Cochrane · systematic review · CD007789
Oral non‐steroidal anti‐inflammatory drugs versus other oral analgesic agents for acute soft tissue injury
Jones, P, Lamdin, R, Dalziel, SR · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
24
current version
GRADE rated
21
No studies
3
Included studies
NR
No studies 3 · 12.5%Ungraded 0 · 0%Very low 9 · 37.5%Low 7 · 29.2%Moderate 3 · 12.5%High 2 · 8.3%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyNSAID compared with paracetamol for acute soft tissue injury
Population: people with acute soft tissue injury, such as ankle sprain
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain at < 24 hours (VAS: 0 to 100 mm: worst) NSAID vs paracetamol | no estimate extracted | 6 studies · 1178 participants | High |
Pain at days 1 to 3 (VAS: 0 to 100 mm: worst) NSAID vs paracetamol | no estimate extracted | 6 studies · 1232 participants | High |
Pain on day 7 or later (VAS: 0 to 100 mm: worst) NSAID vs paracetamol | no estimate extracted | 4 studies · 467 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Little or no swelling on day 7 or later NSAID vs paracetamol | RR 0.84 [0.58, 1.22] | 1 study · 77 participants | Low Downgraded: risk of bias, imprecision |
Return to function on day 7 or latere NSAID vs paracetamol | RR 0.99 [0.9, 1.09] | 3 studies · 386 participants | Very low Downgraded: risk of bias, imprecision |
Gastrointestinal adverse events NSAID vs paracetamol | RR 1.34 [0.97, 1.86] | 10 studies · 1504 participants | Low Downgraded: imprecision |
Neurological adverse events NSAID vs paracetamol | RR 0.85 [0.62, 1.17] | 9 studies · 1679 participants | Low Downgraded: imprecision |
Early re‐injury (within 3 months) NSAID vs paracetamol | no estimate extracted | NR | No studies |
NSAID compared with opioid for acute soft tissue injury
Population: acute soft tissue injury
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain at < 24 hours (VAS: 0 to 100 mm: worst) NSAID vs opioid | no estimate extracted | 4 studies · 1058 participants | Moderate Downgraded: imprecision, indirectness |
Pain at days 4 to 6 (VAS: 0 to 100 mm: worst) NSAID vs opioid | no estimate extracted | 1 study · 706 participants | Low Downgraded: imprecision, indirectness |
Pain on day 7 or later (VAS: 0 to 100 mm: worst) NSAID vs opioid | no estimate extracted | 1 study · 706 participants | Low Downgraded: imprecision, indirectness |
Little or no swelling on day 7 or later NSAID vs opioid | RR 1.14 [0.61, 2.13] | 1 study · 84 participants | Very low Downgraded: risk of bias, imprecision |
Return to function on day 7 or later (numbers returning to full function or returning to training) NSAID vs opioid | RR 1.13 [1.03, 1.25] | 2 studies · 749 participants | Low Downgraded: imprecision, indirectness |
Gastrointestinal adverse events NSAID vs opioid | RR 0.48 [0.36, 0.62] | 5 studies · 1151 participants | Moderate Downgraded: imprecision, indirectness |
Neurological adverse events NSAID vs opioid | RR 0.4 [0.3, 0.53] | 5 studies · 1151 participants | Moderate Downgraded: imprecision, indirectness |
Early re‐injury (with 3 months) NSAID vs opioid | no estimate extracted | NR | No studies |
NSAID compared with combination (paracetamol and opioid) analgesic for acute soft tissue injury
Population: people with acute soft tissue injury, such as ankle sprain
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Little or no pain at < 24 hours NSAID vs combination (paracetamol and opioid) analgesic | no estimate extracted | 1 study · 51 participants | Very low Downgraded: risk of bias, imprecision |
Little or no pain at 1 to 3 days NSAID vs combination (paracetamol and opioid) analgesic | RR 1.49 [0.65, 3.4] | 2 studies · 149 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Little or no pain on day 7 or later NSAID vs combination (paracetamol and opioid) analgesic | RR 1.05 [0.88, 1.25] | 2 studies · 138 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Swelling on day 7 or later NSAID vs combination (paracetamol and opioid) analgesic | no estimate extracted | 3 studies · 230 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Return to function on day 7 or later Assessed as 'cure' NSAID vs combination (paracetamol and opioid) analgesic | RR 1.28 [0.9, 1.81] | 1 study · 89 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Gastrointestinal adverse events NSAID vs combination (paracetamol and opioid) analgesic | RR 0.21 [0.03, 1.74] | 3 studies · 141 participants | Very low Downgraded: risk of bias, imprecision |
Neurological adverse events NSAID vs combination (paracetamol and opioid) analgesic | RR 0.52 [0.09, 2.84] | 3 studies · 141 participants | Very low Downgraded: risk of bias, imprecision |
Early re‐injury (with 3 months) NSAID vs combination (paracetamol and opioid) analgesic | no estimate extracted | NR | No studies |
