Postoperative pain management: Number-needed-to-treat approach versus procedure-specific pain management approach

摘要

To the Editor: We read with great interest the article by McQuay et al. that reported the use of number-needed-to-treat (NNT) league tables as a guide to measuring efficacy of various analgesic drugs. The authors present several benefits of using the league tables to guide analgesic choice. However, the authors did not discuss the limitations of using NNT as a guide to pain therapy in day-to-day clinical practice. We would like to point out some of the limitations of using NNT to guide pain therapy. The concept of NNT is dichotomous, as it sets a cutoff at 50% pain relief compared with placebo, which implies that gradual effects of analgesic cannot be considered. However, therapeutic objectives may vary based upon patient population and surgical procedures. Thus, although an analgesic providing 30% pain relief may be considered clinically relevant, it will be deemed to be ineffective based on NNT league tables. Furthermore, the clinical significance of a 50% reduction in pain scores may vary based upon the degree of pain at the time of measurement.