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Randomized Controlled Trial
. 2015 Feb;19(2):187-92.
doi: 10.1002/ejp.536. Epub 2014 May 22.

Validating speed of onset as a key component of good analgesic response in acute pain

R A Moore  1 , S Derry, S Straube, J Ireson-Paine, P J Wiffen
Affiliations
Randomized Controlled Trial

Validating speed of onset as a key component of good analgesic response in acute pain

R A Moore et al. Eur J Pain. 2015 Feb.

Abstract

Background: Previous analysis of a single data set in acute pain following third molar extraction demonstrated a strong relationship between the speed of reduction of pain intensity and overall pain relief, as well as need for additional analgesia.

Methods: Individual patient data analysis of a single randomized, double-blind trial of placebo, paracetamol 1000 mg, ibuprofen sodium 400 mg and ibuprofen-poloxamer 400 mg following third molar extraction. Visual analogue scale pain intensity (VASPI) and other measurements were made at baseline, every 5-45 min, and at 60, 90, 120, 180, 240, 300 and 360 min.

Results: Most patients produced consistent VASPI results over time. For placebo and paracetamol, few patients achieved low VASPI scores and maintained them. For both ibuprofen formulations, VASPI scores fell rapidly during the first hour and were then typically maintained until later re-medication. Analysis of all patients showed that rapid VASPI reduction in the first hour was strongly correlated with good overall pain relief (high total pain relief over 0-6 h), and with lesser need for additional analgesia within 6 h. Results for this analysis were in very good agreement with a previous analysis, validating the relationship between fast initial pain intensity reduction and overall good pain relief in this setting.

Conclusions: In acute pain following third molar extraction, faster acting analgesic formulations provide earlier onset of pain relief, better overall pain relief and a less frequent need for additional analgesia, indicating longer lasting pain relief.

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Figures

Figure 1
Figure 1
Evolution of median visual analogue scale pain intensity (VASPI) and patients remaining in the study without re-medicating. Placebo = purple; paracetamol 1000 mg = red; ibuprofen sodium 400 mg = light blue; ibuprofen-poloxamer 400 mg = dark blue.
Figure 2
Figure 2
Evolution of individual patient visual analogue scale pain intensity (VASPI) scores over 6 h for all four treatments. Individual colours represent individual patients, with 80–82 patients in each treatment arm.
Figure 3
Figure 3
Relationship between speed of reduction of visual analogue scale pain intensity (VASPI) over 0–60 min and overall pain experience measured as %maxTOTPAR over 0–6 h in individual patients, for the analysis in this paper (NL0406) and a previous analysis (Moore et al., 2014).
Figure 4
Figure 4
Relationship between speed of reduction of visual analogue scale pain intensity (VASPI) over 0–60 min and proportion of patients achieving the standard individual pain relief outcome of ≥50%maxTOTPAR over 0–6 h, for the analysis in this paper (NL0406; red) and a previous analysis (Moore et al., blue).
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