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Eleutério OHP, Veronezi RN, Martinez-Sobalvarro JV, Marrafon DAFDO, Eleutério LP, Rascado RR, Dos Reis TM, Podestá MHMC, Torres LH. Safety of metamizole (dipyrone) for the treatment of mild to moderate pain-an overview of systematic reviews. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03240-2. [PMID: 38888755 DOI: 10.1007/s00210-024-03240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
Metamizole, as known as dipyrone or novaminsulfone is widely used, especially in Latin America, for its analgesic and antipyretic function. However, several countries have banned it due to the risk of agranulocytosis, skin necrosis, and other serious adverse effects. To assess the safety of metamizole compared to other commonly used non-opioid analgesics (paracetamol, ibuprofen, and acetylsalicylic acid). An overview of systematic reviews. The searches were performed in the PubMed, Cochrane Library, Embase, Scopus and LILACS databases. Systematic reviews of randomized and nonrandomized clinical trials with adult patients with mild to moderate pain that assessed the adverse effects of metamizole were included. A methodological quality assessment was performed through ROBIS. The protocol of this systematic review was submitted to the International Prospective Register of Systematic Reviews (Prospero, CRD42021295272). Of 387 identified studies, four were included, with a total of 20,643 participants, all submitted to a single dose by oral, intramuscular, or intravenous route. No study reported a serious adverse effect. However, 60 of 778 patients (7.7%) who used metamizole; 120/828 (14.5%) who used acetylsalicylic acid; 56/443 (12.6%) who used paracetamol; and 27/213 (12.7%) who used ibuprofen had mild adverse effects. A complementary statistical analysis showed that metamizole, at any dose, has a 38.8% lower chance of adverse effects compared to paracetamol and 46.8% compared to acetylsalicylic acid. The results shows that metamizole is a safe drug with evidence of a lower incidence of adverse effects compared to paracetamol and acetylsalicylic acid.
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Affiliation(s)
- Otávio Henrique Porto Eleutério
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700 Centro, Alfenas, MG, 37130-001, Brazil
- School of Medicine, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas, MG, 37130-001, Brazil
| | - Rafael Nakano Veronezi
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700 Centro, Alfenas, MG, 37130-001, Brazil
- School of Medicine, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas, MG, 37130-001, Brazil
| | - Joselin Valeska Martinez-Sobalvarro
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700 Centro, Alfenas, MG, 37130-001, Brazil
- Department of Pharmacy, Health Sciences Sector, Federal University of Paraná, Avenida Prefeito Lothário Meissner, 632, Jardim Botânico, Curitiba, PR, 80210-170, Brazil
| | | | - Larissa Porto Eleutério
- Institute of Mathematics, Statistics and Scientific Computing, University of Campinas, Rua Sérgio Buarque de Holanda, 651, Campinas, SP, 13083-859, Brazil
| | - Ricardo Radighieri Rascado
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700 Centro, Alfenas, MG, 37130-001, Brazil
| | - Tiago Marques Dos Reis
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Alfenas, MG, 37130-001, Brazil
| | - Márcia Helena Miranda Cardoso Podestá
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700 Centro, Alfenas, MG, 37130-001, Brazil
| | - Larissa Helena Torres
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700 Centro, Alfenas, MG, 37130-001, Brazil.
