Perlas Cochrane

Fuente: Rafael Bravo en

Los antidepresivos son efectivos en el dolor neuropático

Pregunta Clínica: ¿Son los antidepresivos efectivos en el dolor neuropático?

Respuesta: Los antidepresivos triciclicos y la venlafaxina proporcionan alivio del dolor neuropático (NNT*= 3.6 y 3.1 respectivamente). Este efecto es independiente de cualquier efecto en la depresión. Hay evidencia limitada de la eficacia de los inhibidores de la recaptación de serotonina(IRS), podrían ser eficaces pero el numero de participantes fue insuficiente para calcular NNT sólidos.

*NNT= numero necesario a tratar para beneficiar a un individuo

Advertencia: El NNH* para los efectos adversos importantes, definidos como un evento que lleva a la retirada del ensayo, fue de 28 para la amitriptilina y 16,2 para la velanfaxina. El NNH para efectos adversos menores como somnolencia, mareos, boca seca y estreñimiento fue 6 para la amitriptilina y 9.6 para la venlafaxina.

*NNH = número necesario a tratap ra causar daño en un individuo.

Contexto: El dolor neuropático puede ser muy discapacitante, grave e intratable, causando angustia y sufrimiento en las personas, incluyendo disestesias y parestesias parestesias. Durante muchos años los antidepresivos se han utilizado para el tratamiento del dolor neuropático, y son a menudos el tratamiento de primera elección. No esta claro sin embargo, cual antidepresivo es mas efectivo, cual es el papel que pueden jugar los nuevos antidepresivos como los IRS o la velanfaxina en el tratamiento del dolor neuropático y que efectos adversos experimentan los pacientes.

Referencia: Saarto T and Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Reviews 2007, Issue 4. Esta revisión incluye 61 ensayos que involucraban 3,293 participantes

Versión española (previa) : Antidepresivos para el dolor neuropático (Revisión Cochrane traducida). En: La Biblioteca Cochrane Plus, 2007 Número 4. Oxford: Update Software Ltd. Disponible en: (Traducida de The Cochrane Library, 2007 Issue 4. Chichester, UK: John Wiley & Sons, Ltd.).

PERLA No. 29, Febrero 2008 Autor Brian R McAvoy, Trad. Rafael Bravo

Perlas Cochrane

Estimados colegasSe adjuntan en formato PDF las dos últimas perlas nºs 25 y 26. Asi mismo comunicaros que se pueden consultar en http://perlascochrane.wordpress.comPara cualquier problema no dudéis en contactar conmigo.

Un cordial saludo

Rafael Bravo Toledo
Centro de Salud Sector III
Getafe. Madrid
Telefono 916824343

Please find attached P.E.A.R.L.S (practical evidence about real life situations)  #    25  and #   26.
There is also a summary one available (which contains both pearls if you prefer that version titled “both pearls”).
Access to view the PEARLS online.

The actual Cochrane abstracts for the P.E.A.R.L.S are at
# 25     Aquatic exercise beneficial in knee and hip osteoarthritis

 # 26   Exercise improves balance in older people

We would be grateful if you could forward the URL for colleagues to sign up to our website by going to

For more information about the Field, or to view the previously published PEARLS please visit: <>

P.E.A.R.L.S: Practical Evidence About Real Life Situations, Otitis Media Aguda

P.E.A.R.L.S          Practical Evidence About Real Life Situations



Antibiotics or ‘watch and wait’ for acute otitis media


Clinical Question

How should I treat uncomplicated acute otitis media (AOM)?

Bottom line

Immediate antibiotic treatment reduces earache/fever or both at 3-7 days:

<2 years + bilateral AOM     NNT* = 4

<2 years + unilateral AOM   NNT = 20

≥ 2 years + bilateral AOM     NNT = 9

≥ 2 yrs + unilateral AOM    NNT = 15 Watch and wait may be appropriate for unilateral AOM except in children under 6 months of age. Most guidelines recommend routine antibiotics for children less than 6 months.


