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This systematic review and meta-analysis investigated if the combination of oral analgesics offers any major benefit over paracetamol alone in treating patients with acute musculoskeletal injuries.
For acute musculoskeletal
injuries in the emergency department setting, paracetamol monotherapy is a
suitable first-line analgesic. Its combination with other oral analgesics does
not provide better pain relief.
This systematic review and
meta-analysis investigated if the combination of oral
analgesics offers any major benefit over paracetamol alone in treating patients
with acute musculoskeletal injuries.
EMBASE, MEDLINE (via PubMed), and Cochrane electronic databases were extensively searched by two reviewers. Randomized controlled clinical trials that compared the analgesic efficacy of paracetamol plus other oral analgesics and paracetamol alone in treating acute musculoskeletal injuries were detected.
The decline in pain
score, adverse effects, and the requirement for additional analgesia were the
study outcomes. Utilizing Cochrane Risk of Bias Assessment Tool and RevMAN
meta-analysis software, assessment of the data was done.
Overall, six studies were included (n = 1254), in which no paediatric study was detected. In five studies, paracetamol was compared to paracetamol plus NSAID. In one study, an opioid was included in the combination group.
No significant difference was witnessed between the groups for the decrease in pain score in the first 2 hr, 24 hr or 72 hr. The mean difference in decline in pain score at rest on 100 mm VAS and activity is shown in the following table:
The risk of noxious adverse events in the emergency department was found to be -0.00. More individuals receiving combination therapy were found to need additional analgesia in the first two hours.
For relieving pain in
acute soft tissue injuries, adding other oral analgesic agents to paracetamol
does not improve analgesia on average. The addition of NSAID to paracetamol did
not elevate adverse events. But adding opioid and NSAID to paracetamol
considerably raised adverse events.
For managing
musculoskeletal injuries, paracetamol monotherapy is an appropriate first-line
analgesic as combining it with oral pain-relieving agents does not cause any
major additional analgesic effect.
Emergency Medicine Australasia
Systematic review and meta-analysis of oral paracetamol versus combination oral analgesics for acute musculoskeletal injuries
Gemma Scott et al.
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