506 Over-the-counter analgesics effective for acute postoperative pain

June 05, 2017

written by Brian R McAvoy

Clinical question
How effective are single doses of non-prescription (over-the-counter or OTC) oral analgesics for acute postoperative pain? Successful treatment was defined as at least 50% of maximum possible pain relief, over a period of about 6 hours.

Bottom line
Combinations of ibuprofen plus paracetamol provided pain relief worked in 70% of people (NNT* 2), and fast acting ibuprofen formulations 200mg and 400mg, ibuprofen 200mg plus caffeine 100mg, and diclofenac potassium 50mg worked in over 50% of people (NNT close to 2). Dipyrone 500mg, which is available OTC in many parts of the world, also worked in about 50% of people. Paracetamol plus aspirin at various doses worked in 11% to 43% of people (NNT 3 or above). An important finding was that low doses of some medicines in fast acting formulations were among the best. Taking painkillers with food might reduce how well they work. There were fewer side effects for people taking ibuprofen plus paracetamol than those taking placebo. The quality of the evidence was good. *NNT = number needed to treat to benefit one individual.

There was no information on many of the commonly available combinations containing low doses of codeine. The results for side effects might be different if the painkillers were taken for more than a few days.

OTC analgesics are used frequently. They are available in various brands, package sizes, formulations and dose. They can be used for a range of different types of pain, but this overview reports on how well they work for acute postoperative pain.

Cochrane Systematic Review
Moore RA et al. Single dose oral analgesics for acute postoperative pain in adults - an overview of Cochrane reviews. Cochrane Reviews, 2015, Issue 11. Art. No.: CD010794.DOI: 10.1002/14651858. CD010794.pub2. This review contains information from 39 Cochrane Reviews involving 41 different OTC drugs.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.