Metamizole in the Management of Musculoskeletal Disorders: Current Concept Review
Abstract
:1. Introduction
2. Methodology
3. Pharmacology of Metamizole
4. Clinical Evidence
4.1. Fibromyalgia
4.2. Arthralgia
4.3. Management of Acute and Chronic Pain
4.4. Sciatic Pain
4.5. Colicky Pain
4.6. Postoperative Pain
4.7. Pyrexia
4.8. Cancer Pain
4.9. Experimental Pain
5. Efficacy of Metamizole
6. Safety Profile of Metamizole
7. Comparative Investigations
8. Challenges and Future Directions
9. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Study (Ref.) | Study Type | Design | Study Population | Outcome | Limitation |
---|---|---|---|---|---|
Analgesic medication in fibromyalgia patients: a cross-sectional study [43] | Cross-sectional study | Patients were questioned on their current medication, dose, effect, indication, and treatment regimen | Patients were recruited from the Department of Neurology, University Hospital Würzburg, Germany, between 2014 and 2019 156 patients; 144 women and 12 men were included | A higher frequency of patients used NSAIDs and metamizole with a greater proportion of people discontinuing NSAIDs due to a lack of effect of the drug | Recall bias, Uneven drug distribution, Non-compliance, Overlapping medications, Placebo-related uncertainties |
Pharmacologic management of pain in patients with Chikungunya: a guideline [44] | Review article | - | - | Were stated to be good analgesics when administered in appropriate doses at regular intervals | - |
Clinical management of a pregnant patient with type I osteogenesis imperfecta using quantitative ultrasonometry—a case report [45] | Case report | - | As a result of pre-term labour and pregnancy-related hyperlordosis, the patient was immobilised for 3 weeks at 21 weeks of gestation, which caused an increase in pain of the lumbar spine and arthralgia of the hip joints and hospitalization at 31 weeks and 2 days of gestation | In addition to physiotherapy, metamizole helped alleviate the pain | - |
Dipyrone is the preferred nonopioid analgesic for the treatment of acute and chronic pain. A survey of clinical practice in German-speaking countries [46] | Questionnaire-based study | A link to a questionnaire was sent to anaesthesiologists and pain physicians via mail | A total of 2237 responses were analysed, 94.7% used non-opioid analgesics in which 93.8% administered metamizole, 54% administered NSAIDs, 41.8% administered COX-2 inhibitors and, 49.2% administered paracetamol | Metamizole was concluded to be the preferred analgesic in peri-operative and chronic pain settings | Absence of specific patient numbers, Lack of information on severe side effects |
Use of tramadol or other analgesics in patients treated in the emergency department as a risk factor for opioid use [47] | Cohort study | 3 groups Mean dosage +/− SD (mg) Tramadol (60.0 +/− 29.7) NSAIDs Diclofenac Sodium (75.9 +/− 10.1) Acetaminophen (2689+/− 2339) Metamizole (1599 +/− 1100) | Patients arriving at the emergency department Total 12,783 Tramadol n = 1454 NSAIDs n = 5309 Dipyrone n = 6020 | Efficacy of metamizole and NSAIDs similar Those taking tramadol at risk of receiving morphine >/= 10 mg in following 12 months | Lack of access to medical records to verify indications for analgesics, Possibility of residual confounders, Possibility of drug being bought outside healthcare, Use of other psychoactive substances |
Efficacy and tolerance of metamizole versus morphine for acute pancreatitis pain [48] | Pilot, randomised, active controlled, open clinical trial | 2 groups Morphine (Oglos) 1% 10 mg/kg 4 h s.c Metamizole (Nolotil) 2 g/8 h i.v slow perfusion for 3 min | Patients between the ages of 18 and 75 of both sexes with acute pancreatitis getting admitted within 12 h of onset of symptoms | Efficacy of metamizole was more than morphine with patients attaining greater pain relief | - |
Parenteral dipyrone versus diclofenac and placebo in patients with acute lumbago or sciatic pain: randomized observer-blind multicentre study [49] | Multicentre, observer-blind randomised trial | Administered drugs for 1–2 days Metamizole 2.5 g Diclofenac 75 mg Placebo | 260 patients enrolled into the study Divided into 3 groups Metamizole Diclofenac Placebo | Significant pain reduction in those taking metamizole. % of patients stating drug to be satisfactory of very good Metamizole (59%) Diclofenac (30%) Placebo (18%) | None mentioned |