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Grossner T, Haberkorn U, Gotterbarm T. Evaluation of the Impact of Different Pain Medication and Proton Pump Inhibitors on the Osteogenic Differentiation Potential of hMSCs Using 99mTc-HDP Labelling. Life (Basel) 2021; 11:life11040339. [PMID: 33920381 PMCID: PMC8069736 DOI: 10.3390/life11040339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 01/08/2023] Open
Abstract
First-line analgetic medication used in the field of musculoskeletal degenerative diseases, like Nonsteroidal anti-inflammatory drugs (NSAIDs), reduces pain and prostaglandin synthesis, whereby peptic ulcers are a severe adverse effect. Therefore, proton pump inhibitors (PPI) are frequently used as a concomitant medication to reduce this risk. However, the impact of NSAIDs or metamizole, in combination with PPIs, on bone metabolism is still unclear. Therefore, human mesenchymal stem cells (hMSCs) were cultured in monolayer cultures in 10 different groups for 21 days. New bone formation was induced as follows: Group 1 negative control group, group 2 osteogenic differentiation media (OSM), group 3 OSM with pantoprazole (PAN), group 4 OSM with ibuprofen (IBU), group 5 OSM with diclofenac (DIC), group 6 OSM with metamizole (MET), group 7 OSM with ibuprofen and pantoprazole (IBU + PAN), group 8 OSM with diclofenac and pantoprazole (DIC + PAN), group 9 OSM with metamizole and pantoprazole (MET + PAN) and group 10 OSM with diclofenac, metamizole and pantoprazole (DIC + MET + PAN). Hydroxyapatite content was evaluated using high-sensitive radioactive 99mTc-HDP labeling. Within this study, no evidence was found that the common analgetic medication, using NSAIDs alone or in combination with pantoprazole and/or metamizole, has any negative impact on the osteogenic differentiation of mesenchymal stem cells in vitro. To the contrary, the statistical results indicate that pantoprazole alone (group 3 (PAN) (p = 0.016)) or diclofenac alone (group 5 (DIC) (p = 0.008)) enhances the deposition of minerals by hMSCS in vitro. There is an ongoing discussion between clinicians in the field of orthopaedics and traumatology as to whether post-surgical (pain) medication has a negative impact on bone healing. This is the first hMSC in vitro study that investigates the effects of pain medication in combination with PPIs on bone metabolism. Our in vitro data indicates that the assumed negative impact on bone metabolism is subsidiary. These findings substantiate the thesis that, in clinical medicine, the patient can receive every pain medication needed, whether or not in combination with PPIs, without any negative effects for the osteo-regenerative potential.
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Affiliation(s)
- Tobias Grossner
- Trauma Surgery and Paraplegiology, Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-56-35-443
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany;
- Clinical Cooperation Unit Nuclear Medicine, Deutsches Krebsforschungszentrum (DKFZ), 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), 69120 Heidelberg, Germany
| | - Tobias Gotterbarm
- Department of Orthopedics and Traumatology, Kepler University Hospital, 4020 Linz, Austria;
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Improving Pain Management and Long-Term Outcomes Following High-Energy Orthopaedic Trauma (Pain Study). J Orthop Trauma 2017; 31 Suppl 1:S71-S77. [PMID: 28323806 DOI: 10.1097/bot.0000000000000793] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Poor pain control after orthopaedic trauma is a predictor of physical disability and numerous negative long-term outcomes. Despite increased awareness of the negative consequences of poorly controlled pain, analgesic therapy among hospitalized patients after orthopaedic trauma remains inconsistent and often inadequate. The Pain study is a 3 armed, prospective, double-blind, multicenter randomized trial designed to evaluate the effect of standard pain management versus standard pain management plus perioperative nonsteroidal anti-inflammatory drugs or pregabalin in patients of ages 18-85 with extremity fractures. The primary outcomes are chronic pain, opioid utilization during the 48 hours after definitive fixation and surgery for nonunion in the year after fixation. Secondary outcomes include preoperative and postoperative pain intensity, adverse events and complications, physical function, depression, and post-traumatic stress disorder. One year treatment costs are also compared between the groups.
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Botti M, Kent B, Bucknall T, Duke M, Johnstone MJ, Considine J, Redley B, Hunter S, de Steiger R, Holcombe M, Cohen E. Development of a Management Algorithm for Post-operative Pain (MAPP) after total knee and total hip replacement: study rationale and design. Implement Sci 2014; 9:110. [PMID: 25164125 PMCID: PMC4164760 DOI: 10.1186/s13012-014-0110-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/11/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Evidence from clinical practice and the extant literature suggests that post-operative pain assessment and treatment is often suboptimal. Poor pain management is likely to persist until pain management practices become consistent with guidelines developed from the best available scientific evidence. This work will address the priority in healthcare of improving the quality of pain management by standardising evidence-based care processes through the incorporation of an algorithm derived from best evidence into clinical practice. In this paper, the methodology for the creation and implementation of such an algorithm that will focus, in the first instance, on patients who have undergone total hip or knee replacement is described. METHODS In partnership with clinicians, and based on best available evidence, the aim of the Management Algorithm for Post-operative Pain (MAPP) project is to develop, implement, and evaluate an algorithm designed to support pain management decision-making for patients after orthopaedic surgery. The algorithm will provide guidance for the prescription and administration of multimodal analgesics in the post-operative period, and the treatment of breakthrough pain. The MAPP project is a multisite study with one coordinating hospital and two supporting (rollout) hospitals. The design of this project is a pre-implementation-post-implementation evaluation and will be conducted over three phases. The Promoting Action on Research Implementation in Health Services (PARiHS) framework will be used to guide implementation. Outcome measurements will be taken 10 weeks post-implementation of the MAPP. The primary outcomes are: proportion of patients prescribed multimodal analgesics in accordance with the MAPP; and proportion of patients with moderate to severe pain intensity at rest. These data will be compared to the pre-implementation analgesic prescribing practices and pain outcome measures. A secondary outcome, the efficacy of the MAPP, will be measured by comparing pain intensity scores of patients where the MAPP guidelines were or were not followed. DISCUSSION The outcomes of this study have relevance for nursing and medical professionals as well as informing health service evaluation. In establishing a framework for the sustainable implementation and evaluation of a standardised approach to post-operative pain management, the findings have implications for clinicians and patients within multiple surgical contexts.
