Pain Overview

Changes/additions to materials:

No good evidence for combination antipyretics in children
A study has found that a combination of paracetamol plus ibuprofen was more effective than paracetamol alone but no more effective than ibuprofen alone to relieve fever in children in the first 4 hours. A related blog summarises the study and advises that clinicians should follow NICE guidance on feverish illness in children.

No reason to stop using paracetamol in children
Another study suggested that use of paracetamol for fever in the first year of life was associated with a small increased chance of having wheeze, rhinoconjunctivitis-like symptoms or eczema-like symptoms later in childhood. Current use of paracetamol in 6–7 year olds was also associated with these conditions. However, the study does not prove causation and one possible alternative interpretation is that parents are more likely to give paracetamol to children who have these symptoms. See blog for more details.

Withdrawal of co-proxamol linked to reduced suicides in Scotland
The withdrawal of co-proxamol has been accompanied by a significant reduction in mortality from co-proxamol overdose in Scotland. Initial data suggest there is no evidence of an increase in mortality associated with other analgesics, such as paracetamol and co-codamol, despite a steady increase in their use. Further details are available in a blog.

Pain Overview Data Focussed Commentary

We have produced data-focussed commentaries to highlight areas where there appear to be differences between the evidence-base, as described elsewhere on this floor, and current clinical practice. These resources can be read on the screen by clicking the 'flash' version, or by downloading and printing the 'PDF' version.

This commentary covers the use of tramadol, oxycodone and fentanyl patches.