{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T04:47:29Z","timestamp":1758862049727,"version":"3.40.5"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,8,31]],"date-time":"2020-08-31T00:00:00Z","timestamp":1598832000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim of this systematic review and meta\u2010analysis was to determine if a combination of analgesics conveys any significant clinical benefit over paracetamol alone in managing acute musculoskeletal injuries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two reviewers independently searched MEDLINE (via PubMed), EMBASE and Cochrane electronic databases. Randomised controlled trials comparing paracetamol with paracetamol plus other oral analgesics in managing acute musculoskeletal injuries (e.g. sprains, contusions) were identified. Outcomes were reduction in pain score, adverse events and need for additional analgesia. Studies were critiqued using the Cochrane Risk of Bias Assessment Tool and data analysed using RevMAN meta\u2010analysis software.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six studies were included (<jats:italic>n<\/jats:italic> = 1254). No paediatric studies were identified. Five studies compared paracetamol to paracetamol plus NSAID. One study also included an opioid in the combination group. There was no clinically important difference between groups for reduction in pain score in the first 2\u2009h, 24\u2009h or 72\u2009h. At 2\u2009h the mean difference in reduction in pain score at rest on 100\u2009mm VAS was 0.72\u2009mm (\u22121.36, 2.79), <jats:italic>P<\/jats:italic> = 0.5. On activity it was \u22121.79\u2009mm (\u22124.08, 0.49), <jats:italic>P<\/jats:italic> = 0.12. The risk of adverse events in ED was \u22120.00 (\u22120.04, 0.03). More patients receiving combination therapy required additional analgesia in the first 2\u2009h: \u22120.03 (\u22120.06, \u22120.01), <jats:italic>P<\/jats:italic> = 0.01.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Paracetamol monotherapy is a reasonable first\u2010line analgesic for acute musculoskeletal injuries as combining additional oral agents does not result in any significant additional analgesic effect.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1742-6723.13596","type":"journal-article","created":{"date-parts":[[2020,8,31]],"date-time":"2020-08-31T07:40:34Z","timestamp":1598859634000},"page":"107-113","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Systematic review and meta\u2010analysis of oral paracetamol <i>versus<\/i> combination oral analgesics for acute musculoskeletal injuries"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7392-2020","authenticated-orcid":false,"given":"Gemma","family":"Scott","sequence":"first","affiliation":[{"name":"Adult Emergency Department Auckland City Hospital  Auckland New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiayi","family":"Gong","sequence":"additional","affiliation":[{"name":"Inpatient Pharmacy Department Auckland City Hospital  Auckland New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carl","family":"Kirkpatrick","sequence":"additional","affiliation":[{"name":"Centre for Medicine Use and Safety Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1560-1186","authenticated-orcid":false,"given":"Peter","family":"Jones","sequence":"additional","affiliation":[{"name":"Adult Emergency Department Auckland City Hospital  Auckland New Zealand"},{"name":"Department of Surgery The University of Auckland  Auckland New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,8,31]]},"reference":[{"volume-title":"The Burden of Musculoskeletal Diseases in the United States (BMUS)","year":"2014","author":"United States Bone and Joint Initiative","key":"e_1_2_8_2_1"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ptsp.2013.01.002"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-15-418"},{"key":"e_1_2_8_5_1","first-page":"CD007789","article-title":"Oral non\u2010steroidal anti\u2010inflammatory drugs versus other oral analgesic agents for acute soft tissue injury (review)","author":"Jones P","year":"2015","journal-title":"Cochrane Database Syst. 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