European journal of pain : EJP
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Review Meta Analysis Comparative Study
Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: a systematic review.
The optimal effective dose of epidural morphine that provides postoperative analgesia after caesarean section with minimal side effects remains debated. ⋯ A single bolus of epidural morphine provides better analgesia than parenteral opioids but with an effect limited to the first postoperative day after caesarean section and with an increase in morphine side effects.
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Review Meta Analysis
Psychosocial predictors and correlates for chronic post-surgical pain (CPSP) - a systematic review.
Chronic post-surgical pain (CPSP) is a serious problem. Incidence as high as 50% has been reported, depending on type of surgery undergone. Because the etiology of chronic pain is grounded in the bio-psychosocial model, physical, psychological, and social factors are implicated in the development of CPSP. ⋯ Other factors were determined to have either unlikely (grade of association=3) or inconclusive (grade of association=2) correlations. In addition, results were examined in light of the type of surgery undergone. This review is intended as a first step to develop an instrument for identifying patients at high risk for CPSP, to optimize clinical pain management.
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Review Meta Analysis
Medication adherence in patients with chronic non-malignant pain: is there a problem?
Health care providers, treating patients with chronic non-malignant pain, often experience that medication is not as effective as expected. It is important to realize that the effectiveness of a pharmacological treatment can be influenced by the way the medication is taken. Medication adherence is a topic that gains more attention, especially in chronic conditions, because it affects treatment outcome. ⋯ Both overuse and underuse of medication occurs. However, due to the scarce literature and important methodological limitations, it is not possible to make firm conclusions concerning the impact on outcome, influencing variables and optimal intervention strategies. This review highlights some important gaps in the adherence literature in a chronic non-malignant pain population and sets the stage for future research.
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Review Meta Analysis
Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials.
Pain from myofascial trigger points is often treated by needling, with or without injection, although evidence is inconclusive on whether this is effective. We aimed to review the current evidence on needling without injection, by conducting a systematic literature review. We searched electronic databases to identify relevant randomised controlled trials, and included studies where at least one group were treated by needling directly into the myofascial trigger points, and where the control was either no treatment, or usual care; indirect local dry needling or some form of placebo intervention. ⋯ In conclusion, there is limited evidence deriving from one study that deep needling directly into myofascial trigger points has an overall treatment effect when compared with standardised care. Whilst the result of the meta-analysis of needling compared with placebo controls does not attain statistically significant, the overall direction could be compatible with a treatment effect of dry needling on myofascial trigger point pain. However, the limited sample size and poor quality of these studies highlights and supports the need for large scale, good quality placebo controlled trials in this area.
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Review Meta Analysis
Summary measures of number needed to treat: how much clinical guidance do they provide in neuropathic pain?
Several systematic reviews of randomized controlled trials (RCTs) of drugs to treat neuropathic pain have reported summary estimates of efficacy - specifically, the number needed to treat (NNT). ⋯ Summary NNT estimates may have limited clinical relevance, due to problems of heterogeneity. The most that can be extracted from systematic reviews published to date is the identity of drugs that have demonstrated efficacy for specific types of neuropathic pain, and the strength of such evidence.