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Meta-Analysis
. 2014 Dec 11;2014(12):CD009281.
doi: 10.1002/14651858.CD009281.pub3.

Caffeine as an analgesic adjuvant for acute pain in adults

Christopher J Derry  1 , Sheena Derry, R Andrew Moore
Affiliations
Meta-Analysis

Caffeine as an analgesic adjuvant for acute pain in adults

Christopher J Derry et al. Cochrane Database Syst Rev. .

Abstract

Background: This is an updated version of the original Cochrane review published in Issue 3, 2012. Caffeine has been added to common analgesics such as paracetamol, ibuprofen, and aspirin, in the belief that it enhances analgesic efficacy. Evidence to support this belief is limited and often based on invalid comparisons.

Objectives: To assess the relative efficacy of a single dose of an analgesic plus caffeine against the same dose of the analgesic alone, without restriction on the analgesic used or the pain condition studied. We also assessed serious adverse events.

Search methods: We searched CENTRAL, MEDLINE, and EMBASE from inception to 28 August 2014, the Oxford Pain Relief Database, and also carried out Internet searches and contacted pharmaceutical companies known to have carried out trials that have not been published.

Selection criteria: We included randomised, double-blind studies that compared a single dose of analgesic plus caffeine with the same dose of the analgesic alone in the treatment of acute pain.

Data collection and analysis: Two review authors independently assessed the eligibility and quality of studies, and extracted data. Any disagreements or uncertainties were settled by discussion with a third review author. We sought any validated measure of analgesic efficacy, but particularly the number of participants experiencing at least 50% of the maximum possible pain relief over four to six hours, participants reporting a global evaluation of treatment of very good or excellent, or headache relief after two hours. We pooled comparable data to look for a statistically significant difference, and calculated numbers needed to treat to benefit (NNT) with caffeine. We also looked for any numerical superiority associated with the addition of caffeine, and information about any serious adverse events.

Main results: We identified no new studies with available results for this update. The earlier review included 20 studies (7238 participants) in valid comparisons, but because we used different outcomes for some headache studies, the number of participants in the analyses of the effects of caffeine is now 4262 when previously it was 5243. The studies were generally of good methodological quality, using standard designs and mostly standard scales of pain measurement, although many of those treating postoperative pain were small.Most studies used paracetamol or ibuprofen, with 100 mg to 130 mg caffeine, and the most common pain conditions studied were postoperative dental pain, postpartum pain, and headache. There was a small but statistically significant benefit with caffeine used at doses of 100 mg or more, which was not dependent on the pain condition or type of analgesic. About 5% to 10% more participants achieve a good level of pain relief (at least 50% of the maximum over four to six hours) with the addition of caffeine, giving a NNT of about 14 (high quality evidence).Most comparisons individually demonstrated numerical superiority with caffeine, but not statistical superiority. One serious adverse event was reported with caffeine, but was considered unrelated to any study medication.We know of the existence of around 25 additional studies with almost 12,500 participants for which data for analysis were not obtainable. The additional analgesic effect of caffeine remained statistically significant but clinically less important even if all the known missing data had no effect; the bulk of the unobtainable data are reported to have similar results as this review.

Authors' conclusions: The addition of caffeine (≥ 100 mg) to a standard dose of commonly used analgesics provides a small but important increase in the proportion of participants who experience a good level of pain relief.

PubMed Disclaimer

Conflict of interest statement

CD has no conflicts relating to this review or any similar product.

SD has no conflicts relating to this review or any similar product.

RAM has no conflicts relating to this review or any similar product.

For transparency we have received research support from charities, government, and industry sources at various times, but none relate to this review. We are funded by the NIHR for work on a series of reviews informing the unmet need of chronic pain and providing the evidence for treatments of pain.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
4
4
Individual studies comparing the primary outcome for analgesic + caffeine versus analgesic alone ‐ any pain condition
5
5
Forest plot of comparison: 3 Analgesic plus caffeine versus analgesic alone by dose of caffeine, outcome: 3.1 Primary outcome.
1.1
1.1. Analysis
Comparison 1 Analgesic plus caffeine versus analgesic alone by pain condition, Outcome 1 Primary outcome.
2.1
2.1. Analysis
Comparison 2 Analgesic plus caffeine versus analgesic alone by drug, Outcome 1 Primary outcome.
3.1
3.1. Analysis
Comparison 3 Analgesic plus caffeine versus analgesic alone by dose of caffeine, Outcome 1 Primary outcome.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD009281.pub2

References

References to studies included in this review

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References to studies excluded from this review

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