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Latest & greatest articles for chronic pain
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on chronic pain or other clinical topics then use Trip today.
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A 32-Year-Old Woman With Chronic Abdominal Pain. Functional dyspepsia is a highly prevalent disorder that accounts for 5% of visits to primary care clinicians. It frequently coexists with other gastrointestinal tract disorders, including irritable bowel syndrome and gastroesophageal reflux disease. Symptoms of functional dyspepsia, including epigastric pain, early satiety, and postprandial nausea, are nonspecific, making its diagnosis difficult. Functional dyspepsia is a heterogeneous disorder
Comparison of analgesic effects and patient tolerability of nabilone and dihydrocodeine for chronic neuropathic pain: randomised, crossover, double blind study. 18182416 2008 01 25 2008 02 11 2014 11 20 1756-1833 336 7637 2008 Jan 26 BMJ (Clinical research ed.) BMJ Comparison of analgesic effects and patient tolerability of nabilone and dihydrocodeine for chronic neuropathic pain: randomised, crossover, double blind study. 199-201 10.1136/bmj.39429.619653.80 To compare the analgesic efficacy (...) and side effects of the synthetic cannabinoid nabilone with those of the weak opioid dihydrocodeine for chronic neuropathic pain. Randomised, double blind, crossover trial of 14 weeks' duration comparing dihydrocodeine and nabilone. Outpatient units of three hospitals in the United Kingdom. 96 patients with chronic neuropathic pain, aged 23-84 years. The primary outcome was difference between nabilone and dihydrocodeine in pain, as measured by the mean visual analogue score computed over the last 2
Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. 18713809 2008 08 20 2008 08 25 2016 10 19 1756-1833 337 2008 Aug 19 BMJ (Clinical research ed.) BMJ Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. a884 10.1136/bmj.a884 337/aug19_2/a884 To determine the effectiveness of lessons in the Alexander technique, massage therapy, and advice from (...) a doctor to take exercise (exercise prescription) along with nurse delivered behavioural counselling for patients with chronic or recurrent back pain. Factorial randomised trial. 64 general practices in England. 579 patients with chronic or recurrent low back pain; 144 were randomised to normal care, 147 to massage, 144 to six Alexander technique lessons, and 144 to 24 Alexander technique lessons; half of each of these groups were randomised to exercise prescription. Normal care (control), six sessions
Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain: economic evaluation. 19074232 2008 12 16 2009 01 21 2016 11 22 1756-1833 337 2008 Dec 11 BMJ (Clinical research ed.) BMJ Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain: economic evaluation. a2656 10.1136/bmj.a2656 337/dec11_2/a2656 An economic evaluation of therapeutic massage, exercise, and (...) lessons in the Alexander technique for treating persistent back pain. Cost consequences study and cost effectiveness analysis at 12 month follow-up of a factorial randomised controlled trial. 579 patients with chronic or recurrent low back pain recruited from primary care. Normal care (control), massage, and six or 24 lessons in the Alexander technique. Half of each group were randomised to a prescription for exercise from a doctor plus behavioural counselling from a nurse. Costs to the NHS
Alfuzosin and symptoms of chronic prostatitis-chronic pelvic pain syndrome. 19092152 2008 12 18 2009 01 07 2016 11 22 1533-4406 359 25 2008 Dec 18 The New England journal of medicine N. Engl. J. Med. Alfuzosin and symptoms of chronic prostatitis-chronic pelvic pain syndrome. 2663-73 10.1056/NEJMoa0803240 In men with chronic prostatitis-chronic pelvic pain syndrome, treatment with alpha-adrenergic receptor blockers early in the course of the disorder has been reported to be effective in some (...) , but not all, relatively small randomized trials. We conducted a multicenter, randomized, double-blind, placebo-controlled trial to evaluate the efficacy of alfuzosin, an alpha-adrenergic receptor blocker, in reducing symptoms in men with chronic prostatitis-chronic pelvic pain syndrome. Participation in the study required diagnosis of the condition within the preceding 2 years and no previous treatment with an alpha-adrenergic receptor blocker. Men were randomly assigned to treatment for 12 weeks
Advice to use topical or oral ibuprofen for chronic knee pain in older people: randomised controlled trial and patient preference study. 18056743 2008 01 18 2008 03 03 2016 11 22 1756-1833 336 7636 2008 Jan 19 BMJ (Clinical research ed.) BMJ Advice to use topical or oral ibuprofen for chronic knee pain in older people: randomised controlled trial and patient preference study. 138-42 To determine whether older patients with chronic knee pain should be advised to use topical or oral non-steroidal (...) treatments because of adverse effects (16% v 1%, -16% to -5%). In the topical group more participants had chronicpain grade III or IV at three months, and more participants changed treatment because of ineffectiveness. Advice to use oral or topical preparations has an equivalent effect on knee pain over one year, and there are more minor side effects with oral NSAIDs. Topical NSAIDs may be a useful alternative to oral NSAIDs. ISRCTN 79353052. Underwood Martin M Centre for Health Sciences, Barts
