BMJ 1996;313:1209 (9 November)

Letters

Actual size of increase needs to be measured

EDITOR,--Underlying Anton J M de Craen and colleagues' conclusion that adding codeine 60 mg to paracetamol can result in a small but significant increase in analgesia is the crucial question "How big is small?"1 The benefit of adding 60 mg codeine to paracetamol in studies of single doses can be quantified.2 Thirteen of the 19 reports from de Craen and colleagues' search met our inclusion criteria of comparisons of single doses of oral paracetamol with single doses of paracetamol plus codeine 60 mg, double blind treatment with random allocation, baseline pain of moderate to severe intensity, and total pain relief as a derived outcome. Two studies used paracetamol doses of 1000 mg and the rest used 600 mg or 650 mg. We calculated the risk ratio and number needed to treat for paracetamol versus paracetamol with codeine 60 mg, using the criterion of pain relief of at least 50%.2

Only . . . [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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