Metamizole relieves pain by influencing cytokine levels in dorsal root ganglia in a rat model of neuropathic pain [32] | Experimental study | Chronic constriction injury of sciatic nerve deliberately induced metamizole (Met, 500 g/kg; SANOFI, Germany) dissolved in water and administered intraperitoneally pre-emptively 16 and 1 h before CCI and then twice for 7 days | Male Wistar rats (270–300 g) Divided into 2 groups 1 group receiving metamizole and the other group water | Diminished development of neuropathic pain symptoms with inhibiting expression of pronociceptive interleukins and chemokines | None mentioned |
Comparison of the onset and duration of the analgesic effect of dipyrone, 1 or 2 g, by the intramuscular or intravenous route, in acute renal colic [50] | Double-dummy randomised controlled clinical trial | Patients between the ages of 18–70 years diagnosed with renal colic between December 1988 and March 1991 Divided into 6 groups and administered drugs via i.m or i.v route Group 1—metamizole 1 g i.m Group 2—metamizole 1 g i.v Group 3—metamizole 2 g i.m Group 4—metamizole 2 g i.v Group 5—diclofenac sodium 75 mg i.m Group 6—diclofenac sodium 75 mg i.v | Total 293 patients Group 1 n = 71 Group 2 n = 30 Group 3 n = 67 Group 4 n = 71 Group 5 n = 32 Group 6 n= 22 | Analgesic effects in those taking metamizole 2 g i.v was highest when compared to other groups | - |
Comparison of cizolirtine citrate and metamizole sodium in the treatment of adult acute renal colic: A randomized, double-blind, clinical pilot study [51] | A randomised, double-blind, clinical pilot study | conducted in the emergency department of 6 Czech Republic hospitals between October 2000 and February 2001 Patients of both sexes between the ages of 18–65 were divided into 2 groups and administered single i.v dose of either 350 mg of cizolirtine citrate or 2500 mg of metamizole | Total n = 63 Cizolirtine citrate n = 31 Metamizole n = 32 | Proportion of patients stating satisfactory and complete pain relief at the 30-min mark was higher in those taking metamizole | Lack of internal sensitivity measurement, sensitivity to treatment differences is not ensured |
Comparison of intravenous dexketoprofen and dipyrone in acute renal colic [52] | Multicentre double-blind randomised control parallel group trial | Patients were recruited from 18 centres in Spain, Finland, and Sweden from June 1998 to September 1999 of both sexes between the ages 18 and 70 years were divided into 3 groups and were administered dexketoprofen trometamol 25 and 50 mg as solutions of 1 and 2 mL and metamizole 2 g in the form of 5 mL ampules | Total n = 333 Dexketoprofen Trometamol 25 mg n = 112 Dexketoprofen Trometamol 50 mg n = 113 Metamizole n = 108 | Efficacy of 2 drugs were equal with faster effects of analgesia occurring in those taking dexketoprofen trometamol | - |
Efficacy of intravenous paracetamol, metamizole and lornoxicam on postoperative pain and morphine consumption after lumbar disc surgery [53] | Prospective, placebo-controlled randomised double-blind study | 80 patients scheduled for elective lumbar disc surgery under general anaesthesia were divided into 4 groups and were administered supplemental i.v injections of 1 mg metamizole or 1 mg paracetamol or 8 mg lornoxicam or 0.9% isotonic saline | Total n = 80 Metamizole n = 18 Paracetamol n = 20 Lornoxicam n = 20 Control. n = 19 | ANOVA scores revealed pain scores of metamizole to be much lower than lornoxicam | Pain was assessed only at rest, Patients were discharged 1 day after the surgery, Categorical evaluation of side effects caused by metamizole had not used |
Analgesic effectiveness of dipyrone (metamizole) for postoperative pain after herniorrhaphy: a randomized, double-blind, dose-response study [62] | Double-blind, randomised trial | 162 patients undergoing elective inguinal, umbilical or epigastric herniorrhaphy were divided into 2 groups and were administered metamizole of either 15 mg/kg or 40 mg/kg dose | Total n = 162 D15 n = 82 D40 n = 80 | Higher dose led to movement induced constipation and fewer opioid related side effects | Short period of observation |
