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Review The Evidence That Suggests The Combination Of An Nsaid And Paracetamol Provide Better Pain Relief Than Single Therapy

3071 words - 13 pages

Pharmacology of Anaesthetics and Analgesics Review the evidence that suggests the combination of an NSAID and paracetamol provide better pain relief than single therapyScopeIn this review essay, we will firstly explore the some background information on the sensation of pain in the human body, followed by looking at the different types of analgesics available for drug treatment. We will then take a closer look at the mechanism of action of paracetamol and non- steroidal anti- inflammatory drugs (NSAIDs), and adverse effects associated with the two types drugs. This will be followed by a comprehensive discussion of the current literature reviews which support that combination therapy of ...view middle of the document...

In the 'pain ladder' model pain is categorised as mild, moderate and severe. For mild pain administration of paracetamol should be sufficient to give pain relief, moderate pain requires paracetamol coupled with a mild opioid drug or ibuprofen, and for severe pain paracetamol coupled with a stronger opioid or ibuprofen. This model has been clinically proven to be effective 80 to 90% cases (Organisation, 2012).In this review focus will be placed on paracetamol and NSAIDs, both drugs are non-opioid drugs (Bisgaard, 2006). Both drugs are commonly used in clinical practice for postoperative pain management; the two drugs have different mechanism of action. The general mechanism of action behind NSAIDs is that they inhibit cyclooxygenase enzyme, thus inhibiting the production of prostaglandins (Raffa, 2001). The administration of NSAIDs comes with its side effects, most of the side effects results from the reduction in prostaglandin production. Side effects primarily involve gastrointestinal bleeding or ulceration, reduced ability for platelet aggregation and nephrotoxicity (Raffa, 2001). In comparison to NSAIDs, paracetamol is considered to be a safer therapeutic drug as it does not inhibit prostaglandin production to a significant degree. It has been shown that overdose of paracetamol is associated with hepatotoxicity. As long as the daily dose is below 4 grams per day there should be no risk of hepatotoxicity unless the patient has conditions which predisposes them to hepatotoxicity even at safe dosages (Raffa, 2001). The mechanism of action of paracetamol is still debated, it has been suggested that paracetamol may act of the COX pathway and reduce prostaglandin production levels (Anderson, 2008). Despite paracetamol having lesser adverse effects in comparison to NSAIDs, some studies have shown NSAID is more superior than paracetamol in terms of pain management (Bisgaard, 2006).It has been shown that there are patients that are not able to relieve pain postoperatively even if they follow the standard analgesic administration as instructed by the medical professional (Elvir-Lazo & White, 2010). This coupled with the increase in outpatient population, due to the medical advances which allow patients to receive the same quality outcome even if they are not at the hospital. With the increase in outpatient population there is an increasing demand for the development of multimodal drug regimens which are effective, inexpensive, intrinsically safe and easily managed by the patient or their family members (Elvir-Lazo & White, 2010). For this reason it has been suggested that perhaps by co- administering drugs that will act in a synergistic manner, would reduce the dosage required, increase efficacy and reduce the adverse effects experienced by the patient (Hyllested, Jones, Pedersen, & Kehlet, 2002). Developing an efficient multimodal drug regimen is important; however there are also other factors that need to be addressed in order to improve...

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