Efficacy and safety of nonopioid analgesics for pain and palliative care in adults indexed on World Health Organizations Essential Medicines List : master's thesis

Acetilsalicilna kiselina, paracetamol i ibuprofen su analgetici navedeni u Osnovnoj listi lijekova Svjetske zdravstvene organizacije za liječenje boli i palijativnu skrb odraslih. Cilj ovog istraživanja je bio analizirati dokaze iz sustavnih pregleda s meta-analizom o djelotvornosti i sigurnosti tih analgetika za liječenje boli i palijativnu skrb u odraslih. Pretražene su četiri baze podataka: MEDLINE, EMBASE, CDSR i DARE. Napravljen je dvostruki neovisni probir naslova/sažetaka i zatim cjelovitih tekstova kako bi se uključili relevantni sustavni pregledi koji sadrže barem jednu meta-analizu vezanu za intenzitet boli i sigurnost lijeka. Procjena metodološke kvalitete sustavnih pregleda je analizirana uz pomoć AMSTAR ljestvice. Uključena su 43 sustavna pregleda koja su objavljena u vremenskom razdoblju od 1996. do 2015. godine. Dokazana je djelotvornost ASK za postporođajnu bol, postoperativnu bol, dentalnu bol i za različite modele boli, ali ne za primarnu dismenoreju. Također je dokazan najveći broj nuspojava uz primjenu ASK kao što je iritacija želuca i pospanost. Za ibuprofen je dokazana djelotvornost u svim studijama osim u studiji koja je analizirala analgeziju tijekom umetanja intrauterine kontracepcije. Za liječenje fibromijalgije nema dovoljno dokaza. Ibuprofen se pokazao djelovornijim od paracetamola, ali će češće izazvati nuspojave. Najveći broj sustavnih pregleda je analizirao paracetamol koji je uglavnom pokazao manju djelotvornost u ispitivanim indikacijama. Za ublažavanje boli tijekom prehlade je ista djelotvornost kao kod primjene nesteroidnih protuupalnih lijekova, a može se koristiti za liječenje dentalne i postoperativne boli. Nuspojave su blagog intenziteta. Kvaliteta pronađenih dokaza je procijenjena kao srednja. Dokazi o djelotvornosti i sigurnosti ASK, paracetamola i ibuprofena kao terapije za nociceptivnu i upalnu bol su zadovoljavajuće kvalitete te su pokazali u većini slučajeva opravdanost primjene. Primjena navedenih analgetika kao zasebnih lijekova za liječenje boli u neuropatskoj boli, kroničnoj boli, kao i u palijativnoj skrbi je upitna zbog nedostatka dokaza o djelotvornosti. Osnovnu listu lijekova SZO trebalo bi revidirati na način da se navedu indikacije za koja stanja su navedeni analgetici dokazano djelotvorni.Acetylsalicylic acid (ASA), paracetamol and ibuprofen are analgesics listed in the World Health Organization Model Lists of Essential Medicines (WHO EML) for relieving pain and palliative care in adults. The aim of this study was to analyse evidence from systematic reviews with meta-analysis on efficacy and safety of those analgesics for pain and palliative care in adults. Four databases were searched: MEDLINE, EMBASE, CDSR and DARE. Independent duplicate screening of bibliographic records and retrieved full texts was conducted in order to find relevant systematic reviews containing at least one meta-analysis on pain and safety of studied medicines. Methodological quality of included systematic reviews was analysed using the AMSTAR scale. There were 43 systematic reviews included, published from 1996 till 2015. The efficacy of ASA was proven for pain after childbirth, postoperative pain, dental pain and many other different models of pain, but not for primary dysmenorrhea. Moreover, high number of side effects was reported as a result of taking ASA, such as irritation of stomach and insomnia. For ibuprofen, the efficacy was proven in all the included studies except the one analysing analgesia during implantation of intrauterine contraception. For treatment of fibromyalgia there was not enough evidence. Ibuprofen proved to be more efficacious than paracetamol, but it often causes side effects. The highest number of systematic reviews analysed paracetamol which mainly showed lower efficacy in the studied indications. When it comes to treatment of pain during common cold, the efficacy was the same as with the use of non-steroidal anti-inflammatory drugs and it can be used for treating dental pain and postoperative pain. The side effects were minor. Quality of evidence from included systematic reviews was moderate. Evidence from systematic reviews about efficacy and safety of ASA, paracetamol and ibuprofen as a therapy for nociceptive and inflammatory pain is of satisfactory quality and their use in the majority of analysed indications is justified. The role of these analgesics for managing neuropathic pain, chronic pain, as well as their role in palliative care is unclear due to lack of evidence of efficacy from systematic reviews. The WHO EML should be revised in order to specify the indications for which these analgesics have been proven as effective