A randomized double-blind placebo-controlled study of dipyrone and aspirin in post-operative orthopaedic patients [54] | Randomised double-blind placebo-controlled study | Patients with sustained long bone fracture underwent surgical manipulation and closed reduction of fracture under general anaesthesia were divided into 3 groups and received either 500 mg metamizole, 500 mg aspirin or placebo | Total n = 254 Metamizole n = 91 Male n = 74 Female n = 17; Aspirin n = 93 Male n = 65 Female n = 26 2 patients lacked sex record; Placebo = 70 Male n = 54 Female n = 16 | Pain relief was faster in onset and greater in those taking metamizole | - |
Postoperative analgesia at home after ambulatory hand surgery: a controlled comparison of tramadol, metamizole, and paracetamol [55] | Prospective, randomised, double-blinded study | 120 patients who had undergone hand surgery were allocated in equal sizes to 3 groups receiving Paracetamol 1 g every 6 h Metamizole 1 g every 6 h Tramadol 100 mg every 6 h | Total n =120 Paracetamol n = 40 Metamizole n = 40 Tramadol n = 40 | Adequate efficacy was seen on those taking metamizole | - |
Treatment of postoperative pain after total hip arthroplasty: comparison between metamizole and paracetamol as adjunctive to opioid analgesics—prospective, double-blind, randomised study [56] | Prospective, double-blind randomised study | 110 patients were divided into 2 groups receiving either metamizole i.v 1.5 g every 8 h or paracetamol 1 g every 8 h during the first 24 h | Total n = 94 Metamizole n = 51 Paracetamol n = 43 | Mean values of pain AUC were lower for metamizole | Measuring pain using the VAS scale due to it be influenced by various psychological and other factors |
Efficacy of intravenous paracetamol compared to dipyrone and parecoxib for postoperative pain management after minor-to-intermediate surgery: a randomised, double-blind trial [57] | Randomised, double-blind trial | 222 patients were recruited and were assigned to 4 groups and received either i.v paracetamol 1 g every 6 h, metamizole 1 g every 6 h, parecoxib 40 mg every 12 h or placebo (0.9% saline) | Total n = 196 Paracetamol n = 49 Metamizole n = 49 Parecoxib n = 49 Placebo n = 49 | Lesser proportion of patients asked and demanded for rescue medication with a longer duration between the administration of metamizole and the rescue medication | - |
Metamizole vs. ibuprofen at home after day case surgery: A double-blind randomised controlled noninferiority trial [58] | Investigator-initiated, double-blind, randomised controlled, non-inferiority trial | 200 patients undergoing elective arthroscopic shoulder, haemorrhoid, or knee surgery or inguinal hernia repair were randomised to receive either a combination of metamizole and paracetamol 1 g orally, thrice daily or ibuprofen and paracetamol 600 mg orally thrice daily for 4 days | Total n = 200 Metamizole and paracetamol n = 100 Ibuprofen and paracetamol n = 100 | Similar efficacy of both drugs. On postoperative day 2, patients taking ibuprofen required rescue medication. Metamizole acts as a valuable replacement for NSAIDs in the event of a contraindication | Lack of firm conclusions about medical safety, Intake of tramadol by patients at home was significantly higher than control group, Rigorous exclusion criteria leading to a decrease in sample size |
Metamizole in pain and fever [59] | Open non-comparative study | 100 children in Ganga Ram Hospital, Lahore, aged between 3 months to 12 years with an oral temperature of 38.5 degree were included | Children were administered metamizole 10–15 mg/kg 6 to 8 hourly for 3 days | For those in pain, 57% showed a good response and 43% showed a satisfactory response. For those with fever, 66.7% showed a good response and 25.8% showed a satisfactory response. | - |
