title: Higher pain scores, similar opioid doses and side effects associated with antipyretic analgesics in specialised tertiary pain care.
abstract: OBJECTIVE
  To evaluate whether non-opioid antipyretic analgesics are associated with lower pain scores, opioid doses and side effects in pain patients in tertiary care.
  
  
  METHODS
  In a cross-sectional observational study, data from 519 Caucasians (197 men, 322 women; mean age 55.6 ± 15 years) who had undertaken pain therapy for various causes for 77.5 ± 90.8 months, obtained in three separate study centres, was analysed for actual 24-h pain scores, daily opioid doses and the occurrence of side effects.
  
  
  RESULTS
  Of the 519 patients, 352 received opioids and 260 antipyretic analgesics, from whom 154 received both classes and 304 only either class. The administration of non-opioid antipyretic analgesics was associated with higher average pain scores (4.6 ± 2.5 vs 3.9 ± 2.6; P = 0.01), tendentially higher average oral morphine equivalent doses (121.8 ± 162.2 vs 146.7 ± 242.4 mg/d; P = 0.25) and a similar incidence of side effects (P = 0.21). These results were correspondingly seen when analysing the three study centres separately as independent cohorts.
  
  
  CONCLUSIONS
  With the caution advised for cross-sectional data, the results dispute a clinical benefit of non-opioid antipyretic analgesics for most chronic pain patients in tertiary care and draw attention towards prospectively re-evaluating the utility of non-opioid antipyretic analgesics in tertiary pain care in a randomised placebo controlled trial.
authors.affiliation: Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe-University, Frankfurt am Main, Germany. j.loetsch@em.uni-frankfurt.de
authors.forename: Jörn
authors.initials: J
authors.lastname: Lötsch
authors.forename: Rainer
authors.initials: R
authors.lastname: Freynhagen
authors.forename: Nils
authors.initials: N
authors.lastname: von Hentig
authors.forename: Norbert
authors.initials: N
authors.lastname: Griessinger
authors.forename: Michael
authors.initials: M
authors.lastname: Zimmermann
authors.forename: Reinhard
authors.initials: R
authors.lastname: Sittl
authors.forename: Gerd
authors.initials: G
authors.lastname: Geisslinger
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D058633:Antipyretics / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D058633:Antipyretics