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Acute Pain | Chronic Pain | General

Analgesic efficacy of NSAIDs: comparison of different routes in chronic pain

Clinical bottom line:

Based on one small trial of ketoprofen 100 mg, intramuscular administration relieves pain faster than oral administration.

NSAIDs are an important component of simple 'low-technology' pharmacological control of acute and chronic pain, and, given orally, are surprisingly effective in patients with moderate to severe postoperative pain. Invasive procedures such as continuous extradural opiate infusion, or patient-controlled analgesia, carry recognised risks. Rectal and injectable formulations are currently fashionable, despite unclear evidence for any advantage over oral routes (for patients who are conscious, can swallow, have no nausea or ileus).

Systematic review

Tramèr MR, Williams JE, Carroll D, Wiffen PJ, Moore RA, McQuay HJ. Comparing analgesic efficacy of non-steroidal anti-inflammatory drugs given by different routes in acute and chronic pain: a qualitative systematic review. Acta Anaesth Scand. 1998; 42: 71-9.

Inclusion criteria were full journal publication of randomised controlled trials of direct comparisons of NSAIDs given by different routes; acute and chronic pain; pain outcomes; group size 10; design with internal sensitivity (i.e. at least two dose comparison or placebo control). Topical and intra-articular applications were excluded. Findings for acute pain are presented separately.

Statistically significant findings were extracted from the original reports, and then qualitatively summarised.

Findings

Only one trial met inclusion criteria in rheumatoid arthritis. This double-dummy trial compared ketoprofen 100 mg intramuscularly with the same dose orally. A significantly shorter delay until the lowest pain intensity score was achieved with intramuscular administration.

Adverse effects

Not reported.

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