Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Oct 7;2009(4):CD007540.
doi: 10.1002/14651858.CD007540.pub2.

Single dose oral sulindac for acute postoperative pain in adults

R Andrew Moore  1 , Sheena Derry, Henry J McQuay
Affiliations

Single dose oral sulindac for acute postoperative pain in adults

R Andrew Moore et al. Cochrane Database Syst Rev. .

Abstract

Background: Sulindac is a non-steroidal anti-inflammatory drug (NSAID) licensed for use in rheumatic disease and other musculoskeletal disorders in the UK, and widely available in other countries worldwide. This review sought to evaluate the efficacy and safety of oral sulindac in acute postoperative pain, using clinical studies of patients with established pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties.

Objectives: To assess the efficacy of single dose oral sulindac in acute postoperative pain, and any associated adverse events.

Search strategy: We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies up to June 2009.

Selection criteria: Randomised, double-blind, placebo-controlled clinical trials of oral sulindac for relief of acute postoperative pain in adults.

Data collection and analysis: Two review authors independently assessed trial quality and extracted data. We planned to use area under the "pain relief versus time" curve to derive the proportion of participants with meloxicam experiencing least 50% pain relief over 4 to 6 hours, using validated equations; to use number needed to treat to benefit (NNT); the proportion of participants using rescue analgesia over a specified time period; time to use of rescue analgesia; information on adverse events and withdrawals.

Main results: No studies were identified by the searches that examined oral sulindac in patients with established postoperative pain.

Authors' conclusions: In the absence of evidence of efficacy, at present, for oral sulindac in acute postoperative pain, its use in this indication is not justified. Because trials clearly demonstrating analgesic efficacy in the most basic of acute pain studies is lacking, use in other indications should be evaluated carefully. Given the large number of available drugs of this and similar classes, there is no urgent research agenda.

PubMed Disclaimer

Conflict of interest statement

SD, RAM & HJM have received research support from charities, government and industry sources at various times, this work was supported by NHS Cochrane Collaboration Grant and NIHR Biomedical Research Centre Programme. RAM and HJM have consulted for various pharmaceutical companies. RAM and HJM have received lecture fees from pharmaceutical companies related to analgesics and other healthcare interventions.