*NNT = number needed to treat to benefit one individual.


Adverse events reported included diarrhoea (4-21% of children in the treatment groups, 2-14% in the control groups), and rash (1-8% in the treatment groups and 2-6% in the control groups). No serious adverse events were reported.

Children with a temperature >37.5 C and vomiting are more likely to be distressed or have night disturbance after 3 days and would appear to benefit from antibiotics.1


AOM is very common in preschool children, uncommon in older children and very rare in adults.

Systematic Review

Rovers MM et al. Antibiotics for acute otitis media: a meta-analysis with individual patient data. Lancet 2006;368:1429-35. This review contains 6 studies involving 1643 patients.

PEARLS No. 21, November 2007, written by Brian R McAvoy                    

1. Little P, et al. Predictors of poor outcomes and benefits from antibiotics in children with acute otitis media: pragmatic randomised trial. BMJ 2002;325:22-25. This is a single study involving 315 patients.

P.E.A.R.L.S: un simple susurro es efectivo en el diagnostico de dificultad auditiva

A simple whisper test is effective for diagnosing hearing impairment

Clinical Question

How useful are simple screening tests for diagnosing hearing impairment?

Bottom Line

The whispered voice tests and the audio scope are very accurate for ruling out hearing impairment (i.e if patient can hear whisper, they are unlikely to be deaf)


Compared to the Weber and Rinne tuning fork tests the whispered voice test is the most accurate and may be better than the expensive audioscope, with pooled positive and negative likelihood ratios of 6.1 and 0.03 respectively.


There is no single standard method for the whispered voice test but modified Paul Glasziou suggests the following: stand behind the patient at arm’s length (hands on their shoulders), then cover one ear (by rubbing a piece of paper over the external meatus). Exhale fully and whisper letters and numbers with different types of sound. (e.g. b, 6, k, 2, m, 9). Ask the patient to repeat the letters/numbers after each sound. Allow 1-2 errors and repeat each sound once if necessary.


Bagai A, et al. Does this patient have hearing impairment ? JAMA 2006;295:416-28

Date (Author) #20

January 2007 (Bruce Arroll/Brian McAvoy)

P.E.A.R.L.S: Inhibidores de la bomba de protones, mas efectivos en la esofagitis

Proton pump inhibitors (PPPIs)  most effective treatment for oesophagitis


Clinical Question

What is the most effective treatment for reflux oesophagitis?

Bottom Line

Proton pump inhibitor (PPI) therapy is the most effective treatment for short-term (8wks) management of gastro- oesophageal reflux disease (GORD)  – NNT= 1 to 2 (for PPI vs placebo). PPI better than H2 receptor antagonist (H2RA)  but both superior to placebo. There is a paucity of evidence on prokinectic therapy but no evidence that it is superior to placebo.


GORD is a common problem with an estimated prevalence of 20% in adults. PPIs and H2RAs relieve symptoms by reducing acid secretion in the stomach.


In equivalent dosage different PPI preparations do not show statistically significant differences in their healing effects. Although there was an apparently higher disease persistence rate at the end of the treatment with double dose PPI compared to standard dose, this difference was not statistically significant.


Mostafizur Khan, Jose Santana, Clare Donnellan, Cathryn Preston, Paul Moayyedi. Medical treatments in the short term management of reflux oesophagitis. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD003244. DOI: 10.1002/14651858.CD003244.pub2. This review contains 134 trials with 35978 participants.

Cochrane Reviews 2007, Issue 1.

Date (Author)  #19

May 2007 (Brian R McAvoy)


NNT = numbers needed to treat to benefit one person

NNH = numbers needed to harm to benefit one person

Both NNT and NNH are only reported if the studies or pooling of studies is statistically significant

Disclaimer : The P.E.A.R.L.S. are for educational use only and are not meant to guide clinical activity nor are they a clinical guideline.