Caffeine or NSAIDs for Pain? Both?

800px-Café_parisienLet’s be honest for a second.  Drinking a morning cup of coffee (or four!) tends to bring more guilt in our society than drinking a social glass or two of wine.  When people talk about their coffee consumption it is as if they are admitting that they are weak and unable to handle the stress of their life.  Regardless of this fact, it seems that every month a study is published in favor or against coffee consumption.  I personally think drinking an 8 oz cup of coffee is great for the body and allows millions of Americans to have a bowel movement everyday, which makes me really happy.  There really is nothing worse than dealing with people who are full of sh*t.  I have never been a fan of coffee, but am a strong tea connoisseur.  In fact this post was written while enjoying some green-tea at my favorite tea shop in Kirkland, WA Savrika.  My over-arching belief on these two morning beverages is that you should be able to eliminate them from your diet in a moment’s notice and not experience any side-effects such as caffeine withdrawal.

Coffee_backpack

Walking around with a coffee backpack.  Caffeine withdrawal imminent!

A fascinating Cochrane Review was published in Issue 8 of 2012 reviewed the literature on caffeine helping to improve the efficacy of analgesics (pain relievers).  I came across this review while I was reading American Family Physician.

QUICK SIDENOTE- Just because I am studying to become a Naturopathic Doctor does not mean that I don’t read MD literature.  In fact, I often find myself reading DO, DC, RD, MS, MD literature all the time.  Knowledge is just information, but applied knowledge is power.

The paper identified 19 different studies that were randomized, double-blind trials that looked at acute pain and the use of analgesics plus caffeine or just analgesics alone.  The most common dose of caffeine used was 100 to 130 mg of caffeine (a substantial dose) and either paracetamol or ibuprofen.  The studies were looking at pain from headache, post-partum, dysmenorrhea, and post-operative dental pain.  From the review “About 5% to 10% more participants achieve a good level of pain relief (at least 50% of the maximum) with the addition of caffeine, giving a NNT of about 15.”

WHAT DOES NNT mean?

Number needed to treat.  This is the number you would need to treat for 1 person to derive benefit.

Effects of Caffeine on the body

  • Increased Heart Rate
  • Increased Blood Pressure
  • Increased Wakefulness
  • Increased Alertness
  • Psycho-active stimulant.
  • Increased Endurance

How many more people did caffeine+ NSAID help vs. NSAID alone for Headache?

caff NSAIDS

THE NNT is 14

The results for dysmenorrhea were a little less stellar but still favored caffeine plus NSAID instead of NSAID alone.  134 patients out of 310 had greater than 50% reduction in pain vs. 121 patients out of 310 in a study by Ali et. Al.  Interesting, but nothing to jump out of your seat about.

The authors also separated the dose of caffeine used, with slightly higher doses being more beneficial than doses lower than 65mg.  

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