Revisiting established medicines: an overview of systematic reviews about ibuprofen and paracetamol for treating pain in children.

BACKGROUND AND OBJECTIVE:

We explored how systematic reviews evaluated paracetamol and ibuprofen for treating pain in children, as these two nonopioid analgesics are well-established medicines included in most national essential medicines lists.

DATABASES AND DATA TREATMENT:

We carried out an overview of systematic reviews (SRs) of randomized controlled trials (RCTs) of interventions (PROSPERO registration: 42016045367). We searched MEDLINE, EMBASE, Cochrane Database of Systematic Reviews (CDSR) and Database of Reviews of Effects (DARE) up to August 23, 2017. We used AMSTAR checklist to analyze methodological quality of included SRs.

RESULTS:

We found 17 SRs with 72 unique RCTs; the majority of those trials included under 100 children. Positive conclusive evidence was found in only one SR, regarding safety of paracetamol. Conclusions of other SRs for efficacy and safety of ibuprofen and paracetamol were inconclusive, unclear, or there was no opinion. Only one SR analyzed efficacy of ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) in chronic pain and the conclusion was that there was no evidence from RCTs that NSAIDs were effective for chronic noncancer pain in children and adolescents. Most of the SRs addressed very narrow questions, included few trials, with few children and were of low or medium methodological quality.

CONCLUSIONS:

Most SRs on two relevant medicines have inconsistent conclusions and doubt upon their effectiveness. Instead of focusing on very narrow questions, SRs should examine more comprehensive research topics to obtain a general sense of consistency, particularly when analyzing established medicines. This article is protected by copyright. All rights reserved.