Evidence map›Paper›PMID 23941628›Full record

SynthesisPain practice : the official journal of World Institute of Pain2014

Nonsteroidal anti-inflammatory drugs, gastroprotection, and benefit-risk.

Robert Andrew Moore, Sheena Derry, Lee S Simon, Paul Emery

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Pain practice : the official journal of World Institute of Pain, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
32citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

32 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Oral nonsteroidal anti-inflammatory drugs for fibromyalgia in adults.The Cochrane database of systematic reviews · 2017
    Pooled it
  5. Pooled it
  6. Review
  7. Article
  8. Review
  9. Review
  10. Review
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Review
  18. Article
  19. Article
  20. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Robert Andrew MoorePain Research and Nuffield Division of Anaesthetics, University of Oxford, Oxford, U.K.
Sheena Derry
Lee S Simon
Paul Emery

Funding

Versus Arthritis 18475
6 · The paper itself

Abstract

backgroundGastroprotective agents (GPA) substantially reduce morbidity and mortality with long-term nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin.

objectiveTo evaluate efficacy of NSAIDs, protection against NSAID-induced gastrointestinal harm, and balance of benefit and risk.

methodsFree text searches of PubMed (December 2012) supplemented with "related citation" and "cited by" facilities on PubMed and Google Scholar for patient requirements, NSAID effectiveness, pain relief benefits, gastroprotective strategies, adherence to gastroprotection prescribing, and serious harm with NSAIDs and GPA.

resultsPatients want 50% reduction in pain intensity and improved fatigue, distress, and quality of life. Meta-analyses of NSAID trials in musculoskeletal conditions had bimodal responses with good pain relief or little. Number needed to treat (NNTs) for good pain relief were 3 to 9. Proton pump inhibitors (PPI) and high-dose histamine-2 receptor antagonists (H2 RA) provided similar gastroprotection, with no conclusive evidence of greater PPI efficacy compared with high-dose H2 RA. Prescriber adherence to guidance on use of GPA with NSAIDS was 49% in studies published since 2005; patient adherence was less than 100%. PPI use at higher doses over longer periods is associated with increased risk of serious adverse events, including fracture; no such evidence was found for H2 RA. Patients with chronic conditions are more willing to accept risk of harm for successful treatment than their physicians.

conclusionGuidance on NSAIDs use should ensure that patients have a good level of pain relief and that gastroprotection is guaranteed for the NSAID delivering good pain relief. Fixed-dose combinations of NSAID plus GPA offer one solution.

Indexed as

AnimalsAnti-Inflammatory Agents, Non-SteroidalCost-Benefit AnalysisGastrointestinal DiseasesHistamine H2 AntagonistsHumansMeta-Analysis as TopicMusculoskeletal DiseasesPainProton Pump InhibitorsPubMedRisk AssessmentAnti-Inflammatory Agents, Non-SteroidalHistamine H2 AntagonistsProton Pump Inhibitorsgastroprotectionjoint painnonsteroidal anti-inflammatory drugsNSAIDpainrisk-benefit analysissystematic review

Identifiers

PMID23941628
PMCPMC4238833

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.