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Cochrane Database of Systematic Reviews

Paracetamol (acetaminofeno) con o sin codeína o dihidrocodeína para el dolor neuropático en adultos

Información

DOI:
https://doi.org/10.1002/14651858.CD012227.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 27 diciembre 2016see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Dolor y cuidados paliativos

Copyright:
  1. Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

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Contraer

Autores

  • Philip J Wiffen

    Thame, UK

  • Roger Knaggs

    School of Pharmacy, University of Nottingham, Nottingham, UK

  • Sheena Derry

    Oxford, UK

  • Peter Cole

    Oxford Pain Relief Unit, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK

  • Tudor Phillips

    Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics), University of Oxford, Oxford, UK

  • R Andrew Moore

    Correspondencia a: Plymouth, UK

    [email protected]

Contributions of authors

SD and RAM wrote the protocol, though this was based on a template that had previously been the subject of input from many sources, and which has been subject to extensive peer review.

SD and RAM searched for and selected studies for inclusion.

All review authors were involved in writing the full review.

PW will be responsible for any updates required.

Sources of support

Internal sources

  • Oxford Pain Relief Trust, UK.

    General institutional support

External sources

  • The National Institute for Health Research (NIHR), UK.

    NIHR Cochrane Programme Grant: 13/89/29 ‐ Addressing the unmet need of chronic pain: providing the evidence for treatments of pain

Declarations of interest

PW: none known.

RK has consulted for Grünenthal Ltd (2014 to 2015) and MundiPharma Research (2015), and received lecture fees from Grünenthal Ltd (2013 to 2014), and Pfizer Ltd (2013 to 2014). He is an Associate Professor in Clinical Pharmacy Practice and Advanced Pharmacy Practitioner.

SD: none known.

PC received support from Boston Scientific (2014) for travel and accommodation at a scientific meeting; Boston Scientific does not market paracetamol products. PC is a specialist pain physician and manages patients with chronic pain.

TP: none known; TP is a specialist pain physician and manages patients with neuropathic pain.

RAM has received grant support from RB relating to individual patient level analyses of trial data on ibuprofen in acute pain and the effects of food on drug absorption of analgesics (2013), and from Grünenthal relating to individual patient level analyses of trial data regarding tapentadol in osteoarthritis and back pain (2015). He has received honoraria for attending boards with Menarini concerning methods of analgesic trial design (2014), with Novartis (2014) about the design of network meta‐analyses, and RB on understanding pharmacokinetics of drug uptake (2015).

Acknowledgements

Institutional support was provided by the Oxford Pain Relief Trust.

The National Institute for Health Research (NIHR) is the largest single funder of the Cochrane Pain, Palliative and Supportive Care Review Group.

Disclaimer: the views and opinions expressed herein are those of the review authors and do not necessarily reflect those of the NIHR, National Health Service (NHS), or the Department of Health.

The protocol followed the agreed template for neuropathic pain, which was developed in collaboration with the Cochrane Musculoskeletal Group and Cochrane Neuromuscular Diseases Group. The editorial process was managed by the Cochrane Pain, Palliative and Supportive Care Group.

Version history

Published

Title

Stage

Authors

Version

2016 Dec 27

Paracetamol (acetaminophen) with or without codeine or dihydrocodeine for neuropathic pain in adults

Review

Philip J Wiffen, Roger Knaggs, Sheena Derry, Peter Cole, Tudor Phillips, R Andrew Moore

https://doi.org/10.1002/14651858.CD012227.pub2

2016 Jun 05

Paracetamol (acetaminophen) with or without codeine or dihydrocodeine for neuropathic pain in adults

Protocol

Philip J Wiffen, Roger Knaggs, Sheena Derry, Peter Cole, Tudor Phillips, R Andrew Moore

https://doi.org/10.1002/14651858.CD012227

Differences between protocol and review

We have removed the planned analysis by tiers of evidence as this is largely replaced by GRADE, updated the criteria for assigning a quality level to a body of evidence in line with the latest standards, and extended the description of the GRADE assessment for exceptional circumstances to explain possible decisions.

Notes

A restricted search in March 2018 did not identify any potentially relevant studies likely to change the conclusions. The authors and editors are confident that further research will not change the conclusions. Therefore, this review has now been stabilised following discussion with the authors and editors. If appropriate, we will update the review if new evidence likely to change the conclusions is published, or if standards change substantially which necessitate major revisions.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adult; Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Summary of findings for the main comparison. Paracetamol alone, paracetamol plus codeine, or paracetamol plus dihydrocodeine compared with placebo for neuropathic pain

Paracetamol alone, paracetamol plus codeine, or paracetamol plus dihydrocodeine compared with placebo for neuropathic pain

Patient or population: adults with chronic neuropathic pain

Settings: community

Intervention: paracetamol alone, paracetamol plus codeine, or paracetamol plus dihydrocodeine

Comparison: placebo

Outcomes

Probable outcome with
intervention

Probable outcome with
comparator

RR
(95% CI)

No of studies, participants

Certainty of the evidence
(GRADE)

Comments

Moderate benefit:

At least 30% reduction in pain, or

PGIC much or very much improved

No data

No data

Not calculated

No data

Very low

No trials found for paracetamol alone, paracetamol plus codeine, or paracetamol plus dihydrocodeine

Substantial benefit:

At least 50% reduction in pain, or

PGIC much improved

No data

No data

Not calculated

No data

Very low

No trials found for paracetamol alone, paracetamol plus codeine, or paracetamol plus dihydrocodeine

Lack of efficacy withdrawal

No data

No data

Not calculated

No data

Very low

No trials found for paracetamol alone, paracetamol plus codeine, or paracetamol plus dihydrocodeine

Adverse event withdrawal

No data

No data

Not calculated

No data

Very low

No trials found for paracetamol alone, paracetamol plus codeine, or paracetamol plus dihydrocodeine

Serious adverse events

No data

No data

Not calculated

No data

Very low

No trials found for paracetamol alone, paracetamol plus codeine, or paracetamol plus dihydrocodeine

Deaths

No data

No data

Not calculated

No data

Very low

No trials found for paracetamol alone, paracetamol plus codeine, or paracetamol plus dihydrocodeine

CI: confidence interval; PGIC: Patient Global Impression of Change; RR: risk ratio

Descriptors for levels of evidence (EPOC 2015):
High quality: This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different† is low.
Moderate quality: This research provides a good indication of the likely effect. The likelihood that the effect will be substantially different† is moderate.
Low quality: This research provides some indication of the likely effect. However, the likelihood that it will be substantially different† is high.
Very low quality: This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different† is very high.

† Substantially different: a large enough difference that it might affect a decision.

Figuras y tablas -
Summary of findings for the main comparison. Paracetamol alone, paracetamol plus codeine, or paracetamol plus dihydrocodeine compared with placebo for neuropathic pain
Ir a la tabla de la revisión