BMJ 1996;313:1209 (9 November)

Letters

Paracetamol-codeine combinations versus paracetamol alone

EDITOR,--In their systematic review Anton J M de Craen and colleagues conclude, on the basis of a range of outcome measures, that the combination of paracetamol and codeine is a more effective analgesic than paracetamol alone.1 They find the increase in efficacy to be small but significant and suggest that future studies should report the proportion of patients in whom good or moderate pain relief is achieved. Such data would enable us to relate statistical significance to clinical importance.

In a similar overview we also concluded that codeine added to the analgesic efficacy of paracetamol, using derived outcome measures of pain such as the sum of the pain intensity difference (as defined in de Craen and colleagues' paper).2 In the meta-analysis of six head to head comparison trials, however, a significant pooled estimate of a 6.7 point difference in the sum of the pain intensity difference (95% confidence interval 3.2 . . . [Full text of this article]


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Relevant Article

Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review
Anton J M de Craen, Giuseppe Di Giulio, Angela J E M Lampe-Schoenmaeckers, Alphons G H Kessels, and Jos Kleijnen
BMJ 1996 313: 321-325. [Abstract] [Full Text]

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