsiness, drugs and placebo and with the use of an opioid, between the two active non-opioid or combination drugs. However, in patients painkillers in comparison with moderate baseline with placebo or no pain, no differences were treatment. found between the study drugs in any of the analgesic Authors’ conclusion: Due efficacy variables. to limited data available no conclusions can be made As this study used 60mg of regarding the safest and codeine it does not provide most effective forms of oral evidence of incremental analgesia for effectiveness of low-dose caesarean pain. codeine. R. A., et al. (2015a) Acute pain Primary outcome = Over-the-counter Overview of 1 The authors considered that prescription (OTC) oral number of (OTC) analgesics and 10 Cochrane products with “combination (generally post-operative analgesics for acute pain - an participants with at reviews involving 21 low doses of codeine pain after third molar vs overview of Cochrane least 50% pain relief different analgesic represent the major gap in extraction) reviews. over four to six hours products. the evidence, but probably Cochrane Database of placebo Systematic Reviews DOI: represent a large part of OTC The authors indicate that analgesic sales. The lack of they found no data for OTC any information on the analgesics combining a low efficacy of low dose codeine
Secondary outcomes: adverse events; days in hospital; readmission to hospital. placebo/no treatment); opioids vs non opioids, opioids vs combinations and non-opioids vs combinations women, contributed data to the analysis. Authors considered only 4 of the 8 trials were of high quality. All trials were small. There was insufficient evidence to establish analgesic effects. were more side effects, including nausea, vomiting and drowsiness, with the use of an opioid, non-opioid or combination painkillers in comparison with placebo or no treatment. Authors’ conclusion: Due to limited data available no conclusions can be made regarding the safest and most effective forms of oral analgesia for pain. paracetamol 1000mg (50 women) with a combination of submaximal dose of paracetamol 800 mg + codeine 60mg (50 women), and placebo (25 women). The abstract of this indicates that, in patients with strong baseline pain, statistically highly significant differences were documented in efficacy variables between the active drugs and placebo and between the two active drugs. However, in patients with moderate baseline pain, no differences were found between the study drugs in any of the analgesic efficacy variables. As this study used 60mg of codeine it does not provide evidence of incremental effectiveness of low-dose codeine. R. A., et al. (2015a) (OTC) oral analgesics for acute pain - an overview of Cochrane reviews. Cochrane Database of Systematic Reviews DOI: Acute pain (generally post-operative pain after third molar extraction) Primary outcome = number of participants with at least 50% pain relief over four to six hours Over-the-counter (OTC) analgesics vs placebo Overview of 1 and 10 Cochrane reviews involving 21 different analgesic products. The authors indicate that they found no data for OTC analgesics combining a low The authors considered that “combination products with low doses of codeine represent the major gap in the evidence, but probably represent a large part of OTC analgesic sales. The lack of any information on the efficacy of low dose codeine caesarean prescription
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