Oral metamizole (1 g and 2 g) versus ibuprofen and placebo in the treatment of lower third molar surgery pain: randomised double-blind multi-centre study. Cooperative Study Group [63] | Double-blind, double-dummy, randomised, controlled clinical trial | Between January 1994 and January 1995, patients between the ages of 18 and 60 of both sexes who had undergone extraction of the lower third molar were assigned to 4 groups and were provided with either a single oral dose of 1 g or 2 g metamizole in a new galenic form, Ibuprofen 600 mg or placebo | Total n = 253 Metamizole 1 g n = 75 Metamizole 2 g n = 72 Ibuprofen 600 mg n = 74 Placebo n = 32 | Quicker and more effective analgesia was achieved with those taking metamizole 2 g. No significant differences were found between those taking metamizole 1 g and 2 g. | - |
Is dipyrone effective as a pre-emptive analgesic in third molar surgery? A pilot study [64] | Pilot prospective double-blind placebo-controlled study | 36 patients in need of oral and maxillofacial surgery were selected and were divided into study and control groups | Study group was administered metamizole preoperatively and the control group was administered metamizole in the immediate postoperative period | Improved efficacy was seen when the drug was administered pre-emptively | - |
Efficacy and tolerance of oral dipyrone versus oral morphine for cancer pain [60] | Double-blind, randomised, and parallel clinical trial | Between January 1991 and May 1992, patients of both sexes above the age of 18 years were included in a 7-day trial. Patients were assigned to 3 groups and were administered either metamizole 1 g (Nolotil, half an ampule) every 8 h, morphine 10 mg orally every 4 h or metamizole 2 g (Nolotil, an ampule) every 8 h | Total n = 121 Group 1 n = 41 Group 2 n = 42 Group 3 n = 38 | Comparable pain relief in those taking metamizole 2 g and morphine 10 mg with an increased number of side effects seen in those taking morphine. Faster onset of pain relief seen in those taking morphine | - |
Tilidine and dipyrone (metamizole) in cold pressor pain: A pooled analysis of efficacy, tolerability, and safety in healthy volunteers [61] | Randomised, double-blind, parallel group. Pre-test-post-test design. | 264 healthy volunteers from 3 separate substudies Substudies 1 and 2 tilidine/naloxone combination was given (Tilidin comp. STADA 50 mg/4 mg per 0.72 mL, STADA Arzneimittel AG) Substudy 3 was given metamizole solution (Novaminsulfon-ratiopharm 500 mg/mL, Ratiopharm) | Substudies 1 and 2 Low dose opioid group n = 60 High dose opioid group n = 59 Pooled control group n = 58 Substudy 3 Metamizole group n = 40 Control group n = 41 | %AUPC was in the following order from ascending to descending
High-dose opioid group | - |
Comparison of the analgesic efficacy of metamizole and tramadol in experimental pain [65] | Randomised double-blind study | Constant painful stimuli were applied by controlled electric stimulation of tooth pulp. Analgesia was monitored by verbal pain rating | 10 healthy volunteers | Higher pain relief was attained in those taking tramadol. However, no side effects were reported with the intake of metamizole | - |
Study (Ref.) | Drug Evaluation Criteria: Conditions under Assessment | Efficacy |
---|---|---|
Analgesic medication in fibromyalgia patients: A cross-sectional study [43] | Assessing the efficacy of metamizole in managing pain in those with fibromyalgia syndrome | In accordance to the NRS scale pain, reduction in those taking metamizole was 2.0 (0–8) |
Clinical management of a pregnant patient with type I osteogenesis imperfecta using quantitative ultrasonometry—a case report [45] | Managing a pregnant patient with osteogenesis type 1 | Values had not been mentioned; however, in addition to physiotherapy, metamizole was the only drug that helped alleviate pain |
Use of tramadol or other analgesics in patients treated in the emergency department as a risk factor for opioid use [47] | Assessing the risk of opioid usage within 12 months of initial administration of metamizole | Those taking metamizole received analgesics only on day 1 when compared to other groups who had receive additional doses in the following day |
Efficacy and tolerance of metamizole versus morphine for acute pancreatitis pain [48] | Assessing the efficacy of metamizole in the management of acute pancreatitis pain | 75% of patients taking metamizole achieved pain relief within the first 24 h. The mean time to achieve pain relief was 10 +/− 6.6. 75% of patients taking metamizole achieved pain relief |
