Articles: pain.
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Review Meta Analysis
How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis.
This review aimed to quantify the benefit of patient-based educational interventions in the management of cancer pain. We undertook a systematic review and meta-analysis of experimentally randomised and non-randomised controlled clinical trials identified from six databases from inception to November 2007. Two reviewers independently selected trials comparing intervention (formal instruction on cancer pain and analgesia on an individual basis using any medium) to usual care or other control in adults with cancer pain. ⋯ Compared to usual care or control, educational interventions improved knowledge and attitudes by half a point on 0-5 rating scale (weighted mean difference 0.52, 95% confidence interval 0.04-1.0), reduced average pain intensity by over one point on 0-10 rating scale (WMD -1.1, -1.8 to -0.41) and reduced worst pain intensity by just under one point (WMD -0.78, -1.21 to -0.35). We found equivocal evidence for the effect of education on self-efficacy, but no significant benefit on medication adherence or on reducing interference with daily activities. Patient-based educational interventions can result in modest but significant benefits in the management of cancer pain, and are probably underused alongside more traditional analgesic approaches.
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ANZ journal of surgery · Jun 2009
Review Meta AnalysisNeedlescopic versus laparoscopic cholecystectomy: a meta-analysis.
To systematically analyse clinical trials on needlescopic (NC) versus laparoscopic cholecystectomy (LC) that evaluated the effectiveness of both procedures for the management of cholelithiasis. ⋯ NC is a safe and effective procedure for the management of gallstone disease. NC is as effective as LC for perioperative complications and total stay in hospital. NC is superior to LC for less post-operative pain and better cosmetic results. NC is associated with longer operative time and higher conversion rate.
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Review Meta Analysis
The diagnostic accuracy of brief screening questions for psychosocial risk factors of poor outcome from an episode of pain: A systematic review.
To determine the diagnostic accuracy of brief screening questions for psychosocial risk factors predictive of poor outcome from an episode of pain. ⋯ Data were only available on the accuracy of brief screening instruments for depression and anxiety, and there was variability in the results. Head-to-head studies are required to determine if this variability reflects differential question accuracy or population characteristics, and studies that determine the diagnostic accuracy of brief screening questions for other common psychosocial risk factors would be useful.
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Gen Hosp Psychiatry · May 2009
Review Meta AnalysisPharmacotherapy of chronic pain: a synthesis of recommendations from systematic reviews.
Chronic pain is one of the most prevalent, costly and disabling conditions in both clinical practice and the workplace, yet often remains inadequately treated. Moreover, chronic pain commonly co-occurs with depression, anxiety and somatoform disorders, and adversely affects response of these conditions to psychiatric treatments. This article provides an evidence-based approach to the pharmacotherapy of chronic pain. ⋯ A number of medications have proven effective in chronic pain disorders and their use individually or in combination should improve the management of chronic pain.
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Cochrane Db Syst Rev · Apr 2009
Review Meta AnalysisIntravenous or intramuscular parecoxib for acute postoperative pain in adults.
Parecoxib was the first COX-2 available for parenteral administration, and may, given intravenously or intramuscularly, offer advantages over oral medication when patients have nausea and vomiting or are unable to swallow, such as in the immediate postoperative period. ⋯ A single dose of parecoxib 20 mg or 40 mg provided effective analgesia for 50 to 60% of those treated compared to about 15% with placebo, and was well tolerated. Duration of analgesia was longer, and significantly fewer participants required rescue medication over 24 hours with the higher dose.