Efficacy of analgesics in chronic pain: a series of N-of-1 studies.
Rational drug treatment of chronic musculoskeletal pain remains a challenge. Although commonly prescribed, the true efficacy of opioid analgesics or of nonsteroidal antiinflammatory drugs remains to be established. Using an N-of 1 design, eight patients with regional cervicobrachial pain received ibuprofen 800 mg/day, codeine 120 mg/day, or placebo during six 2 week periods. Clinical outcomes were assessed by pain diary, VAS of pain and change in pain, and uptime/downtime estimates. In none of the five subjects who completed the 12-week trial was analgesic efficacy of either drug shown. Major psychosocial and other medical influences on the subjects' status were encountered. The N-of 1 methodology is appropriated for evaluating true efficacy of pharmacotherapy in patients with regional musculoskeletal pain.
Sheather-Reid
R B
RB
Department of Rheumatology St. Vincent's Hospital, Sydney, New South Wales, Australia.
Cohen
M
M
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002908:Chronic Disease; D003061:Codeine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003061:Codeine; D007052:Ibuprofen