Parenteral dipyrone versus diclofenac and placebo in patients with acute lumbago or sciatic pain: randomized observer-blind multicentre study [49] | Assessing the analgesic effect of metamizole in lumbago or sciatic pain | A greater number of patients taking metamizole achieved significant pain relief at the end of 1 and 6 h. 59% of those taking metamizole stated the efficacy of the drug to be “very good” or “excellent” |
Comparison of the onset and duration of the analgesic effect of dipyrone, 1 or 2 g, by the intramuscular or intravenous route, in acute renal colic [50] | Assessing the onset and duration of analgesia by metamizole in treating cancer pain | The pain scores at the 1 and 6 h mark were greatest in those taking dipyrone 2 g i.m |
Comparison of cizolirtine citrate and metamizole sodium in the treatment of adult acute renal colic: A randomized, double-blind, clinical pilot study [51] | Assessing efficacy of the drug in treating adult acute renal colic | From a baseline VAS pain score of 82.59 at the 30-min mark, values were reduced to 25.41, which marks a decrease in pain scores by 69.1% |
Comparison of intravenous dexketoprofen and dipyrone in acute renal colic [52] | Assessing the efficacy of metamizole in treating renal colic | Those taking metamizole showed a total sum of pain relief of 14.2+/− and pain intensity difference on the VAS scale as 58.6 +/− 22.7. 87% of patients attained pain relief scores below 50% |
Efficacy of intravenous paracetamol, metamizole and lornoxicam on postoperative pain and morphine consumption after lumbar disc surgery [53] | Assessing postoperative pain and the degree of morphine consumption after lumbar disc surgery | During the first 24 h of the study period, pain was reduced in patients taking metamizole (p = 0.001) and paracetamol (p = 0.20) but not in those taking lornoxicam (p = 0.20) Pain scores in the metamizole group were significantly lower in metamizole when compared to lornoxicam (p = 0.031) |
Analgesic effectiveness of dipyrone (metamizole) for postoperative pain after herniorrhaphy: a randomized, double-blind, dose-response study [62] | Assessing the analgesic efficacy of metamizole in treating postoperative pain after herniorrhaphy | The study showed a dose dependent efficacy with a lower incidence of moderate and severe pain in those taking 40 mg of metamizole and a lower cumulative effect of morphine consumption post-surgery |
A randomized double-blind placebo-controlled study of dipyrone and aspirin in post-operative orthopaedic patients [54] | Assessing the analgesic effect of metamizole in postoperative orthopaedic patients | Onset of action was quick and higher values of relief from pain were achieved |
Postoperative analgesia at home after ambulatory hand surgery: a controlled comparison of tramadol, metamizole, and paracetamol [55] | Assessing the efficacy of the drug in relieving postoperative analgesia after an ambulatory hand surgery | 81% of patients taking metamizole on day 1 and 82% of patients taking the drug on day 2 stated adequate pain relief, with 59 of patients stating drug satisfaction |
Treatment of postoperative pain after total hip arthroplasty: comparison between metamizole and paracetamol as adjunctive to opioid analgesics—prospective, double-blind, randomised study [56] | Assessing postoperative pain after hip arthroplasty | VAS pain values showed a statistically significant difference, which favoured metamizole at the 6 h mark (p = 0.038), 8 h mark (p = 0.036), 14 h mark (p = 0.011), and 22 h mark (p = 0.025) Mean cumulative pain values for metamizole and paracetamol were 17.9 and 30.6, respectively |
Efficacy of intravenous paracetamol compared to dipyrone and parecoxib for postoperative pain management after minor-to-intermediate surgery: a randomised, double-blind trial [56] | Assessing the efficacy of the drug in the management of pain after minor-to-intermediate surgeries | Patients with pain scores more than 40 on VAS scale were taken in the study. Surgical pain postoperatively in the 1 h was highest in those taking placebo (33.8{19.2}) and lowest in those taking metamizole (25,7{15.3)}. Associated pain was once again highest in those taking placebo (25.4{16.6}) and lowest in those taking metamizole (9.0{11.7}) |
