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Caffeine as an analgesic adiuvant has been discussed for many years. In a recent Cochrane review based on 19 studies with a total of 7238 patients, caffeine enhanced the efficacy of paracetamol, ibuprofen or aspirin with a number needed to treat (NNT) of about 16, comparable to the effect of doubling the dose of the primary analgesic, reported by other authors. Analgesia by caffeine is best explained by antagonism at adenosine receptors.
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