Summary of findings: NSAIDs versus paracetamol
Population: people with acute soft tissue injury, such as ankle sprain
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain at < 24 hours (VAS: 0 to 100 mm: worst) Summary of findings: NSAIDs vs paracetamol | MD 1.5 | 4 studies · 377 participants | Moderate Downgraded: imprecision, indirectness |
Pain at days 1 to 3 (VAS: 0 to 100 mm: worst) Summary of findings: NSAIDs vs paracetamol | MD 4.26 [0.69, 7.83] | 4 studies · 431 participants | Low Downgraded: risk of bias, inconsistency, indirectness |
Pain at day 7 or greater (VAS: 0 to 100 mm: worst) Summary of findings: NSAIDs vs paracetamol | MD 1.55 | 4 studies · 467 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Swelling days 0 to 3 (mL) Summary of findings: NSAIDs vs paracetamol | no estimate extracted | 1 study · 86 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Little/no swelling day 7 or greater Summary of findings: NSAIDs vs paracetamol | RR 0.84 [0.58, 1.22] | 1 study · 77 participants | Low Downgraded: risk of bias, imprecision |
Return to function at or after day 77 Summary of findings: NSAIDs vs paracetamol | RR 0.99 [0.9, 1.09] | 3 studies · 316 participants | Very low Downgraded: risk of bias, imprecision |
Gastrointestinal adverse events Summary of findings: NSAIDs vs paracetamol | RR 1.76 [0.99, 3.14] | 7 studies · 627 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Re‐injury Summary of findings: NSAIDs vs paracetamol | no estimate extracted | NR | No studies |
Summary of findings: NSAIDs versus opioid
Population: people with acute soft tissue injury, such as ankle sprain
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain at < 24 hours (VAS: 0 to 100 mm: worst) Summary of findings: NSAIDs vs opioid | MD 0.1 | 2 studies · 774 participants | Low Downgraded: imprecision, indirectness |
Pain at days 4 to 6 (VAS: 0 to 100 mm: worst) Summary of findings: NSAIDs vs opioid | no estimate extracted | 1 study · 706 participants | Low Downgraded: imprecision, indirectness |
Pain at day 7 or greater (VAS: 0 to 100 mm: worst) Summary of findings: NSAIDs vs opioid | no estimate extracted | 1 study · 706 participants | Low Downgraded: imprecision, indirectness |
Swelling days 0 to 3 ( Summary of findings: NSAIDs vs opioid | no estimate extracted | 1 study · 68 participants | Very low Downgraded: risk of bias, indirectness |
Little/no swelling day 7 or greater Summary of findings: NSAIDs vs opioid | RR 1.14 [0.61, 2.13] | 1 study · 84 participants | Very low Downgraded: risk of bias, imprecision |
Return to function at or after day 76 Summary of findings: NSAIDs vs opioid | RR 1.13 [1.03, 1.25] | 2 studies · 749 participants | Low Downgraded: imprecision, indirectness |
Gastrointestinal adverse events Summary of findings: NSAIDs vs opioid | RR 1.86 [0.7, 4.93] | 1 study · 63 participants | Very low Downgraded: risk of bias, imprecision |
Re‐injury Summary of findings: NSAIDs vs opioid | no estimate extracted | NR | No studies |
Summary of findings: NSAIDs versus combination (paracetamol and opioid) analgesic
Population: people with acute soft tissue injury, such as ankle sprain
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Little or no pain at < 24 hours Summary of findings: NSAIDs vs combination (paracetamol and opioid) analgesic | RR 2.89 [0.12, 67.75] | 1 study · 51 participants | Very low Downgraded: risk of bias, imprecision |
Little or no pain at 1 to 3 days Summary of findings: NSAIDs vs combination (paracetamol and opioid) analgesic | RR 1.49 [0.65, 3.4] | 2 studies · 149 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Little or no pain at day 7 or greater Summary of findings: NSAIDs vs combination (paracetamol and opioid) analgesic | RR 1.05 [0.88, 1.25] | 2 studies · 138 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Swelling days 0 to 3 Summary of findings: NSAIDs vs combination (paracetamol and opioid) analgesic | no estimate extracted | 1 study · 82 participants | Very low Downgraded: risk of bias, indirectness |
Swelling day 7 or greater Summary of findings: NSAIDs vs combination (paracetamol and opioid) analgesic | no estimate extracted | 1 study · 98 participants | Very low Downgraded: risk of bias, indirectness |
Return to function at or after day 76 Summary of findings: NSAIDs vs combination (paracetamol and opioid) analgesic | RR 1.28 [0.9, 1.81] | 1 study · 89 participants | Very low Downgraded: risk of bias, indirectness |
Gastrointestinal adverse events Summary of findings: NSAIDs vs combination (paracetamol and opioid) analgesic | RR 0.21 [0.03, 1.74] | 3 studies · 141 participants | Very low Downgraded: risk of bias, imprecision |
Re‐injury Summary of findings: NSAIDs vs combination (paracetamol and opioid) analgesic | no estimate extracted | NR | No studies |