BMJ 1996;313:1209 (9 November)

Letters

Intention to treat approach is not popular

EDITOR,--Anton J M de Craen and colleagues address the question of the added analgesic effect and safety of codeine combined with paracetamol through a literature review with meta-analysis and an assessment of the methodological quality of the published trials.1 Their paper is a long overdue contribution to evidence based pharmacotherapy. Their recommendations to improve the quality of clinical trials, however, deserve attention.

The authors criticise several of the papers for not using the intention to treat approach. The justification for using this approach is its supposed relation to actual clinical practice.2 Furthermore, the authors recommend the use of larger treatment groups (n>100) to ensure that baseline pain intensities are similar.

Contrary to the view still held by many people, the efficacy of oral analgesics in relieving pain is not universal. Their efficacy is highly dependent on the quality3 and quantity4 of the pain against which they are intended to be . . . [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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