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Affiliation(s)
- Mari Botti
- />Epworth/Deakin Centre for Clinical Nursing Research, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Bridie Kent
- />Plymouth University, Drake Circus, Plymouth England
| | - Tracey Bucknall
- />School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Maxine Duke
- />School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Megan-Jane Johnstone
- />School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Julie Considine
- />Eastern Health/Deakin University Nursing and Midwifery Research Centre, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Bernice Redley
- />Epworth/Deakin Centre for Clinical Nursing Research, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Susan Hunter
- />Epworth/Deakin Centre for Clinical Nursing Research, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Richard de Steiger
- />Epworth Victor Smorgon Chair of Surgery, Epworth HealthCare, 185-187 Hoddle Street, Richmond, 3121 VIC Australia
| | - Marlene Holcombe
- />Epworth HealthCare, 62 Erin Street, Richmond, 3121 VIC Australia
| | - Emma Cohen
- />Epworth/Deakin Centre for Clinical Nursing Research, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
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Preoperative administration of intramuscular dezocine reduces postoperative pain for laparoscopic cholecystectomy. J Biomed Res 2013; 25:356-61. [PMID: 23554711 PMCID: PMC3596732 DOI: 10.1016/s1674-8301(11)60047-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 02/24/2011] [Accepted: 06/14/2011] [Indexed: 01/17/2023] Open
Abstract
Postoperative pain is the most common complaint after laparoscopic cholecystectomy. This study was carried out to evaluate whether preoperative administration of intramuscular dezocine can provide postoperative analgesia and reduce postoperative opioid consumption in patients undergoing laparoscopic cholecystectomy. Patients (ASA I or II) scheduled for laparoscopic cholecystectomy were randomly assigned into intramuscular dezocine group (group 1) or intramuscular normal saline group (group 2). Dezocine and equal volume normal saline were administered intramuscularly 10 min before the induction of anesthesia. After operation, the severity of postoperative pain, postoperative fentanyl requirement, incidence and severity of side-effects were assessed. Postoperative pain and postoperative patient-controlled fentanyl consumption were reduced significantly in group 1 compared with group 2. The incidence and severity of side effects were similar between the two groups. Preoperative single-dose administration of intramuscular dezocine 0.1 mg/kg was effective in reducing postoperative pain and postoperative patient-controlled fentanyl requirement in patients undergoing laparoscopic cholecystectomy.
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Reporting randomised clinical trials of analgesics after traumatic or orthopaedic surgery is inadequate: a systematic review. BMC CLINICAL PHARMACOLOGY 2010; 10:2. [PMID: 20067642 PMCID: PMC2822812 DOI: 10.1186/1472-6904-10-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 01/12/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Several randomised clinical trials (RCTs) of analgesics in postoperative pain after traumatic or orthopaedic surgery (TOS) have been published, but no studies have assessed the quality of these reports. We aimed to examine the quality of reporting RCTs on analgesics for postoperative pain after TOS. METHODS Reports of RCTs assessing analgesics in postoperative pain after TOS were systematically searched from electronic databases. The quality of reports was assessed using the CONSORT checklist (scoring range from 0 to 22). The quality was considered poor when scoring was 12 or lesser. The publication year and the impact factor of journals were recorded. RESULTS A total of 92 reports of RCTs were identified and 69 (75%) scored 12 or lesser in CONSORT checklist (range 5-17). The mean (SD) CONSORT score of all reports was 10.6 (2.7). Missing CONSORT items included primary and secondary outcome measures (11%), the specific objectives and hypothesis definition (12%), the sample size calculation (12%), the dates defining the periods of recruitment (12%), the discussion of external validity of findings (14%), the allocation sequence generation (24%), and the interpretation of potential bias or imprecision of results (25%). There was a little improvement in CONSORT scores over time (r = 0.62; p < 0.001) and with impact factor of journals (r = 0.30; p < 0.001). CONCLUSION Quality of reporting RCTs on analgesics after TOS is poor. Reporting of those RCTs should be improved according to methodological standard checklists in the next years.
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