SynthesisBMJ (Clinical research ed.)1996
Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review.
Synthesis in BMJ (Clinical research ed.), 1996. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 4 of them syntheses that pooled 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.
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.
Who cites it
26 citing papers in PubMed, 4 syntheses or guidelines pooled it, 141 citations in OpenAlex.
- Low back pain (chronic).BMJ clinical evidence · 2008Pooled it
- [Evidence and consensus based Austrian guidelines for management of acute and chronic nonspecific backache].Wiener klinische Wochenschrift · 2007Guideline
- EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT).Annals of the rheumatic diseases · 2005Guideline
- North of England evidence based guideline development project: summary guideline for non-steroidal anti-inflammatory drugs versus basic analgesia in treating the pain of degenerative arthritis. The North of England Non-Steroidal Anti-Inflammatory Drug Guideline Development Group.BMJ (Clinical research ed.) · 1998Guideline
- Effectiveness of green tea mouthwash in postoperative pain control following surgical removal of impacted third molars: double blind randomized clinical trial.Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences · 2013Trial
- Article
- Co-prescribing of opioids and benzodiazepines/Z-drugs associated with all-cause mortality-A population-based longitudinal study in primary care with weak opioids most commonly prescribed.Frontiers in pharmacology · 2022Article
- Interventional and Non-interventional Medical Rehabilitation Approaches to Axial Spine Pain in Vertebral Metastatic Disease.Frontiers in pain research (Lausanne, Switzerland) · 2021Review
- Resolving Issues About Efficacy and Safety of Low-Dose Codeine in Combination Analgesic Drugs: A Systematic Review.Pain and therapy · 2020Review
- Selected pathobiological features and principles of pharmacological pain management.The Journal of international medical research · 2020Review
- Anticholinergic and sedative drug burden in community-dwelling older people: a national database study.BMJ open · 2018Article
- Tighter regulations needed for over-the-counter codeine in Canada.Canadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPC · 2016Article
- Using an Electronic Decision Support Tool to Reduce Inappropriate Polypharmacy and Optimize Medicines: Rationale and Methods.JMIR research protocols · 2016Article
- [Ins and outs of neurologic therapy for chronic pain].Der Nervenarzt · 2008Review
- Pain management today - what have we learned?Clinical rheumatology · 2006Review
- Pharmacological treatments for persistent non-malignant pain in older persons.Drugs & aging · 2004Review
- Pain management in older adults.Current psychiatry reports · 2003Review
- Emergency analgesia in the paediatric population. Part II Pharmacological methods of pain relief.Emergency medicine journal : EMJ · 2002Review
- Myth: codeine is a powerful and effective analgesic.The Western journal of medicine · 2001Article
- Review
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess whether adding codeine to paracetamol has an additive analgesic effect; to assess the safety of paracetamol-codeine combinations versus paracetamol alone.
designSystematic literature review with meta-analysis, methodological quality of published trials being scored by means of 13 predefined criteria. TRIALS: 24 of 29 trials that met the inclusion criteria. Models studied in the trials were postsurgical pain (21), postpartum pain (one), osteoarthritic pain (one), and experimentally induced pain (one).
interventionsDosages ranged from 400 to 1000 mg paracetamol and 10 to 60 mg codeine.
main outcome measuresThe sum pain intensity difference (efficacy analysis) and the proportion of patients reporting a side effect (safety analysis).
resultsMost trials were considered of good to very good quality. Only the single dose studies could be combined for analysis of analgesic efficacy. Pooled efficacy results indicated that codeine added to paracetamol provided a 5% increase in analgesia on the sum pain intensity difference. This effect was comparable to the difference in analgesic effect between codeine and placebo. The cumulative incidence of side effects with each treatment was comparable in the single dose trials. In the multidose studies a significantly higher proportion of side effects occurred with paracetamol-codeine preparations.
conclusionThe difference is analgesic effect between paracetamol-codeine combinations and paracetamol alone was small but statistically significant. In the multidose studies the proportion of patients reporting a side effect was significantly higher with paracetamol-codeine combinations. For occasional pain relief a paracetamol-codeine combination might be appropriate but repeated use increases the occurrence of side effects.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.