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Latest & greatest articles for 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 pain or other clinical topics then use Trip today.
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Deep Brain Stimulation for Pain in the Modern Era: A Systematic Review. Deep brain stimulation (DBS) has been considered for patients with intractable pain syndromes since the 1950s. Although there is substantial experience reported in the literature, the indications are contested, especially in the United States where it remains off-label. Historically, the sensory-discriminative pain pathways were targeted. More recently, modulation of the affective sphere of pain has emerged as a plausible (...) alternative.To systematically review the literature from studies that used contemporary DBS technology. Our aim is to summarize the current evidence of this therapy.A systematic search was conducted in the MEDLINE, EMBASE, and Cochrane libraries through July 2017 to review all studies using the current DBS technology primarily for pain treatment. Study characteristics including patient demographics, surgical technique, outcomes, and complications were collected.Twenty-two articles were included
Pain Outcomes Following Microvascular Decompression for Drug-Resistant Trigeminal Neuralgia: A Systematic Review and Meta-Analysis. Microvascular decompression (MVD) is a potentially curative surgery for drug-resistant trigeminal neuralgia (TN). Predictors of pain freedom after MVD are not fully understood.To describe rates and predictors for pain freedom following MVD.Using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, PubMed, Cochrane Library (...) , and Scopus were queried for primary studies examining pain outcomes after MVD for TN published between 1988 and March 2018. Potential biases were assessed for included studies. Pain freedom (ie, Barrow Neurological Institute score of 1) at last follow-up was the primary outcome measure. Variables associated with pain freedom on preliminary analysis underwent formal meta-analysis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for possible predictors.Outcome data were analyzed for 3897
Dexmedetomidine versus other sedatives for non-painful pediatric examinations: A systematic review and meta-analysis of randomized controlled trials. Procedural sedation for non-painful pediatric examinations outside the operating room remains a challenge, this study was designed to compare the safety and effectiveness of sedation provided by dexmedetomidine versus other sedatives including chloral hydrate, midazolam, and pentobarbital for pediatric patients to complete diagnostic (...) examinations.Systematic review and meta-analysis of RCTs.Pediatric procedural sedation.Comparison of sedation by dexmedetomidine and chloral hydrate, or pentobarbital, or midazolam for pediatric non-painful sedation.The PubMed, Embase, and Cochrane Library databases and the Cochrane Controlled Trials Register for randomized clinical trials were searched and limited the studies to those published in English through July 30, 2018.Prospective randomized clinical trials (RCTs) comparing dexmedetomidine to chloral hydrate
The Effects of Opioids on Cognition in Older Adults With Cancer and Chronic Noncancer Pain: A Systematic Review. Opioids are prescribed to manage moderate-to-severe pain and can be used with older adults; however, they may lead to several adverse effects, including cognitive impairment.To identify, appraise, and synthesize evidence on the impact of opioids on cognition in older adults with cancer/chronic noncancer pain, and screening tools/neuropsychological assessments used to detect opioid (...) -induced cognitive impairment.A systematic literature review following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (international prospective register of systematic reviews registration: CRD42018092943). MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Web of Science were searched up to December 2018. Randomized controlled trials, quasi-experimental studies, and observational studies of adults aged 65 years and older with cancer/chronic noncancer pain taking
Cannabinoids versus placebo or no intervention for pain: protocol for a systematic review with meta-analysis and trial sequential analysis. Pain is a frequent clinical symptom with significant impact on the patient's well-being. Therefore, adequate pain management is of utmost importance. While cannabinoids have become a more popular alternative to traditional types of pain medication among patients, the quality of evidence supporting the use of cannabinoids has been questioned. The beneficial (...) and harmful effects of cannabinoids in patients with pain is unknown. Accordingly, we aim to assess the efﬁcacy, tolerability and safety of cannabinoids (herbal, plant-derived extracts and synthetic) compared with placebo or no intervention for any type of pain.We will conduct a systematic review of randomised clinical trials with meta-analysis and Trial Sequential Analysis to assess the beneficial and harmful effects of cannabinoids in any dose, formulation and duration. We will accept placebo
Prognostic factors for pain and functional disability in children and adolescents with persisting pain: A systematic review and meta-analysis. The aim of this study was to investigate prognostic factors for pain and functional disability in children and/or adolescents with persisting pain.To be included, studies had to be published, peer-reviewed prospective cohort studies of children and/or adolescents with persisting pain at baseline, that reported at least one baseline prognostic factor (...) and its relationship with pain or functional disability at least 1 month after baseline. Two reviewers independently assessed study eligibility, completed data extraction and undertook quality assessment. Meta-analyses were performed when a prognostic factor was reported in two or more studies.Of 10,992 studies identified from electronic database searches, 18 were included, investigating 62 potential prognostic factors. In clinical settings, insufficient data were available for meta-analysis. Some