Update of

  • doi: 10.1002/14651858.CD007540

References

Additional references

Ahern 1992
    1. Ahern MJ, Wetherall M, Leslie A, James RH, Roberts‐Thomson PJ, Rennie GC. A comparison of ketoprofen SR and sulindac in the elderly with rheumatoid arthritis. The British journal of Clinical Practice 1992;46(4):229‐33. - PubMed
Barden 2004
    1. Barden J, Edwards JE, McQuay HJ, Wiffen PJ. Relative efficacy of oral analgesics after third molar extraction. British Dental Journal 2004;197(7):407‐11. - PubMed
Clarke 2009
    1. Clarke R, Derry S, Moore RA, McQuay HJ. Single dose oral etoricoxib for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD004309.pub2] - DOI - PubMed
Collins 1997
    1. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres?. Pain 1997;72:95‐7. - PubMed
Collins 2001
    1. Collins SL, Edwards J, Moore RA, Smith LA, McQuay HJ. Seeking a simple measure of analgesia for mega‐trials: is a single global assessment good enough?. Pain 2001;91(1‐2):189‐94. - PubMed
Cook 1995
    1. Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995;310(6977):452‐4. - PMC - PubMed
Cooper 1991
    1. Cooper SA. Single‐dose analgesic studies: the upside and downside of assay sensitivity. The Design of Analgesic Clinical Trials. Advances in Pain Research Therapy 1991;18:117‐24.
Davies 1997
    1. Davies NM, Watson MS. Clinical pharmacokinetics of sulindac. A dynamic old drug. Clinical Pharmacokinetics 1997;32(6):437‐59. - PubMed
Derry 2008
    1. Derry S, Moore RA, McQuay HJ. Single dose oral celecoxib for acute postoperative pain. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD004233] - DOI - PubMed
Derry C 2009a
    1. Derry C, Derry S, Moore RA, McQuay HJ. Single dose oral naproxen and naproxen sodium for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 1. [DOI: 10.1002/14651858.CD004234.pub2] - DOI - PMC - PubMed
Derry C 2009b
    1. Derry C, Derry S, Moore RA, McQuay HJ. Single dose oral ibuprofen for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD001548.pub2] - DOI - PMC - PubMed
Derry P 2009
    1. Derry P, Derry S, Moore RA, McQuay HJ. Single dose oral diclofenac for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD004768] - DOI - PMC - PubMed
Fitzgerald 2001
    1. FitzGerald GA, Patrono C. The coxibs, selective inhibitors of cyclooxygenase‐2. New England Journal of Medicine 2001;345(6):433‐42. - PubMed
Gaskell 2009
    1. Gaskell H, Derry S, Moore RA, McQuay HJ. Single dose oral oxycodone and oxycodone plus paracetamol (acetaminophen) for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD002763.pub2] - DOI - PMC - PubMed
Hattori 2007
    1. Hattori Y, Hashizume K, Nakajima K, Nishimura Y, Naka M, Miyanaga K. The effect of long‐term treatment with sulindac on the progression of diabetic retinopathy. Current Medical Research and Opinion 2007;23(8):1913‐7. [PUBMED: 17621415] - PubMed
Hawkey 1999
    1. Hawkey CJ. Cox‐2 inhibitors. Lancet 1999;353(9149):307‐14. - PubMed
Jadad 1996a
    1. Jadad AR, Carroll D, Moore RA, McQuay H. Developing a database of published reports of randomised clinical trials in pain research. Pain 1996;66(2‐3):239‐46. - PubMed
Jadad 1996b
    1. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Controlled Clinical Trials 1996;17:1‐12. - PubMed
L'Abbé 1987
    1. L'Abbé KA, Detsky AS, O'Rourke K. Meta‐analysis in clinical research. Annals of Internal Medicine 1987;107:224‐33. - PubMed
Lloyd 2009
    1. Lloyd R, Derry S, Moore RA, McQuay HJ. Intravenous or intramuscular parecoxib for acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD004771.pub4] - DOI - PMC - PubMed
McQuay 2005
    1. McQuay HJ, Moore RA. Placebo. Postgraduate Medical Journal 2005;81:155‐60. - PMC - PubMed
Meyskens 2008
    1. Meyskens FL Jr, McLaren CE, Pelot D, Fujikawa‐Brooks S, Carpenter PM, Hawk E, et al. Difluoromethylornithine plus sulindac for the prevention of sporadic colorectal adenomas: a randomized placebo‐controlled, double‐blind trial. Cancer prevention research (Philadelphia, Pa.) 2008;1(1):32‐8. [DOI: 10.1158/1940-6207.CAPR-08-0042] - DOI - PMC - PubMed
Moore 1996
    1. Moore A, McQuay H, Gavaghan D. Deriving dichotomous outcome measures from continuous data in randomised controlled trials of analgesics. Pain 1996;66(2‐3):229‐37. - PubMed
Moore 1997a
    1. Moore A, McQuay H, Gavaghan D. Deriving dichotomous outcome measures from continuous data in randomised controlled trials of analgesics: verification from independent data. Pain 1997;69(1‐2):127‐30. - PubMed
Moore 1997b
    1. Moore A, Moore O, McQuay H, Gavaghan D. Deriving dichotomous outcome measures from continuous data in randomised controlled trials of analgesics: use of pain intensity and visual analogue scales. Pain 1997;69(3):311‐5. - PubMed
Moore 1997c
    1. Moore RA, McQuay HJ. Single‐patient data meta‐analysis of 3453 postoperative patients: oral tramadol versus placebo, codeine and combination analgesics. Pain 1997;69(3):287‐94. [DOI: 10.1016/S0304-3959(96)03291-5] - DOI - PubMed
Moore 1998
    1. Moore RA, Gavaghan D, Tramer MR, Collins SL, McQuay HJ. Size is everything‐large amounts of information are needed to overcome random effects in estimating direction and magnitude of treatment effects. Pain 1998;78(3):209‐16. - PubMed
Moore 2003
    1. Moore RA, Edwards J, Barden J, McQuay HJ. Bandolier's Little Book of Pain. Oxford: Oxford University Press, 2003. [ISBN: 0‐19‐263247‐7]
Moore 2005
    1. Moore RA, Edwards JE, McQuay HJ. Acute pain: individual patient meta‐analysis shows the impact of different ways of analysing and presenting results. Pain 2005;116(3):322‐31. - PubMed
Moore 2006
    1. Moore A, McQuay H. Bandolier's Little Book of Making Sense of the Medical Evidence. Oxford: Oxford University Press, 2006. [ISBN: 0‐19‐856604‐2]
Moore 2008
    1. Moore RA, Barden J. Systematic review of dexketoprofen in acute and chronic pain. BMC Clinical Pharmacology 2008;8:11. [DOI: 10.1186/1472-6904-8-11] - DOI - PMC - PubMed
Morris 1995
    1. Morris JA, Gardner MJ. Calculating confidence intervals for relative risk, odds ratio and standardised ratios and rates. In: Gardner MJ, Altman DG editor(s). Statistics with Confidence ‐ Confidence Intervals and Statistical Guidelines. British Medical Journal, 1995:50‐63. - PMC - PubMed
PACT 2007
    1. Prescription Cost Analysis. England 2007. [ISBN: 978‐1‐84636‐210‐1]
Sawdy 2003
    1. Sawdy RJ, Lye S, Fisk NM, Bennett PR. A double‐blind randomized study of fetal side effects during and after the short‐term maternal administration of indomethacin, sulindac, and nimesulide for the treatment of preterm labor. American Journal of Obstetrics and Gynecology 2003;188(4):1046‐51. [DOI: 10.1067/mob.2003.255] - DOI - PubMed
Toms 2008
    1. Toms L, McQuay HJ, Derry S, Moore RA. Single dose oral paracetamol (acetaminophen) for postoperative pain in adults. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD004602.pub2] - DOI - PMC - PubMed
Tramér 1997
    1. Tramèr MR, Reynolds DJM, Moore RA, McQuay HJ. Impact of covert duplicate results on meta‐analysis: a case study. BMJ 1997;315:635‐9. - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources