The University of Sydney, Sydney, NSW.
Institute for Musculoskeletal Health, University of Sydney, Sydney.
Med J Aust. 2021 Apr;214(7):324-331. doi: 10.5694/mja2.50992. Epub 2021 Mar 30.
To evaluate the efficacy and safety of paracetamol as an analgesic medication in a range of painful conditions.
Systematic review of systematic reviews of the analgesic effects of paracetamol in randomised, placebo-controlled trials. Conduct of systematic reviews was assessed with AMSTAR-2; confidence in effect estimates (quality of evidence) was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
MEDLINE, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews; systematic reviews published 1 January 2010 - 30 April 2020.
We extracted pain and adverse events outcomes from 36 systematic reviews that assessed the efficacy of paracetamol in 44 painful conditions. Continuous pain outcomes were expressed as mean differences (MDs; standardised 0-10-point scale); dichotomous outcomes were expressed as risk ratios (RRs). There is high quality evidence that paracetamol provides modest pain relief for people with knee or hip osteoarthritis (MD, -0.3 points; 95% CI, -0.6 to -0.1 points) and after craniotomy (MD, -0.8 points; 95% CI, -1.4 to -0.2 points); there is moderate quality evidence for its efficacy in tension-type headache (pain-free at 2 hours: RR, 1.3; 95% CI, 1.1-1.4) and perineal pain soon after childbirth (patients experiencing 50% pain relief: RR, 2.4; 95% CI, 1.5-3.8). There is high quality evidence that paracetamol is not effective for relieving acute low back pain (MD, 0.2 points; 95% CI, -0.1 to 0.4 points). Evidence regarding efficacy in other conditions was of low or very low quality. Frequency of adverse events was generally similar for people receiving placebo or paracetamol, except that transient elevation of blood liver enzyme levels was more frequent during repeated administration of paracetamol to patients with spinal pain (RR, 3.8; 95% CI, 1.9-7.4).
For most conditions, evidence regarding the effectiveness of paracetamol is insufficient for drawing firm conclusions. Evidence for its efficacy in four conditions was moderate to strong, and there is strong evidence that paracetamol is not effective for reducing acute low back pain. Investigations that evaluate more typical dosing regimens are required.
CRD42015029282 (prospective).
评估扑热息痛作为一种镇痛药物在一系列疼痛病症中的疗效和安全性。
对随机对照试验中扑热息痛镇痛效果的系统评价进行系统评价。采用 AMSTAR-2 评估系统评价的进行情况；采用 Grading of Recommendations Assessment, Development and Evaluation (GRADE) 标准评估效应估计值的置信度（证据质量）。
MEDLINE、EMBASE、PsycINFO、Cochrane 系统评价数据库；2010 年 1 月 1 日至 2020 年 4 月 30 日发表的系统评价。
我们从 36 项评估扑热息痛在 44 种疼痛病症中疗效的系统评价中提取疼痛和不良事件结局。连续疼痛结局以均数差值（MD；标准化 0-10 分量表）表示；二分类结局以风险比（RR）表示。有高质量证据表明，扑热息痛能为膝或髋关节骨关节炎患者（MD，-0.3 分；95%CI，-0.6 至-0.1 分）和接受颅切除术的患者（MD，-0.8 分；95%CI，-1.4 至-0.2 分）提供适度的疼痛缓解；有高质量证据表明其对紧张型头痛（2 小时无疼痛：RR，1.3；95%CI，1.1-1.4）和分娩后不久的会阴疼痛（RR，2.4；95%CI，1.5-3.8）有效，50%的患者感到疼痛缓解）。有高质量证据表明，扑热息痛对缓解急性腰痛无效（MD，0.2 分；95%CI，-0.1 至 0.4 分）。关于其他疾病疗效的证据质量较低或非常低。接受安慰剂或扑热息痛的患者不良反应的发生频率通常相似，但在接受多次脊柱疼痛患者的扑热息痛治疗时，短暂性血液肝酶水平升高更为频繁（RR，3.8；95%CI，1.9-7.4）。
对于大多数疾病，扑热息痛有效性的证据不足以得出明确的结论。有四项疾病的疗效证据为中等至强，有强有力的证据表明扑热息痛对减轻急性腰痛无效。需要评估更典型剂量方案的研究。
PROSPERO 注册：CRD42015029282（前瞻性）。