Clinical effectiveness of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain: A cluster randomized trial. OBJECTIVE: Chronic knee pain is a major cause of disability and health care expenditure, but there are concerns about efficacy, cost, and side effects associated with usual primary care. Conservative rehabilitation may offer a safe, effective, affordable alternative. We compared the effectiveness of a rehabilitation program (...) integrating exercise, self-management, and active coping strategies (Enabling Self-management and Coping with Arthritic Knee Pain through Exercise [ESCAPE-knee pain]) with usual primary care in improving functioning in persons with chronic knee pain. METHODS: We conducted a single-blind, pragmatic, cluster randomized controlled trial. Participants age >/=50 years, reporting knee pain for >6 months, were recruited from 54 inner-city primary care practices. Primary care practices were randomized
Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: A randomized trial. Practice guidelines recommend various types of exercise and manipulative therapy for chronic back pain but there have been few head-to-head comparisons of these interventions. We conducted a randomized controlled trial to compare effects of general exercise, motor control exercise and manipulative therapy on function and perceived effect of intervention (...) in patients with chronic back pain. Two hundred and forty adults with non-specific low back pain 3months were allocated to groups that received 8weeks of general exercise, motor control exercise or spinal manipulative therapy. General exercise included strengthening, stretching and aerobic exercises. Motor control exercise involved retraining specific trunk muscles using ultrasound feedback. Spinal manipulative therapy included joint mobilization and manipulation. Primary outcomes were patient-specific
Economic evaluation of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain. OBJECTIVE: To conduct an economic evaluation of the Enabling Self-Management and Coping with Arthritic Knee Pain through Exercise (ESCAPE-knee pain) program. METHODS: Alongside a clinical trial, we estimated the costs of usual primary care and participation in ESCAPE-knee pain delivered to individuals (Indiv-rehab) or groups of 8 participants (Grp-rehab (...) (WTP) increased, reaching 50% probability at WTP 5,500 pounds. The lack of differences in QALYs across the arms led to lower probabilities of cost-effectiveness based on this outcome. CONCLUSION: Provision of ESCAPE-knee pain had small cost implications, but it was more likely to be cost-effective in improving function than usual primary care. Group rehabilitation reduces costs without compromising clinical effectiveness, increasing probability of cost-effectiveness.
WITHDRAWN: Injection therapy for subacute and chronic benign low-back pain. BACKGROUND: Injection with anaesthetics and/or steroids is one of the treatment modalities used in patients with chronic low back pain which needs evaluation with respect to the effectiveness on short and long term pain relief. OBJECTIVES: To evaluate the effectiveness of injection therapy in patients with low back pain lasting longer than one month. We distinguished between three injection sites: facet joint, epidural (...) or local injections. SEARCH STRATEGY: We searched the Medline and Embase databases up to 1996 and other search methods as advocated by the Back Review Group search strategy. Abstracts and unpublished studies were not included. SELECTION CRITERIA: Randomized controlled trials of injection therapy for pain relief (although additional treatments were allowed) in patients with benign low back pain lasting longer than one month and not originating from cancer. DATA COLLECTION AND ANALYSIS: Two authors
WITHDRAWN: Multidisciplinary bio-psycho-social rehabilitation for chronic low-back pain. BACKGROUND: Chronic low back pain is, in many countries, the main cause of long term disability in middle age. Patients with chronic low back pain are often referred for multidisciplinary treatment. Previous published systematic reviews on this topic included no randomised controlled trials and pooled together controlled and non-controlled studies. OBJECTIVES: To assess the effect of multidisciplinary bio (...) -psycho-social rehabilitation on pain, function, employment, quality of life and global assessment outcomes in subjects with chronic disabling low back pain. SEARCH STRATEGY: We searched MEDLINE, EMBASE, PsychLIT, CINAHL, Health STAR, and The Cochrane Library from the beginning of the database to June 1998 using the comprehensive search strategy recommended by the Back Review Group of the Cochrane Collaboration. INTERVENTION specific key words for this review were: patient care team, patient care
Prolotherapy injections for chronic low-back pain. BACKGROUND: Prolotherapy involves repeated injections of irritant solutions to strengthen lumbosacral ligaments and reduce some types of chronic low-back pain; spinal manipulation and exercises are often used to enhance its effectiveness. OBJECTIVES: To determine the efficacy of prolotherapy in adults with chronic low-back pain. SEARCH STRATEGY: We searched CENTRAL 2006, Issue 3 and MEDLINE, EMBASE, CINAHL, and AMED from their respective (...) varied from study to study, making meta-analysis impossible. MAIN RESULTS: We identified five high quality studies with a total of 366 participants. All measured pain or disability levels at six months, and four measured the proportion of participants reporting a greater than 50% reduction in pain or disability scores. Three randomized controlled trials (206 participants) found that prolotherapy injections alone are no more effective than control injection for chronic low-back pain and disability