Metamizole in pain and fever [59] | Assessing the efficacy, safety, and tolerability in the management of pain and fever in children | 66.7% patients showed a good response, 25.8% showed a satisfactory response, and 7.5% showed an unsatisfactory response |
Oral metamizole (1 g and 2 g) versus ibuprofen and placebo in the treatment of lower third molar surgery pain: randomised double-blind multi-centre study. Cooperative Study Group [63] | Assessing the efficacy of metamizole in the treatment of surgery pain of the lower third molar | 36.1% of those taking metamizole 2 g had a decrease of 50% of basal VAS scores within the first 15 min and 88.7% of patients within the 1 h mark. A sum pain intensity difference of 38.1(17.0) was achieved by those taking the drug |
Is dipyrone effective as a pre-emptive analgesic in third molar surgery? A pilot study [64] | Assessing the effectiveness of metamizole as a pre-emptive analgesic in third molar surgery | The efficacy of metamizole was better in those taking the drug pre-emptively rather than in the immediate postoperative period |
Efficacy and tolerance of oral dipyrone versus oral morphine for cancer pain [60] | Assessing the efficacy and tolerance of cancer pain | The mean percentage decrease in pain was highest in those taking 1 g of metamizole (64.4 +/− 37.9%) and lowest in those taking 10 mg of morphine (49.6 +/− 38.8%). There were no significant differences in pain intensity between the groups and percentage of pain improvement was significantly higher in those taking 10 mg of morphine and 2 g of metamizole at days 3 and 5 |
Tilidine and dipyrone (metamizole) in cold pressor pain: A pooled analysis of efficacy, tolerability, and safety in healthy volunteers [61] | Assessing the effect of metamizole in cold pressor pain | The area under pain curve % was highest in low-dose opioid and lowest in high-dose opioid with metamizole coming in between. Pain tolerance (in seconds) was highest in those taking high-dose opioids and lowest in those taking low-dose opioids with metamizole being intermediate once again |
Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice [66] | Assessing cancer pain relief | Even in lower doses, metamizole decreased pain intensity significantly when compared to morphine. Higher doses were even more potent and were equally effective as 60 mg of morphine. |
Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice [66] | Assessing acute postoperative pain relief after septoplasty | At 24 h postoperatively, VAS pain scores of metamizole were lowest at 18.1 +/− 11.9 |
Study Title | Efficacy | Onset of Action | Duration | Side Effects |
---|---|---|---|---|
Treatment of postoperative pain after total hip arthroplasty: comparison between metamizol and paracetamol as adjunctive to opioid analgesics-prospective, double-blind, randomized study [56] | Metamizole demonstrated a significant reduction in pain AUC values (17.9) compared to paracetamol (30.6). It is cost-effective, being 10 times cheaper than i.v. paracetamol. Safety profile favours paracetamol. | Effective analgesia during the first 24 h | Not specified | Paracetamol has a better safety profile than Metamizole |
Efficacy of intravenous paracetamol, metamizol and lornoxicam on postoperative pain and morphine consumption after lumbar disc surgery [53] | Metamizole showed significant pain reduction post-lumbar disc surgery compared to lornoxicam. Morphine consumption was higher in the metamizole group. Agranulocytosis risk is a concern for metamizole. | Onset is quicker in the metamizole group | Lower VAS pain scores at the end seen in those taking metamizole | Paracetamol is safer and preferred for supplemental analgesia after lumbar disc surgery |
Tilidine and dipyrone (metamizole) in cold pressor pain: A pooled analysis of efficacy, tolerability, and safety in healthy volunteers [61] | Higher doses of tilidine showed slightly greater pain reduction than metamizole. Tilidine, however, caused side effects like dizziness, nausea, and vomiting. | Not specified | Not specified | Metamizole had lower side effects compared to tilidine |