Opioids for chronic osteoarthritis pain: An updated systematic review and meta-analysis of efficacy, tolerability and safety in randomized placebo-controlled studies of at least 4 weeks double-blind duration. This updated systematic review evaluated the efficacy and safety of opioids compared with placebo for chronic osteoarthritis pain.Clinicaltrials.gov, CENTRAL, MEDLINE and PsycINFO were searched from October 2013 to July 2019. Randomized controlled trials comparing opioids with placebo (...) and at least 4 weeks double-blinded duration were analysed. Primary outcomes were pain relief of 50% or greater, disability, tolerability and safety. Effects were summarized by a random effects model using risk differences or standardized mean differences with 95% confidence intervals. We added two new studies with 397 participants for a total of 22 studies with 8,942 participants. Study duration ranged between 4 and 24 weeks. Studies with a parallel and cross-over design: Based on very low- to low-quality
Incidence and Associated Factors of Chronic Pain After Caesarean Section: A Systematic Review. The number of Caesarean section (CS) procedures has increased dramatically both in developed and developing countries in recent decades. CS has been associated with chronic pain. A vicious impediment on quality of life may occur among women who experience chronic post-CS pain (CPCSP). Therefore, this systematic review aimed to synthesize the available evidence on the incidence of chronic pain after (...) Caesarean delivery and the possible risk factors for the development of chronic pain. The PubMed, Embase, and Google Scholar databases were searched for articles published in English between 2004 and January 2017 using appropriate terms. Studies that examined the incidence of chronic pain after CS as their primary outcome measure, and follow-up period of more than 2 months was selected. Both authors searched and reviewed the studies for eligibility and extracted the data in predefined forms. We also
Treatment based classification systems for patients with non-specific neck pain. A systematic review. We aimed to identify published classification systems with a targeted treatment approach (treatment-based classification systems (TBCSs)) for patients with non-specific neck pain, and assess their quality and effectiveness.Systematic review.MEDLINE, CINAHL, EMBASE, PEDro and the grey literature were systematically searched from inception to December 2019.The main selection criterium was a TBCS (...) for patients with non-specific neck pain with physiotherapeutic interventions. For data extraction of descriptive data and quality assessment we used the framework developed by Buchbinder et al. We considered as score of ≤3 as low quality, a score between 3 and 5 as moderate quality and a score ≥5 as good quality. To assess the risk of bias of studies concerning the effectiveness of TBCSs (only randomized clinical trials (RCTs) were included) we used the PEDro scale. We considered a score of ≥ six points
On "Level of Evidence for Reliability, Validity, and Responsiveness of Physical Capacity Tasks Designed to Assess Functioning in Patients With Low Back Pain: A Systematic Review Using the COSMIN Standards." Jakobsson M, Gutke A, Mokkink LB, Smeets R, Lund 32201875 2020 03 23 1538-6724 2020 Mar 23 Physical therapy Phys Ther On "Level of Evidence for Reliability, Validity, and Responsiveness of Physical Capacity Tasks Designed to Assess Functioning in Patients With Low Back Pain: A Systematic
Central Nervous System Reorganization and Pain After Spinal Cord Injury: Possible Targets for Physical Therapy-A Systematic Review of Neuroimaging Studies. Pain is one of the main symptoms associated with spinal cord injury and may be associated with changes to the central nervous system.This article provides an overview of the evidence relating to central nervous system changes (CNS) (structural and functional) associated with pain in spinal cord injuries (SCI).Data sources. A systematic (...) review was performed, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, on PubMed, EMBASE, and Web of Science in March 2018.Studies were selected if study changes in CNS of patients with SCI regardless of the type of imagery.Data were extracted by two blinded reviewers.There is moderate evidence for impaired electroencephalographic function and metabolic abnormalities in the anterior cingulate in patients experiencing pain. There is preliminary
Regular dosing compared with as-needed dosing of opioids for management of chronic cancer pain: systematic review and meta-analysis. Opioids are the recommended form of analgesia for patients with persistent cancer pain, and regular dosing "by the clock" is advocated in many international guidelines on cancer pain management. The development of sustained-release opioid preparations has made regular dosing easier for patients. However, patients report that the intensity and impact (...) of their cancer pain varies considerably day to day, and many try to find a trade-off between acceptable pain control and impact of cognitive (and other) adverse effects on daily activities. In acute care settings, (eg, postoperative) as-needed dosing and other opioid-sparing approaches have resulted in better patient outcomes compared with regular dosing. The aim of this study was to determine whether regular dosing of opioids was superior to as-needed dosing for persistent cancer pain. We systematically
What is usual care for low back pain? A systematic review of health care provided to patients with low back pain in family practice and emergency departments. International clinical practice guidelines for low back pain (LBP) contain consistent recommendations including universal provision of information and advice to remain active, discouraging routine referral for imaging, and limited prescription of opioids. This systematic review describes usual care provided by first-contact physicians
