Articles: pain.
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Review Meta Analysis
Randomized controlled trials of psychological therapies for management of chronic pain in children and adolescents: an updated meta-analytic review.
The purpose of this meta-analytic review was to quantify the effects of psychological therapies for the management of chronic pain in youth. Specifically, in this review we updated previous systematic reviews of randomized controlled trials by including new trials, and by adding disability and emotional functioning to pain as treatment outcomes. Electronic searches of the Cochrane Register of Randomised Controlled Trials, MEDLINE, PsycLIT, EMBASE, and the Social Sciences Citation Index were conducted from inception through August 2008. ⋯ Studies directly comparing the effects of self-administered versus therapist-administered interventions found similar effects on pain reduction. Psychological therapies result in improvement in pain relief across several different pain conditions in children. Future trials are needed that incorporate non-pain outcome domains, that focus significant therapeutic content on reductions in disability, and that include extended follow-up to better understand maintenance of treatment effects.
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J Pain Symptom Manage · Feb 2010
Review Meta AnalysisA systematic review of oxymorphone in the management of chronic pain.
Opioids are recommended for control of moderate-to-severe, chronic, malignant, and nonmalignant pain. A controlled-release formulation of the opioid oxymorphone has recently been launched. The aim of this review was to assess the effectiveness of oxymorphone as an analgesic in chronic pain. ⋯ No significant differences between oxymorphone and oxycodone at equipotent doses were found. In conclusion, oxymorphone is superior to placebo. There is no evidence that the efficacy of oxymorphone differs from other opioids.
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Paediatric anaesthesia · Feb 2010
Review Meta AnalysisEfficacy of postoperative epidural analgesia in adolescent scoliosis surgery: a meta-analysis.
Scoliosis surgery is one of the most painful operations performed. Postoperative pain management has been historically based on the use of intravenous opioids. Many of the adolescents who undergo these procedures are at increased risk for opioid-related side effects because of underlying medical problems. Epidural analgesia has been demonstrated to provide superior pain control with fewer side effects for chest and abdominal surgery in children as well as adults. We aim to analyze the available literature for sufficient evidence to allow recommendations regarding the use of epidural analgesia with parenteral opioids vs. intravenous opioids only. ⋯ Epidural analgesia is beneficial to patients in terms of improving pain control and reducing side effects. The influence on respiratory depression, length of stay in the intensive care unit, or mortality is not available in the literature at this time.
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Population mean changes from clinical trials are difficult to apply to individuals in clinical practice. Responder analysis may be better, but needs validating for level of response and treatment duration. ⋯ Responder rates and NNTs are reproducible for different levels of response over 12 weeks and have relevance for clinical practice at the individual patient level. An average 10 mm improvement in pain equates to almost one in two patients having substantial benefit.
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisInterventions to improve adherence to exercise for chronic musculoskeletal pain in adults.
Chronic musculoskeletal pain (CMP) is a major health problem, accounting for approximately one-quarter of general practice (GP) consultations in the United Kingdom (UK). Exercise and physical activity is beneficial for the most common types of CMP, such as back and knee pain. However, poor adherence to exercise and physical activity may limit long-term effectiveness. ⋯ Interventions such as supervised or individualised exercise therapy and self-management techniques may enhance exercise adherence. However, high-quality, randomised trials with long-term follow up that explicitly address adherence to exercises and physical activity are needed. A standard validated measure of exercise adherence should be used consistently in future studies.