Individual patient meta-analysis using information from clinically homogeneous
acute pain trials with observations over 24h was used to investigate different ways trials can be analysed and reported. There were 13 third-molar extraction trials, with 1,330 patients using
rofecoxib 50mg, 303 using
ibuprofen 400mg, and 570 using placebo.
Pain relief scores were available at individual time points, plus time to remedication. Many more patients remedicated with placebo than
ibuprofen 400mg, and more with
ibuprofen than
rofecoxib 50mg. Median time to remedication, the proportion remedicated at various times, or survival curves would be useful outcomes. In dealing with missing data points when patients remedicated, baseline observation carried forward was more conservative than last observation carried forward, resulting in higher (worse) NNTs and lower average
pain scores after 12 and 24h. Results based on both methods might be sensible for trials longer than eight hours. The distribution of
pain relief was highly skewed, especially at later times, when almost no patient was average. Different cut points for
pain relief (at least 25, 50 or 75% maxTOTPAR) and longer duration changed the NNT for
ibuprofen compared with placebo, but less for
rofecoxib, reflecting longer duration of action of
rofecoxib. Reporting for each treatment group the percentage of patients with 25, 50 and 75%
pain relief at various times after dose, and reporting the proportion of patients with good or complete
pain relief, and inadequate
pain relief, at each time point, would improve
acute pain trial reporting.