Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2003
ReviewTranscutaneous electrical nerve stimulation (TENS) for the treatment of rheumatoid arthritis in the hand.
Rheumatoid arthritis (RA) is a chronic, inflammatory, system disease. It commonly affects the small peripheral joints (such as fingers and wrist). The main goals of intervention for RA are preventing joint deformity, preserving joint function, and reducing inflammation and pain. Transelectrical nerve stimulation (TENS) is a form of electrotherapy and is thought to produce analgesia according to the gate control theory. ⋯ There are conflicting effects of TENS on pain outcomes in patients with RA. AL-TENS is beneficial for reducing pain intensity and improving muscle power scores over placebo while, conversely, C-TENS resulted in no clinical benefit on pain intensity compared with placebo. However C-TENS resulted in a clinical benefit on patient assessment of change in disease over AL-TENS. More well designed studies with a standardized protocol and adequate number of subjects are needed to fully conclude the effect of C-TENS and AL-TENS in the treatment of RA of the hand.
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Preterm birth is a major contributor to perinatal mortality and morbidity and affects approximately six to seven per cent of births in developed countries. Tocolytics are drugs used to suppress uterine contractions. The most widely tested tocolytics are betamimetics. Although they have been shown to delay delivery, betamimetics have not been shown to improve perinatal outcome, and they have a high frequency of unpleasant and even fatal maternal side effects. There is growing interest in calcium channel blockers as a potentially effective and well tolerated form of tocolysis. ⋯ When tocolysis is indicated for women in preterm labour, calcium channel blockers are preferable to other tocolytic agents compared, mainly betamimetics. Further research should address the effects of different dosage regimens and formulations of calcium channel blockers on maternal and neonatal outcomes.
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Ketamine is a commonly used anaesthetic agent, and in subanaesthetic doses is also given as an adjuvant to opioids for the treatment of cancer pain, particularly when opioids alone prove to be ineffective. Ketamine is known to have hallucinogenic side effects. To date no systematic review of the benefits and harms of adjuvant ketamine for cancer pain has been undertaken. ⋯ Current evidence is insufficient to assess the benefits and harms of ketamine as an adjuvant to opioids for the relief of cancer pain. More randomized controlled trials are needed.
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The use of muscle relaxants in the management of non-specific low back pain is controversial. It is not clear if they are effective, and concerns have been raised about the potential adverse effects involved. ⋯ Muscle relaxants are effective in the management of non-specific low back pain, but the adverse effects require that they be used with caution. Trials are needed that evaluate if muscle relaxants are more effective than analgesics or non-steroidal anti-inflammatory drugs.
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Cochrane Db Syst Rev · Jan 2003
ReviewCaudal epidural block versus other methods of postoperative pain relief for circumcision in boys.
Circumcision is a commonly performed surgical procedure in boys and caudal analgesia is frequently used to minimize discomfort of penile surgery postoperatively. For humanitarian and physiological reasons pain should be anticipated and effectively controlled while ensuring patient safety. Several non-caudal analgesic techniques can be used including: penile block, systemic opioids and topical local anaesthetic cream,emulsion or gel. ⋯ Few studies compare caudal analgesia with other commonly available methods of analgesia in boys having circumcision surgery. Although the need for rescue analgesia is reduced in the early postoperative period when caudal is compared with parenteral analgesia,evidence from trials may no longer reflect current practice and is limited by small numbers and poor methodology. There is a need for properly designed trials to study the relative efficacy of caudal epidural with other methods such as penile block, morphine, simple analgesics and topical local anaesthetic cream,emulsions or gel.