Page 300 Acute Pain Management

Primary dysmenorrhoea
NsNSAIDs are highly effective analgesics in dysmenorrhoea. While no difference was found
between the different nsNSAIDs included in an analysis in terms of efficacy, ibuprofen had the
least adverse effects (Marjoribanks et al, 2003 Level I). Paracetamol was less effective than
naproxen, ibuprofen, mefenamic acid and aspirin; again, ibuprofen had the most favourable
risk‐benefit ratio (Zhang & Li Wan Po, 1998 Level I). NsNSAIDs also reduced bleeding and pain
associated with the use of an intrauterine‐device (Grimes et al, 2006 Level I).
Vitamin B1 (Proctor & Murphy, 2001 Level I), vitamin E (Ziaei et al, 2005 Level II) chinese herbal
medicine (Zhu et al, 2007 Level I), rose tea (Tseng et al, 2005 Level II), guava leaf extract (Psidii
guajavae) (Doubova et al, 2007 Level II), aromatherapy (Han et al, 2006 Level II) and fennel
(Foeniculum vulgare) (Namavar Jahromi et al, 2003 Level III‐2) are also effective.
High frequency TENS was effective in primary dysmenorrhoea (Proctor et al, 2002 Level I).
The effectiveness of acupuncture in primary dysmenorrhoea is undetermined due to
methodological problems in available studies (Yang et al, 2008 Level I).
Abdominal migraine
Abdominal migraine is a neurogastrointestinal disorder, usually of male children, characterised
by recurrent attacks of acute abdominal pain, nausea, vomiting and often headaches. Pizotifen
was found to be effective for prophylaxis and treatment (Symon & Russell, 1995 Level II) (see
Section 9.6.5).

Key messages
1. Provision of analgesia does not interfere with the diagnostic process in acute abdominal
pain (S) (Level I [Cochrane Review]).
2. Non‐selective NSAIDs, opioids and intravenous metamizole (dipyrone) provide effective
analgesia for renal colic (N) (Level I [Cochrane Review]).
3. Non‐selective NSAIDs given for renal colic reduce requirements for rescue analgesia and
produce less vomiting compared with opioids, particularly pethidine (meperidine) (U)
(Level I [Cochrane Review]).
CHAPTER 9 5. The onset of analgesia is faster when non‐selective NSAIDs are given intravenously for the
4. High frequency TENS is effective in primary dysmenorrhoea (N) (Level I [Cochrane
Review]).

treatment of renal colic (U) (Level I).

6. Antispasmodics and peppermint oil are effective for the treatment of acute pain in irritable
bowel syndrome (U) and gastrointestinal spasm (N) (Level I).
7. Non‐selective NSAIDs and vitamin B1 are effective in the treatment of primary
dysmenorrhoea (U) (Level I).
8. There is no difference between pethidine and morphine in the treatment of renal colic (U)
(Level II).
9. Parenteral non‐selective NSAIDs are as effective as parenteral opioids in the treatment of
biliary colic (U) (Level II).

252 Acute Pain Management: Scientific Evidence