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Single dose oral meloxicam for acute postoperative pain in adults
R Andrew Moore1, Sheena Derry, Henry J McQuay
1Pain Research and Nuffield Department of Anaesthetics, University of Oxford, West Wing (Level 6), John Radcliffe Hospital, Oxford, Oxfordshire, UK, OX3 9DU.
Background:
Meloxicam is a non-steroidal anti-inflammatory drug (NSAID) used mainly in treating pain associated with arthritis. The usual oral dose for osteoarthritis is 15 mg daily, but lower doses of 7.5 mg are advised in older patients. This review sought to evaluate the efficacy and safety of oral meloxicam in acute postoperative pain, using clinical studies of patients with established pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties.
Objectives:
To assess the efficacy of single dose oral meloxicam in acute postoperative pain, and any associated adverse events.
Search Strategy:
We searched Cochrane CENTRAL (Issue 2, 2009), MEDLINE (June 2009); EMBASE (June 2009); the Oxford Pain Relief Database.
Selection Criteria:
Randomised, double-blind, placebo-controlled clinical trials of oral meloxicam for relief of acute postoperative pain in adults.
Data Collection And Analysis:
Two review authors independently assessed trial quality and extracted data. We planned to use area under the "pain relief versus time" curve to derive the proportion of participants with meloxicam experiencing least 50% pain relief over 4 to 6 hours, using validated equations; to use number needed to treat to benefit (NNT); the proportion of participants using rescue analgesia over a specified time period; time to use of rescue analgesia; information on adverse events and withdrawals.
Main Results:
No studies were identified by the searches that examined oral meloxicam in patients with established postoperative pain.
Authors' Conclusions:
In the absence of evidence of efficacy, at present, for oral meloxicam in acute postoperative pain, its use in this indication is not justified. Because trials clearly demonstrating analgesic efficacy in the most basic of acute pain studies is lacking, use in other indications should be evaluated carefully. Given the large number of available drugs of this and similar classes, there is no urgent research agenda.
Insights
This review found no studies on oral meloxicam for acute postoperative pain. Therefore, its use for this condition is not currently justified due to a lack of evidence for efficacy.
Area of Science:
- Pain Management
- Pharmacology
- Clinical Research
Background:
- Meloxicam is a non-steroidal anti-inflammatory drug (NSAID) commonly used for arthritis pain.
- Standard oral doses include 15 mg daily for osteoarthritis, with 7.5 mg recommended for older adults.
- This review focused on evaluating oral meloxicam's efficacy and safety in acute postoperative pain settings.
Purpose of the Study:
- To assess the efficacy of a single oral dose of meloxicam in managing acute postoperative pain.
- To identify and evaluate any associated adverse events linked to oral meloxicam use in this context.
Main Methods:
- Searched major databases including Cochrane CENTRAL, MEDLINE, and EMBASE up to June 2009.
- Included randomized, double-blind, placebo-controlled trials of oral meloxicam in adults with acute postoperative pain.
- Data extraction focused on pain relief, rescue analgesia use, and adverse events.
Main Results:
- No clinical studies were identified that investigated the efficacy of oral meloxicam in patients experiencing established acute postoperative pain.
- The searches did not yield any trials meeting the inclusion criteria for this specific indication.
Conclusions:
- The current lack of evidence for oral meloxicam's efficacy in acute postoperative pain means its use is not justified.
- Further research should carefully evaluate meloxicam's use in other indications due to the absence of basic efficacy data.
- Given numerous alternatives, there is no immediate need for new research in this area.
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