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Oral Non-Steroidal Anti-Inflammatory Drugs Versus Other Oral Analgesic Agents for Acute Soft Tissue Injury (Review)

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Oral Non-Steroidal Anti-Inflammatory Drugs Versus Other Oral Analgesic Agents for Acute Soft Tissue Injury (Review) Cochrane Database of Systematic Reviews Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury (Review) Jones P, Dalziel SR, Lamdin R, Miles-Chan JL, Frampton C Jones P, Dalziel SR, Lamdin R, Miles-Chan JL, Frampton C. Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD007789. DOI: 10.1002/14651858.CD007789.pub2. www.cochranelibrary.com Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury (Review) Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . ..... 4 BACKGROUND .................................... 7 OBJECTIVES ..................................... 8 METHODS ...................................... 8 RESULTS....................................... 12 Figure1. ..................................... 13 Figure2. ..................................... 17 Figure3. ..................................... 18 Figure4. ..................................... 23 Figure5. ..................................... 24 Figure6. ..................................... 25 ADDITIONALSUMMARYOFFINDINGS . 26 DISCUSSION ..................................... 34 AUTHORS’CONCLUSIONS . 36 ACKNOWLEDGEMENTS . 37 REFERENCES ..................................... 37 CHARACTERISTICSOFSTUDIES . 46 DATAANDANALYSES. 78 Analysis 1.1. Comparison 1 NSAIDs versus paracetamol, Outcome 1 Pain at < 24 hours (VAS: 0 to 100 mm: worst). 82 Analysis 1.2. Comparison 1 NSAIDs versus paracetamol, Outcome 2 Pain at days 1 to 3 (VAS: 0 to 100 mm: worst). 83 Analysis 1.3. Comparison 1 NSAIDs versus paracetamol, Outcome 3 Little/no pain days 1 to 3. 84 Analysis 1.4. Comparison 1 NSAIDs versus paracetamol, Outcome 4 Pain at days 4 to 6 (VAS: 0 to 100 mm: worst). 84 Analysis 1.5. Comparison 1 NSAIDs versus paracetamol, Outcome 5 Pain at day 7 or greater (VAS: 0 to 100 mm: worst). 85 Analysis 1.6. Comparison 1 NSAIDs versus paracetamol, Outcome 6 Little/no pain day 7 or greater. 86 Analysis 1.7. Comparison 1 NSAIDs versus paracetamol, Outcome 7 Swelling days 0 to 3. 86 Analysis 1.8. Comparison 1 NSAIDs versus paracetamol, Outcome 8 Swelling days 4 to 6 (VAS: 0 to 100 mm: worst) [mm]. .................................... 87 Analysis 1.9. Comparison 1 NSAIDs versus paracetamol, Outcome 9 Swelling day 7 or greater. 87 Analysis 1.10. Comparison 1 NSAIDs versus paracetamol, Outcome 10 Little/no swelling day 7 or greater. 88 Analysis 1.11. Comparison 1 NSAIDs versus paracetamol, Outcome 11 Return to function before 7 days. 88 Analysis 1.12. Comparison 1 NSAIDs versus paracetamol, Outcome 12 Return to function at or after day 7. 89 Analysis 1.13. Comparison 1 NSAIDs versus paracetamol, Outcome 13 Time to return to full activity (days). 90 Analysis 1.14. Comparison 1 NSAIDs versus paracetamol, Outcome 14 Range of motion. 91 Analysis 1.15. Comparison 1 NSAIDs versus paracetamol, Outcome 15 Gastrointestinal adverse events. 91 Analysis 1.16. Comparison 1 NSAIDs versus paracetamol, Outcome 16 Neurological adverse events. 93 Analysis 2.1. Comparison 2 NSAID versus opioid, Outcome 1 Pain at < 24 hours (VAS: 0 to 100 mm: worst). 94 Analysis 2.2. Comparison 2 NSAID versus opioid, Outcome 2 Pain at days 4 to 6 (VAS: 0 to 100 mm: worst). 95 Analysis 2.3. Comparison 2 NSAID versus opioid, Outcome 3 Pain at day 7 or greater (VAS: 0 to 100 mm: worst). 95 Analysis 2.4. Comparison 2 NSAID versus opioid, Outcome 4 Swelling day 7 or greater. 96 Analysis 2.5. Comparison 2 NSAID versus opioid, Outcome 5 Return to function within 7 days. 96 Analysis 2.6. Comparison 2 NSAID versus opioid, Outcome 6 Return to function within or after day 7. 97 Analysis 2.7. Comparison 2 NSAID versus opioid, Outcome 7 Gastrointestinal adverse events. 98 Analysis 3.1. Comparison 3 NSAID versus combination (paracetamol and opioid) analgesic, Outcome 1 Little/no pain < 24hours. ................................... 99 Analysis 3.2. Comparison 3 NSAID versus combination (paracetamol and opioid) analgesic, Outcome 2 Little/no pain days1TO3................................... 99 Analysis 3.3. Comparison 3 NSAID versus combination (paracetamol and opioid) analgesic, Outcome 3 Little/no pain days4to6. .................................. 