Page 62 Acute Pain Management
P. 62






2
A
systematic
review
(Katz
&
Clarke,
2008
Level
I )
reported
preventive
effects
following
the
use

of
a
number
of
different
drugs,
but
equivocal
or
no
benefit
from
pre‐emptive
treatment

(Table
1.5).
The
methodology
was
unable
to
identify
specific
therapeutic
techniques
that
may

be
of
benefit.


Table
1.5
 Summary
of
studies
according
to
target
agent
administered


 Pre‐emptive
effects
 Preventive
effects
 

Agent(s)
 No.
of
 Positive
 Negative
 Positive
 Negative
 Opposite
 Total
no.

studies
 effects
 effects

Gabapentin
 6
 0
(0)
 1
(16.7)
 4
(66.6)
 1
(16.7)
 0
(0)
 6
(100)

Local
 13
 3
(20)
 3
(20)
 6
(40)
 1
(6.7)
 2
(13.3)
 15
(100)

CHAPTER
1
 Opioids
 [‐1]
 7
(43.8)
 3
(18.8)
 4
(25)
 2
(12.4)
 0
(0)
 16
(100)

anaesthetics

5
(100)

0
(0)

1
(20)

1
(20)

5

3
(60)

[‐1]

[‐1]

0
(0)

NSAIDs

14

[‐1]

[‐2]

[‐1]

NMDA
 [‐2]
 2
(11.8)
 1
(5.9)
 9
(53)
 4
(23.4)
 1
(5.9)
 17
(100)

14

antagonists

Multimodal
 5
 1
(16.7)
 1
(16.7)
 2
(33.3)
 2
(33.3)
 0
(0)
 6
(100)

Other
 4
 1
(25)
 0
(0)
 3
(75)

 0
(0)
 0
(0)
 4
(100)

[‐1]
 [‐1]
 [‐1]

a
Total 
 61
 17 b
 10
 28 
 c 11
 3
 69

(24.6)
 (14.5)
 (40.6)
 (15.9)
 (4.4)
 (100)

Notes:
 Table
shows
the
total
number
of
studies
and
number
(%)
with
positive
and
negative
pre‐emptive
and

preventive
effects.
Also
shown
is
the
number
(%)
of
studies
reporting
effects
opposite
to
those
predicted
and

the
total
number
of
effects
(positive,
negative
and
opposite).
The
total
number
of
effects
exceeds
the
number

of
studies
because
some
studies
were
designed
to
evaluate
both
pre‐emptive
and
preventive
effects.
See
text

for
definition
of
pre‐emptive
and
preventive
effects.


a

 p
=
0.02
for
z‐test
comparison
of
proportion
of
total
positive
pre‐emptive
plus
preventive
effects
(0.64)

versus
proportion
of
total
negative
pre‐emptive
plus
preventive
effects
(0.31).

b

 p
=
0.
36
for
z‐test
comparison
of
proportion
of
total
positive
pre‐emptive
effects
(17/27
=
0.63)
versus

proportion
of
total
negative
pre‐emptive
effects
(10/27
=
0.37)


c

 p
=
0.03
for
z‐test
comparison
of
proportion
of
total
positive
preventive
effects
(28/39
=
0.72)
versus

proportion
of
total
negative
preventive
effects
(11/39
=
0.28)

Legend:
NSAIDs:
non‐steroidal
anti‐inflammatory
drugs;
NMDA:
N‐methyl‐D‐aspartate

Source:
 Reproduced
with
kind
permission
from
Katz
and
Clark,
Preventive
analgesia
and
beyond:
current
status,

evidence,
and
future
directions,
Table
9.4
p
165
Clinical
Pain
Management:
Acute
Pain
2e,
Hodder
Arnold.















































































2


This
meta‐analysis
includes
studies
that
have
since
been
withdrawn
from
publication
and
which
are
shown
as

subtractions
in
Table
1.5.
These
were
four
positive
reports:
pre‐emptive
effects
of
opioids,
pre‐emptive
effects
of

venlafaxine
(listed
under
‘Other’),
and
both
pre‐emptive
and
preventive
effects
of
NSAIDs.
Reanalysis
of
the
data

would
be
required
to
determine
the
overall
strength
of
the
evidence.
Please
refer
to
the
Introduction
at
the

beginning
of
this
document
for
comments
regarding
the
management
of
retracted
articles.

14
 Acute
Pain
Management:
Scientific
Evidence

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