From analyses of individual patient data ( seven studies , 918 patients ) , we found baseline pain strongly associated with absolute , but not relative , MCID as patients with higher baseline pain needed larger pain reduction to perceive relief .
Conclusions The MCID in acute pain varied greatly between studies and was influenced by baseline pain , definitions of improved patients and study design .
Background The minimum clinical ly important difference ( MCID ) is used to interpret the clinical relevance of results reported by trials and meta-analyses as well as to plan sample sizes in new studies .
However , there is a lack of consensus about the size of MCID in acute pain , which is a core symptom affecting patients across many clinical conditions .
Acetaminophen (paracetamol) improves pain and well-being in people with advanced cancer already receiving a strong opioid regimen: a randomized, double-blind, placebo-controlled cross-over trial.
PURPOSE To determine whether adding regular acetaminophen ( paracetamol ) could improve pain and well-being in people with advanced cancer and pain despite strong opioids . PATIENTS AND METHODS Participants took acetaminophen for 48 hours and placebo for 48 hours . The order ( acetaminophen or placebo first ) was r and omly allocated . Pain was the primary outcome . Preferences , number of opioid breakthrough doses , overall well-being , nausea and vomiting , drowsiness , constipation , and cold sweats were secondary outcomes . Patients rated themselves daily with visual analog scales ( VAS ) and a verbal numeric scale ( VNS ) for pain , all scaled from 0 to 10 . RESULTS Thirty patients completed the trial . The oral opioid was morphine in 23 patients and hydromorphone in seven patients . The median daily opioid dose in oral morphine equivalents was 200 mg ( range , 20 to 2,100 mg ) . Nonsteroidal anti-inflammatory drugs , corticosteroids , or both were used by 16 patients . Pain and overall well-being were better for patients receiving acetaminophen than for those receiving placebo . The mean difference was 0.4 ( 95 % CI , 0.1 to 0.8 ; P = .03 ) in VNS for pain , 0.6 ( 95 % CI , -0.1 to 1.3 ; P = .09 ) in VAS for pain , and 0.7 ( 95 % CI , 0.0 to 1.4 ; P = .05 ) in VAS for overall well-being . More patients preferred the period they took acetaminophen ( n = 14 ) than the period they took placebo ( n = 8) , but many had no preference ( n = 8) . There were no differences in the other outcomes . CONCLUSION Acetaminophen improved pain and well-being without major side effects in patients with cancer and persistent pain despite a strong opioid regimen . Its addition is worth considering in all such patients
From analyses of individual patient data ( seven studies , 918 patients ) , we found baseline pain strongly associated with absolute , but not relative , MCID as patients with higher baseline pain needed larger pain reduction to perceive relief .
Conclusions The MCID in acute pain varied greatly between studies and was influenced by baseline pain , definitions of improved patients and study design .
Background The minimum clinical ly important difference ( MCID ) is used to interpret the clinical relevance of results reported by trials and meta-analyses as well as to plan sample sizes in new studies .
However , there is a lack of consensus about the size of MCID in acute pain , which is a core symptom affecting patients across many clinical conditions .