Lamotrigine for acute and chronicpain. BACKGROUND: Anticonvulsant medicines have a place in the treatment of neuropathic pain (pain due to nerve damage). This review looks at the evidence for the pain relieving properties of lamotrigine. OBJECTIVES: To assess the analgesic efficacy and adverse effects of the anticonvulsant lamotrigine for acute and chronicpain. SEARCH STRATEGY: Randomised Controlled Trials (RCTs) of lamotrigine (and key brand names Lamictal, Lamictin, Neurium) in acute (...) , chronic or cancer pain were identified from MEDLINE (1966 to August 2006), EMBASE 1994 to August 2006 and the CENTRAL register on The Cochrane Library (Issue 3, 2006). Additional reports were sought from the reference list of the retrieved papers. SELECTION CRITERIA: RCTs investigating the use of lamotrigine (any dose and by any route) for treatment of acute or chronicpain. Assessment of pain intensity or pain relief, or both, using validated scales. Participants were adults aged 18 and over. Only
Chronicpain after mesh repair of inguinal hernia: a systematic review Chronicpain after mesh repair of inguinal hernia: a systematic review Chronicpain after mesh repair of inguinal hernia: a systematic review Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R CRD summary This review concluded that chronicpain following mesh-based inguinal hernia repair was experienced by 11% of patients, and it impacted on employment and leisure. Chronicpain was less frequent after (...) endoscopic repair and using light-weighted mesh. Poor reporting of the review methods and between-study differences mean that the reliability of the authors’ conclusions is uncertain. Authors' objectives To evaluate the nature, severity and consequences of chronicpain after mesh repair of inguinal hernia. Searching MEDLINE, CINAHL, EMBASE and the Cochrane CENTRAL Register were searched; the search terms were reported. Articles published between January 1996 and June 2006 were assessed for inclusion
Programmable intrathecal opioid delivery systems for chronic noncancer pain: a systematic review of effectiveness and complications Programmable intrathecal opioid delivery systems for chronic noncancer pain: a systematic review of effectiveness and complications Programmable intrathecal opioid delivery systems for chronic noncancer pain: a systematic review of effectiveness and complications Turner J A, Sears J M, Loeser J D CRD summary The authors concluded that in patients with a successful (...) systems (IDDS) in patients with chronic noncancer pain. Searching PubMed (including MEDLINE), Science Citation Index Expanded, the Cochrane CENTRAL Register, EMBASE: Drugs and Pharmacology, Global Health, Current Contents Connect and International Pharmaceutical Abstracts were searched from inception to October 2005 using the reported search terms. In addition, reference lists of screened studies, the authors’ personal files, journals, books and reviews were screened and Medtronic Inc. were contacted
Meta-analysis of psychological interventions for chronic low back pain Meta-analysis of psychological interventions for chronic low back pain Meta-analysis of psychological interventions for chronic low back pain Hoffman B M, Papas R K, Chatkoff D K, Kerns R D CRD summary This review concluded that psychological interventions have positive effects in patients with noncancerous chronic low back pain. The authors’ conclusions appear to be supported by the data, but without further details (...) of the quality of the individual studies the reliability of the findings is unclear. Authors' objectives To evaluate the efficacy of psychological interventions for adults with chronic noncancerous low back pain (CLBP). Searching MEDLINE, PsycINFO, EMBASE, the Cochrane CENTRAL Register and CINAHL were searched from inception to October 2004. Some details of the search strategy were reported, with full details available on request. In addition, reference lists were checked, unpublished studies were sought via
A review of outcome studies on cognitive-behavioral therapy for reducing fear-avoidance beliefs among individuals with chronicpain A review of outcome studies on cognitive-behavioral therapy for reducing fear-avoidance beliefs among individuals with chronicpain A review of outcome studies on cognitive-behavioral therapy for reducing fear-avoidance beliefs among individuals with chronicpain Lohnberg J A CRD summary The review assessed the efficacy of CBT for reducing fear-avoidance beliefs (...) in patients with chronicpain. The author concluded that graded exposure in vivo appeared to be the most effective treatment for chronicpain in individuals with increased fear and avoidance. Given the small sample sizes and lack of reporting of review process the results should be interpreted with caution. Authors' objectives To examine the background and development of the fear-avoidance model, consider its relationship with chronicpain and disability, look at the use of cognitive