Efficacy of intravenous paracetamol compared to dipyrone and parecoxib for postoperative pain management after minor-to-intermediate surgery: a randomized, double-blind trial [56] | Metamizole demonstrated a greater decrease in VAS pain scores postoperatively. Patients required fewer rescue medications, but efficacy equalised with placebo after 1 week. Parecoxib group under review for safety concerns. | Quicker pain relief in metamizole group | At the end lower pain scores in metamizole | Metamizole has a longer duration of action and fewer rescue medication requests compared to paracetamol and parecoxib |
Efficacy and tolerance of oral dipyrone versus oral morphine for cancer pain [60] | 2 g metamizole efficacy comparable to morphine, with fewer side effects. | Metamizole 2 g showed quicker onset | Not mentioned; however, at day 7, pain scores were least for metamizole. | Incidence of side effects lesser in metamizole group |
Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice [66] | The number needed to treat for achieving a 50% reduction in pain after minor surgeries was 2.1 for metamizole 500 mg, showcasing its superior efficacy compared to other drugs | Not mentioned | Not mentioned | Most number of side effects reported in those taking morphine |
Comparison of cizolirtine citrate and metamizol sodium in the treatment of adult acute renal colic: a randomized, double-blind, clinical pilot study [51] | No statistical difference in pain reduction between cizolirtine citrate and metamizole, but non-inferiority of cizolirtine citrate not established. Cizolirtine citrate is associated with more adverse effects. | Early onset in metamizole group | Not statistically different. Comparable | Metamizole has comparable efficacy with fewer adverse effects |
Postoperative analgesia at home after ambulatory hand surgery: a controlled comparison of tramadol, metamizol, and paracetamol [55] | Metamizole is rated as “adequate” in treating pain by more patients than tramadol and paracetamol. Tramadol caused more adverse effects, including nausea and tiredness. | Onset faster in tramadol followed by metamizole followed by paracetamol | Action of pain relief longest and VAS scores least in metamizole users | Metamizole demonstrated higher efficacy with fewer adverse effects compared to tramadol and paracetamol |
Comparison of the analgesic efficacy of metamizole and tramadol in experimental pain [65] | Tramadol had a longer duration of pain relief, but with adverse effects such as dry mouth, nausea with vomiting, and sleepiness. | Faster onset of action in tramadol | Longer duration of action exhibited by tramadol | Metamizole had a shorter duration of action but fewer adverse effects compared to tramadol |
Comparison of intravenous dexketoprofen and dipyrone in acute renal colic [52] | Dexketoprofen showed greater and faster analgesic effects compared to 2 g metamizole. Adverse effects were similar in renal and gastrointestinal systems for both drugs. | Faster onset of action by dexketoprofen | Time taken for patients to ask additional analgesics highest in metamizole | Similar adverse effects in both groups |
Efficacy of lornoxicam for acute postoperative pain relief after septoplasty: a comparison with diclofenac, ketoprofen, and dipyrone [88] | Diclofenac and ketoprofen showed greater pain reduction compared to lornoxicam and metamizole, except at specific time points. Fewer patients needed additional opioids with diclofenac and ketoprofen. | Earlier onset shown by Lornoxicam followed by metamizole followed by diclofenac measured at 2 h postoperatively | Not mentioned. However, at 24 h, VAS scores were lowest in metamizole. | Metamizole is less effective compared to diclofenac and ketoprofen in reducing pain |
Metamizole vs. ibuprofen at home after day case surgery: A double-blind randomized controlled noninferiority trial [58] | Metamizole and paracetamol showed a greater reduction in PACU compared to ibuprofen and paracetamol. Metamizole and paracetamol had a lower I.V. piritramide consumption. Different side effects observed in both groups. | Early onset in ibuprofen | Longer duration in ibuprofen. However, a need for rescue medication is less in metamizole. | Metamizole and paracetamol combination demonstrated higher efficacy with different side effects compared to ibuprofen and paracetamol |