100 Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury (Review) i Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Analysis 3.4. Comparison 3 NSAID versus combination (paracetamol and opioid) analgesic, Outcome 4 Little/no pain day 7orgreater. .................................. 100 Analysis 3.5. Comparison 3 NSAID versus combination (paracetamol and opioid) analgesic, Outcome 5 Return to function withinorafterday7. 101 Analysis 3.6. Comparison 3 NSAID versus combination (paracetamol and opioid) analgesic, Outcome 6 Gastrointestinal adverseevents. ... ... ... ... ... ... ... ... ... ... .. 101 Analysis 3.7. Comparison 3 NSAID versus combination (paracetamol and opioid) analgesic, Outcome 7 Neurological adverseevents. ... ... ... ... ... ... ... ... ... ... .. 102 Analysis 3.8. Comparison 3 NSAID versus combination (paracetamol and opioid) analgesic, Outcome 8 Rash/itch. 103 Analysis 4.1. Comparison 4 NSAID versus other oral analgesics, Outcome 1 Pain at < 24 hours (VAS: 0 to 100 mm: worst). .................................... 103 Analysis 4.2. Comparison 4 NSAID versus other oral analgesics, Outcome 2 Little/no pain at days 1 to 3. 105 Analysis 4.3. Comparison 4 NSAID versus other oral analgesics, Outcome 3 Return to function by or after day 7. 106 Analysis 4.4. Comparison 4 NSAID versus other oral analgesics, Outcome 4 Gastrointestinal adverse events. 107 Analysis 4.5. Comparison 4 NSAID versus other oral analgesics, Outcome 5 Neurological adverse events. 108 ADDITIONALTABLES. 109 APPENDICES ..................................... 111 FEEDBACK...................................... 122 WHAT’SNEW..................................... 123 CONTRIBUTIONSOFAUTHORS . 124 DECLARATIONSOFINTEREST . 124 SOURCESOFSUPPORT . 124 DIFFERENCES BETWEEN PROTOCOL AND REVIEW . .... 125 INDEXTERMS .................................... 126 Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury (Review) ii Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [Intervention Review] Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury Peter Jones1, Stuart R Dalziel2, Rain Lamdin1, Jennifer L Miles-Chan3, Christopher Frampton4 1Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand. 2Liggins Institute, The University of Auck- land, Auckland, New Zealand. 3Department of Medicine/Physiology, University of Fribourg, Fribourg, Switzerland. 4Department of Medicine, University of Otago, Christchurch, New Zealand Contact address: Peter Jones, Adult Emergency Department, Auckland City Hospital, Auckland District Health Board, Park Road, Grafton, Auckland, New Zealand. [email protected]. [email protected]. Editorial group: Cochrane Bone, Joint and Muscle Trauma Group. Publication status and date: Edited (no change to conclusions), comment added to review, published in Issue 4, 2016. Review content assessed as up-to-date: 12 September 2014. Citation: Jones P, Dalziel SR, Lamdin R, Miles-Chan JL, Frampton C. Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD007789. DOI: 10.1002/14651858.CD007789.pub2. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. ABSTRACT Background Acute soft tissue injuries are common and costly. The best drug treatment for such injuries is not certain, although non-steroidal anti- inflammatory drugs (NSAIDs) are often recommended. Objectives To assess the effects (benefits and harms) of NSAIDs compared with other oral analgesics for treating acute soft tissue injuries. Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (12 September 2014), the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2014 Issue 8), MEDLINE (1966 to September 2014), EMBASE (1980 to September 2014), CINAHL (1937 to November 2012), AMED (1985 to November 2012), International Pharmaceutical Abstracts (1970 to November 2012), PEDro (1929 to November 2012), and SPORTDiscus (1985 to November 2012), plus internet search engines, trial registries and other databases. We also searched reference lists of relevant articles and contacted authors of retrieved studies and pharmaceutical companies to obtain relevant unpublished data. Selection criteria We included randomised or quasi-randomised controlled trials involving people with acute soft tissue injury (sprain, strain or contusion of a joint, ligament, tendon or muscle occurring up to 48 hours prior to inclusion in the study) and comparing oral NSAID versus paracetamol (acetaminophen), opioid, paracetamol plus opioid, or complementary and alternative medicine. The outcomes were pain, swelling, function, adverse effects and early re-injury. Data collection and analysis At least two review authors independently assessed
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