Pleuritic pain: reduced by indomethacin.

Clinical bottom line (level 1b)

  1. Indomethacin reduced severe pleuritic chest pain compared with placebo (NNT = 2 at 2 hours) .
  2. Indomethacin increased FVC and FEV 1 and reduced the respiratory rate.
Sacks and Kanarek: American Review of Respiratory Diseases 1973; 108: 666-669
Expires September 2003

The study

Double-blinded concealed randomised trial without intention-to-treat
Setting: university hospital, South Africa

51 patients (aged ?, ?% male) with severe pleuritic chest pain (ie. worse on inspiration or coughing) lasting <72 hours

Excluded if
  • active peptic ulcer
  • history of haematemesis or melena


    • Control Group: (n = 26, 26 analysed): placebo suppository
    Experimental Group: (n = 25, 25 analysed): indomethacin 100 mg pr
    Following administration of analgesia, patients were asked to rank pain by a score every 30 minutes.
    100% followed for 2 hours
    Outcome notes:
    • no pain relief : excellent- score decreased by 3 points; good- score decreased by 2 points
    • side effects : dizziness or nausea

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    no pain relief 2 hours 17
    (65.4%)    		 4
    (16.0%)    		 76%
    (37% to 90%)    		 49.4%
    (26.1% to 72.6%)    		 2
    (1 to 4)
    side effects 2 hours 2
    (7.70%)    		 4
    (16.0%)    		 -108%
    (-937% to 58%)    		 -8.31%
    (-26.0% to 9.34%)    		 -12
    (NNT = 11 to infinity;
    NNH = 4 to infinity)

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    % improvement in FVC 21.0
    (9.0)     		45.7
    (6.7)     		24
    (19 to 30)
    % improvement in FEV 1 20.8
    (8.2)     		65.2
    (15.8)     		44
    (36 to 52)
    respiratory rate reduction 9.3
    (3.3)     		20.9
    (4.4)     		11
    (8.9 to 14)

  • severe pleuritic pain- prevalence of diagnoses (95% CI):
    • broncho- or lobar pneumonia: 65% (52% to 78%)
    • pulmonary embolism: 29% (17% to 42%)
    • chest injury: 6% (0% to 12%)

    • Comments

    1. Too small to effectively assess side effect rates.

    Citation

    1. Sacks PV, and Kanarek D: Treatment of acute pleuritic pain: comparison between indomethacin and a placebo. American Review of Respiratory Diseases 1973; 108: 666-669
    Contributor: Chris Ball and Clare Wotton, Unknown Month 2000
    Reviewer: Gerard Ryan

    Clinical Question.
    Patient
    Intervention or Exposure
    Outcome