Analgesic Medication in Fibromyalgia Patients: A Cross-Sectional Study [43] | Reduction in pain severity was achieved better in those taking metamizole and NSAIDs | Higher number of patients took NSAIDs as an on-demand drug | Not mentioned | Greater number of patients withdrew NSAIDs due to no effect of the drug. However, side effects appeared greater in those taking metamizole. |
Dipyrone is the preferred nonopioid analgesic for the treatment of acute and chronic pain. A survey of clinical practice in German-speaking countries [46] | Not mentioned | Not mentioned | Not mentioned | Change in blood values, symptoms of influenza, infection needing treatment, and treatment in the intensive care unit was observed in those taking metamizole. Fatal outcomes were reported by 11 physicians. |
Use of tramadol or other analgesics in patients treated in the emergency department as a risk factor for opioid use [47] | Efficacy was similar in those taking NSAIDs and metamizole | Metamizole has a faster onset of action | Metamizole had a longer duration of action | Those taking tramadol were at risk of receiving opioids within 12 months leading to adverse effects caused by opioids |
Efficacy and tolerance of metamizole versus morphine for acute pancreatitis pain [48] | Efficacy of metamizole is greater than morphine | Metamizole showed a non-significant quicker onset of analgesia | Not mentioned | Similar in both groups. 3 cases of vomiting and 1 case of somnolence in the morphine group and 1 case of vomiting in the metamizole group. |
Parenteral dipyrone versus diclofenac and placebo in patients with acute lumbago or sciatic pain: randomized observer-blind multicenter study [49] | Greater reduction in pain scores in those taking metamizole | Faster onset in those taking metamizole | Not mentioned | Comparatively more adverse effects were seen in those taking metamizole. |
Comparison of the onset and duration of the analgesic effect of dipyrone, 1 or 2 g, by the intramuscular or intravenous route, in acute renal colic [50] | Marked increase in efficacy were seen in those taking metamizole 2 g either by i.m or i.v | Faster onset seen in those taking metamizole 2 g i.v | Not mentioned | There were no significant differences in the appearance of adverse effects. Drowsiness was seen in those taking metamizole and dry mouth and hypotension was seen in those taking diclofenac sodium. |
A randomized double-blind placebo-controlled study of dipyrone and aspirin in post-operative orthopaedic patients [54] | Relief scores were greatest in those taking metamizole | Onset was faster in those taking metamizole | Not mentioned | Greater number of side effects was seen in those taking aspirin in the form of burning in the abdomen, abdominal discomfort, nausea and vomiting, and itching |
Oral metamizole (1 g and 2 g) versus ibuprofen and placebo in the treatment of lower third molar surgery pain: randomised double-blind multi-centre study. Cooperative Study Group [63] | Greater relief was seen in those taking metamizole 2 g | Onset of action was quicker in those taking metamizole | Not mentioned | Slight decrease from baseline blood pressure levels were seen in all groups. Moderate sleepiness occurred in those taking metamizole. Syncope associated with dizziness occurred in those taking ibuprofen and local bleeding occurred in those taking placebo. |
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Jeyaraman, N.; Migliorini, F.; Murugan, S.; Ramasubramanian, S.; Balaji, S.; Maffulli, N.; Jeyaraman, M. Metamizole in the Management of Musculoskeletal Disorders: Current Concept Review. J. Clin. Med. 2024, 13, 4794. https://doi.org/10.3390/jcm13164794
Jeyaraman N, Migliorini F, Murugan S, Ramasubramanian S, Balaji S, Maffulli N, Jeyaraman M. Metamizole in the Management of Musculoskeletal Disorders: Current Concept Review. Journal of Clinical Medicine. 2024; 13(16):4794. https://doi.org/10.3390/jcm13164794
Chicago/Turabian StyleJeyaraman, Naveen, Filippo Migliorini, Shrideavi Murugan, Swaminathan Ramasubramanian, Sangeetha Balaji, Nicola Maffulli, and Madhan Jeyaraman. 2024. "Metamizole in the Management of Musculoskeletal Disorders: Current Concept Review" Journal of Clinical Medicine 13, no. 16: 4794. https://doi.org/10.3390/jcm13164794