Articles: pain.
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Anticonvulsant drugs have been used in the management of pain since the 1960s. The clinical impression is that they are useful for chronic neuropathic pain, especially when the pain is lancinating or burning. ⋯ There is evidence to show that gabapentin is effective in neuropathic pain. There is limited evidence to show that gabapentin is ineffective in acute pain.
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Review Meta Analysis
Efficacy and safety of opioid agonists in the treatment of neuropathic pain of nonmalignant origin: systematic review and meta-analysis of randomized controlled trials.
In the United States, an estimated 2 million persons have neuropathic pain that is often resistant to therapy. The use of opioids for neuropathic pain remains controversial, in part because studies have been small, have yielded equivocal results, and have not established the long-term risk-benefit ratio of this treatment. ⋯ Short-term studies provide only equivocal evidence regarding the efficacy of opioids in reducing the intensity of neuropathic pain. Intermediate-term studies demonstrate significant efficacy of opioids over placebo for neuropathic pain, which is likely to be clinically important. Reported adverse events of opioids are common but not life-threatening. Further RCTs are needed to establish their long-term efficacy, safety (including addiction potential), and effects on quality of life.
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Best Pract Res Clin Anaesthesiol · Jun 2005
Review Meta AnalysisLocal anaesthesia for pain relief after laparoscopic cholecystectomy--a systematic review.
Local anaesthetics (LA) are increasingly being used intraoperatively for the prevention of postoperative pain. The efficacy of local anaesthetic infiltration into incision sites has only been shown in patients undergoing inguinal herniorrhaphy. However, in one meta-analysis of the literature, intraperitoneal LA have been shown to be effective for pain relief following laparoscopic cholecystectomy (LC). ⋯ Although side effects are rare, the dose of LA should be monitored closely to avoid toxicity. Future studies should be directed towards determining whether the analgesic effects of LA are via peripheral mechanisms or systemic absorption. The explanation for the wide interindividual variation in pain following LC should also be better investigated.
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Review Meta Analysis
Deep brain stimulation for pain relief: a meta-analysis.
Deep brain stimulation (DBS) has been used to treat intractable pain for over 50 years. Variations in targets and surgical technique complicate the interpretation of many studies. To better understand its efficacy, we performed a meta-analysis of DBS for pain relief. ⋯ We conclude that DBS is frequently effective when used in well-selected patients. Neuroimaging and neuromodulation technology advances complicate the application of these results to modern practice. Ongoing investigations should shed further light on this complex clinical conundrum.
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In cancer pain therapy treatment with strong opioids is essential. However, it may be accompanied by the occurrence of various adverse effects. The most frequent and persistent side effect in the course of opioid treatment is constipation. ⋯ Present research indicates that there is a relation between type of opioid and degree of constipation, i.e. treatment with transdermal fentanyl or methadone tends to cause less constipation compared to morphine or hydromorphone. The route of administration of morphine--oral vs. subcutaneous--does not seem to affect the incidence of opioid-induced constipation. Furthermore, prophylaxis and efficient control of opioid-induced constipation still fail to be part of the routine in pain treatment.