Moore R A, Derry S, Wiffen P J, Straube S, Aldington D J
Pain Research and Nuffield Division of Anaesthetics, University of Oxford, The Churchill, Oxford, UK.
Division of Preventive Medicine, University of Alberta, Edmonton, Canada.
Eur J Pain. 2015 Oct;19(9):1213-23. doi: 10.1002/ejp.649. Epub 2014 Dec 22.
Ibuprofen and paracetamol have long been used as analgesics in a range of acute, intermittent and chronic pain conditions. Paracetamol is often the first line analgesic recommended, without consensus about which is the better analgesic.
An overview review of systematic reviews and meta-analyses directly compares ibuprofen and paracetamol at standard doses in particular painful conditions, or uses indirect comparisons against placebo. Electronic searches for systematic reviews were sought published since 1995 using outcomes approximating to ≥50% pain intensity reduction. Painful conditions were acute post-operative pain, dysmenorrhoea, tension-type headache (TTH), migraine, osteoarthritis and rheumatoid arthritis, back pain, cancer and paediatric pain. There was no systematic assessment of harm.
Sixteen systematic reviews and four individual patient data meta-analyses were included. Ibuprofen was consistently superior to paracetamol at conventional doses in a range of painful conditions. Two direct comparisons favoured ibuprofen (acute pain, osteoarthritis). Three of four indirect comparisons favoured ibuprofen (acute pain, migraine, osteoarthritis); one showed no difference (TTH), although there were methodological problems. In five pain conditions (dysmenorrhoea, paediatric pain, cancer pain, back pain and rheumatoid arthritis), there were limited data on paracetamol and ibuprofen.
At standard doses in different painful conditions, ibuprofen was usually superior producing more patients with the degree of pain relief that patients feel worthwhile. Neither of the drugs will be effective for everyone, and both are needed. This overview questions the practice of routinely using paracetamol as a first line analgesic because there is no good evidence for efficacy of paracetamol in many pain conditions.
布洛芬和对乙酰氨基酚长期以来一直被用作一系列急性、间歇性和慢性疼痛病症的镇痛药。对乙酰氨基酚通常是推荐的一线镇痛药，但对于哪种药物是更好的镇痛药尚无共识。
对系统评价和荟萃分析的概述性综述直接比较了布洛芬和对乙酰氨基酚在特定疼痛病症中的标准剂量，或与安慰剂进行间接比较。使用自1995年以来发表的系统评价进行电子检索，采用的结局指标为疼痛强度降低≥50%。疼痛病症包括急性术后疼痛、痛经、紧张型头痛（TTH）、偏头痛、骨关节炎和类风湿关节炎、背痛、癌症疼痛和儿科疼痛。未对危害进行系统评估。
纳入了16项系统评价和4项个体患者数据荟萃分析。在一系列疼痛病症中，常规剂量的布洛芬始终优于对乙酰氨基酚。两项直接比较支持布洛芬（急性疼痛、骨关节炎）。四项间接比较中有三项支持布洛芬（急性疼痛、偏头痛、骨关节炎）；一项显示无差异（紧张型头痛），尽管存在方法学问题。在五种疼痛病症（痛经、儿科疼痛、癌症疼痛、背痛和类风湿关节炎）中，关于对乙酰氨基酚和布洛芬的数据有限。
在不同疼痛病症的标准剂量下，布洛芬通常更优，能使更多患者获得他们认为值得的疼痛缓解程度。这两种药物并非对所有人都有效，两者都有必要使用。本概述性质的综述对常规将对乙酰氨基酚用作一线镇痛药的做法提出了质疑，因为在许多疼痛病症中，没有充分证据表明对乙酰氨基酚具有疗效。