The use of quantitative sensory testing in cancer pain assessment: A systematic review. To summarize the literature on the use of quantitative sensory testing (QST) in the assessment of pain in people with cancer and to describe which QST parameters consistently demonstrate abnormal sensory processing in patients with cancer pain.Medline, EMBASE, AMED, CINAHL, SCOPUS and CENTRAL were searched for observational or experimental studies using QST in patients with a cancer diagnosis and reporting (...) pain. Search strategies were based on the terms "quantitative sensory testing", "cancer", "pain", "cancer pain" and "assessment". Databases were searched from inception to January 2019. Data were extracted and synthesized narratively, structured around the different QST modalities and sub-grouped by cancer pain aetiology (tumour- or treatment-related pain).Searches identified 286 records of which 18 met the eligibility criteria for inclusion. Three studies included patients with tumour-related pain
Topical Nonsteroidal Anti-inflammatory Drugs for Pain Resulting from Intravitreal Injections: A Meta-Analysis. The role of topical nonsteroidal anti-inflammatory drugs (NSAIDs) for the reduction of ocular pain after intravitreal injections (IVIs) has been explored. To provide clarity on the evidence for these agents, the present meta-analysis of randomized controlled trials (RCTs) was undertaken.No standard of care regimen exists for the management of pain resulting from IVIs.A systematic (...) literature search was conducted on Ovid MEDLINE, EMBASE, and Cochrane Central from inception through July 2019. The RCTs that treated patients with a topical NSAID and assessed postprocedural pain were included. Risk of bias was assessed using the Cochrane guidelines. For all analyses, weighted mean differences (WMDs) with 95% confidence intervals (CIs) were reported. Random effects models were used for all analyses. The primary analysis analyzed pain on a 0- to 10-point visual analog scale. Literature
The addition of blood flow restriction to resistance exercise in individuals with knee pain: a systematic review and meta-analysis. Blood flow restriction (BFR) is an effective clinical intervention used to increase strength in healthy individuals. However, its effects on pain and function in individuals with knee pain are unknown.To determine the effectiveness of adding BFR to resistance exercise for pain relief and improvement of function improvement in patients with knee pain.DESIGN (...) : Systematic review with meta-analysis of randomized clinical trials.Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases were searched from inception to May 2019.Randomized clinical trials that compared resistance exercise with or without BFR to treat knee pain and function in individuals older than 18 years of age with knee pain.Eight randomized clinical trials met the eligibility criteria and for the quantitative synthesis, five studies were included. The pooled
Early or First Aid Administration Versus Late or In-hospital Administration of Aspirin for Non-traumatic Adult Chest Pain: A Systematic Review. Chest pain is a common symptom of acute coronary syndrome, including myocardial infarction (MI). Treatment with antiplatelet agents, such as aspirin, improves survival, although the ideal dose is uncertain. It is unknown if outcomes can be improved by giving aspirin early in the course of MI as part of the first-aid management as opposed to late (...) or in-hospital administration. We searched the Medline, Embase, and Cochrane databases and used Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for determining the certainty of evidence. We included studies in adults with non-traumatic chest pain, where aspirin was administered early (within two hours) following the onset of chest pain as part of first-aid management as compared with late or in-hospital
Psychosocial areas of worklife and chronic low back pain: a systematic review and meta-analysis. The aim of this review was to synthesize the evidence on the potential relationship between psychosocial work factors from the Areas of Worklife (AW) model (workload, job control, social support, reward, fairness, and values) and chronic low back pain (CLBP; unspecific pain in the lumbar region lasting 3 months or longer).We conducted a systematic literature search of studies in Medline, PsycINFO (...) when developing programs to prevent chronic low back pain. Future studies should apply measures of CLBP that are more precise, and investigate the full areas of work life (AW) factors in combination.
A multicenter real-world review of 10Â kHz SCS outcomes for treatment of chronic trunk and/or limb pain. High-frequency spinal cord stimulation (HF-SCS) at 10 kHz has proven to be efficacious in the treatment of chronic back and leg pain in a randomized, controlled, trial (SENZA-RCT). However, large observational studies have yet to be published. Therefore, we performed a real-world, multicenter, retrospective, review of therapy efficacy in 1660 patients with chronic trunk and/or limb pain.Data (...) were collected in a real-world environment and retrospectively sourced from a global database. Included patients were trialed and/or permanently implanted with HF-SCS at 10 kHz between April 2014 and January 2018. We evaluated responder rates at 3, 6, and 12 months post-implantation. Response was defined as ≥50% pain relief from baseline. A last visit analysis included responder rate along with overall change in function, sleep, quality of life, and medication intake versus baseline.Eighty-four
Noninvasive brain stimulation does not improve neuropathic pain in individuals with spinal cord injury: evidence from a meta-analysis of 11 randomized controlled trials. To examine the effectiveness of noninvasive brain stimulation (NIBS) on neuropathic pain (NP) in individuals with spinal cord injury (SCI).A meta-analysis on pain intensity, depression and anxiety levels was conducted to evaluate the effect of NIBS on NP in individuals with SCI. The authors searched Cochrane Central Register (...) of Controlled Trials (CENTRAL), MEDLINE (Pubmed), Embase (OvidSP), PsycINFO (OvidSP), Physiotherapy Evidence Database (PEDro). Randomized controlled trials comparing NIBS with sham stimulation were included.Eleven studies were selected. The pooled analysis demonstrated no significant effect of repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) or cranial electrotherapy stimulation (CES) on neuropathic pain reduction after SCI. Additionally, NIBS showed