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Paracetamol versus other analgesia in adult patients with minor musculoskeletal injuries: a systematic review
  1. Milan L Ridderikhof1,
  2. Joppe Saanen1,
  3. Helma Goddijn1,
  4. Susan Van Dieren2,
  5. Faridi Van Etten-Jamaludin3,
  6. Philipp Lirk4,
  7. J Carel Goslings5,
  8. Markus W Hollmann6
  1. 1 Department of Emergency Medicine, Amsterdam UMC – Locatie AMC, Amsterdam, The Netherlands
  2. 2 Clinical Research Unit, Amsterdam UMC – Locatie AMC, Amsterdam, The Netherlands
  3. 3 Clinical Library, Amsterdam UMC – Locatie AMC, Amsterdam, The Netherlands
  4. 4 Department of Anaesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  5. 5 Department of Trauma Surgery, OLVG, Amsterdam, The Netherlands
  6. 6 Department of Anaesthesiology, Amsterdam UMC – Locatie AMC, Amsterdam, The Netherlands
  1. Correspondence to Dr Milan L Ridderikhof, Emergency Medicine, Amsterdam UMC - Locatie AMC, 1105 AZ Amsterdam, The Netherlands; m.l.ridderikhof{at}amsterdamumc.nl

Abstract

Objectives Pain treatment in acute musculoskeletal injuries usually consists of paracetamol, non-steroidal antiinflammatory drugs (NSAIDs) or opioids. It would be beneficial to determine whether paracetamol is as effective as other analgesics. The objective of this study was to evaluate available evidence regarding efficacy of paracetamol in these patients.

Methods Embase, MEDLINE, Cochrane and relevant trial registers were searched from inception to 14 February 2018 by two independent reviewers to detect all randomised studies with adult patients with acute minor musculoskeletal injuries treated with paracetamol as compared with other analgesics. There were no language or date restrictions. Two independent reviewers evaluated risk of bias and quality of evidence. Primary outcome was decrease in pain scores during the first 24 hours, and secondary outcomes included pain decrease beyond 24 hours, need for additional analgesia and occurrence of adverse events.

Results Seven trials were included, evaluating 2100 patients who were treated with paracetamol or NSAIDs or the combination of both as comparisons, of which only four studies addressed the primary outcome. No studies were found comparing paracetamol with opioids. There were no differences in analgesic effectiveness within and beyond 24 hours, nor in need for additional analgesia and occurrence of adverse events. Overall, quality of evidence was low. Because of methodological inconsistencies, a meta-analysis was not possible.

Conclusions Based on available evidence, paracetamol is as effective as NSAIDs or the combination of both in treating pain in adult patients with minor musculoskeletal injuries in the acute setting. The quality of evidence is low.

  • analgesia/pain control
  • emergency department
  • musculo-skeletal, soft tissue injury
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Footnotes

  • Contributors MLR, HG, SVD, PL, JCG and MH designed the study. MH and JCG supervised the conduct of the study. FVE-J formulated the search strategy, performed the search and supplied the reviewers with the search results. MLR and JS evaluated the search results independently, and HG acted as a referee in case of disagreement. SVD formulated the statistical analyses plan. MLR drafted the manuscript, and all authors contributed substantially to its revisions. MLR takes responsibility for the paper as a whole.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The study protocol was published previously in the Prospero register for systematic reviews (protocol number CRD42017077538).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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