Abstract
Objective A systematic review of the analgesic efficacy and adverse effects of single-dose aspirin compared with placebo in post-operative pain.
Data sources Medline 1966–1998, Embase 1980–1998, Cochrane Library Issue 1, 1998, Oxford Pain Relief Database 1950–1994, and manual search of the reference lists of retrieved papers using a detailed search strategy.
Study selection Only full journal publication of double-blind studies with randomly allocated adult patients receiving postoperative oral administration for treatment of moderate to severe pain baseline pain (equates to > 30mm on a visual analogue scale, VAS), using acceptable pain measures. [Five-point pain relief scale with standard wording, a four-point pain intensity scale, a VAS for pain relief or intensity, or total pain relief (TOTPAR) or summed pain intensity difference (SPID) or their visual analogues.] Trials using aspirin in combination with other drugs, cross-over design as a single dataset, number of patients per treatment group <10, pain relief data collected after intake of additional analgesics, galenic formulations which may significantly alter absorption kinetics and baseline pain less than moderate to severe pain (VAS <30 mm) were excluded. Abstracts and review articles were not sought. Language other than English was not a restriction. Independent quality scores were made.
Results Of the 175 publications identified, six were unobtainable from the British Library; of the remainder, 69 papers representing 72 trials met all the inclusion criteria, generating 88 aspirin versus placebo comparisons. 68% were in a dental setting. Single-dose aspirin showed significant benefit over placebo for 600/650 mg, 1000 mg and 1200 mg doses. There were insufficient data for 300/325mg and 900mg dosage. Sixty of the trials reported on adverse effects, giving an overall number needed to harm (NNH) for the 600/625 mg dose of 44 (95% CI 23–345), with a NNH of 28 (95% CI 19–52) for drowsiness and 38 (95% CI 22–174) for gastric irritation.
Conclusion There is a clear dose response for pain relief with aspirin even in these single-dose studies. Adverse effects of drowsiness and gastric irritation were also evident even though they were single-dose studies.
Edwards JE, Oldman AD, Smith LA, Carroll D, Wiffen PJ, McQuay HJ, Moore A. Oral aspirin in postoperative pain: a quantitative systematic review. Pain 1999; 81:289–297
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Supported by grants from NHSR&D Health Technology Evaluation Programme (#93/31/4 and #94/11/4), European Union Biomed 2 BMH4 CT95 0172, Smith Kline Beecham Consumer Health Care, The Biotechnology and Biological Sciences Research Council, and Pain Research Funds.
Address for reprints: Dr A Moore, Pain Research and Nuffield Department of Anaesthetics, University of Oxford, Oxford Radcliffe NHS Trust, The Churchill, Headington, Oxford OX3 7LJ, UK
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Skoglund, L. Clear dose response for pain relief with aspirin even in single dose studies. Evid Based Dent 2, 36 (2000). https://doi.org/10.1038/sj.ebd.6400023
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DOI: https://doi.org/10.1038/sj.ebd.6400023