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.

This page lists the very latest high quality evidence on pain and also the most popular articles. Popularity measured by the number of times the articles have been clicked on by fellow users in the last twelve months.

What is Trip?

Trip is a clinical search engine designed to allow users to quickly and easily find and use high-quality research evidence to support their practice and/or care.

Trip has been online since 1997 and in that time has developed into the internet’s premier source of evidence-based content. Our motto is ‘Find evidence fast’ and this is something we aim to deliver for every single search.

As well as research evidence we also allow clinicians to search across other content types including images, videos, patient information leaflets, educational courses and news.

For further information on Trip click on any of the questions/sections on the left-hand side of this page. But if you still have questions please contact us via jon.brassey@tripdatabase.com

Top results for pain

3361. Preoperative morphine pre-empts postoperative pain. (Abstract)

Preoperative morphine pre-empts postoperative pain. Postoperative analgesia is usually inadequate, perhaps because conventional approaches to pain relief do not take account of underlying mechanisms. Pre-emptive analgesia may prevent nociceptive inputs generated during surgery from sensitising central neurons and, therefore, may reduce postoperative pain. In a randomised, double-blind study, we compared the effect of parenteral morphine when given before or after total abdominal hysterectomy (...) in 60 patients. 10 mg of morphine were given intramuscularly 1 hour before operation (im pre), intravenously at induction of anaesthesia (iv pre), or intravenously at closure of the peritoneum (iv post). Response was assessed by morphine consumption from patient-controlled analgesia machines which was found to be significantly reduced in the iv pre group for 24 hours after operation compared with the iv post group. Pain sensitivity around the wound was reduced in both preoperative treatment groups

1993 Lancet Controlled trial quality: uncertain

3362. Subcutaneous sterile water injections for chronic neck and shoulder pain following whiplash injuries. (Abstract)

Subcutaneous sterile water injections for chronic neck and shoulder pain following whiplash injuries. In many cases of whiplash injury symptoms persist and do not respond to treatment. There is uncontrolled evidence to suggest that intracutaneous injections of sterile water might help. Since that route may be unacceptable to patients the subcutaneous route is used in the randomised trial reported here. 40 patients with whiplash syndrome, mean age 46 years (24-73) were given subcutaneous (...) injections of 0.3-0.5 ml sterile water or saline over tender and trigger points in the neck and shoulder. A maximum of three treatments were given during the first two months of the study and the patients were followed up for 8 months. The accidents had occurred 4-6 years previously. X-ray examinations revealed no traumatic spinal lesions. Neck mobility and pain levels were evaluated by a physiotherapist immediately before and after the first treatment and after 1, 3, and 8 months. After 3 months

1993 Lancet Controlled trial quality: uncertain

3363. Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy. (Abstract)

Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy. Laparoscopy is frequently associated with postoperative shoulder pain that may last several days. We have assessed the analgesic effect of intraperitoneal local anaesthetics during day-case diagnostic laparoscopy. 80 young women were randomly assigned to one of four groups of 20 patients each: group 1, no peritoneal administration; group 2, 80 ml saline injected under direct vision in the right subdiaphragmatic area (...) at the start of the procedure; group 3, 80 ml 0.5% lignocaine with adrenaline (320,000 dilution); group 4, 0.125% bupivacaine with adrenaline (800,000 dilution). Scapular pain was assessed with a visual analogue pain scale, and information about nausea, vomiting, abdominal pain, and analgesic requirements during the first 48 h was sought. Both local anaesthetics were more effective in reducing postoperative shoulder pain than either control or saline. Analgesic requirements were greater in the non

1992 Lancet Controlled trial quality: uncertain

3364. Multicentre study of gestrinone in cyclical breast pain. (Abstract)

Multicentre study of gestrinone in cyclical breast pain. Although the aetiology of cyclical mastalgia is poorly understood, the consistent finding of an increased prolactin stimulation response probably due to oestrogen dominance has led to the use of treatment with prolactin-lowering drugs and antioestrogens. The efficacy and safety in cyclical mastalgia of gestrinone, which has androgenic, anti-oestrogenic, and antiprogestagenic properties, were investigated in a multicentre study (...) . In a double-blind randomisation procedure, 72 patients were allocated placebo and 73 treatment with gestrinone (2.5 mg twice a week) for 3 months. The patients recorded the severity of breast pain on a visual analogue scale before and during treatment and scored other breast symptoms as not present (0), mild (1), moderate (2), or severe (3). The gestrinone group had significantly greater reductions than the placebo group in breast pain score at months 1, 2, and 3 of treatment (mean reduction 59.5 [SD 22.6

1992 Lancet Controlled trial quality: uncertain

3365. Safety of early pain relief for acute abdominal pain. Full Text available with Trip Pro

Safety of early pain relief for acute abdominal pain. (a) to determine the efficacy of papaveretum in treating pain when administered early to patients presenting with acute abdominal pain and (b) to assess its effect on subsequent diagnosis and management.Prospective, randomised, placebo controlled study.Walsgrave Hospital, Coventry.100 consecutive patients with clinically significant abdominal pain who were admitted as emergencies to a surgical firm.Intramuscular injection of up to 20 mg (...) papaveretum or an equivalent volume of saline.Pain and tenderness scores, assessment of patient comfort, accuracy of diagnosis, and management decisions.Median pain and tenderness scores were lower after papaveretum (pain score 8.3 in control group and 3.1 in treatment group, p < 0.0001; tenderness score 8.1 in control group and 5.1 in treatment group, p < 0.0001). Forty eight patients were deemed to be comfortable after papaveretum compared with nine after saline. Incorrect diagnoses and management

1992 BMJ Controlled trial quality: uncertain

3366. Warming lignocaine to reduce pain associated with injection. Full Text available with Trip Pro

Warming lignocaine to reduce pain associated with injection. To investigate the effect of warming lignocaine on the pain associated with subcutaneous injection.Double blind, randomised, crossover study.Hospital clinic.40 healthy volunteers.Subcutaneous injection with 1 ml of 1% lignocaine at 20 degrees C and 1 ml of 1% lignocaine at 37 degrees C.Pain assessed by linear analogue pain scores and subjects' comparison of pain on injection.25 subjects (89%; 95% confidence interval 72% to 98 (...) %) thought that lignocaine at 20 degrees C was more painful and 3 (11%; 2% to 28%) thought that lignocaine at 37 degrees C was more painful (p < 0.0001); 12 subjects did not express a difference. Median pain score for injection at 20 degrees C was 11.00 and at 37 degrees C was 3.25 (p < 0.001). Median difference was 8.25 (4.00 to 13.50).The simple procedure of warming to 37 degrees C reduced the pain associated with subcutaneous injection of lignocaine.

1992 BMJ Controlled trial quality: predicted high

3367. Morphine responsiveness of chronic pain: double-blind randomised crossover study with patient-controlled analgesia. (Abstract)

Morphine responsiveness of chronic pain: double-blind randomised crossover study with patient-controlled analgesia. There is controversy about whether the lack of response of some chronic pain to opioid treatment is absolute or relative. It is widely believed that nociceptive pain is responsive to opioids whereas neuropathic pain tends not to be. We have used a method of patient-controlled analgesia (PCA) with simultaneous nurse-observer measurement of analgesia, mood, and adverse effects (...) to address these issues. Ten patients with chronic pain were given morphine at two concentrations (10 and 30 mg/ml) by PCA in two separate sessions in a double-blind randomised crossover study. Before the study a clinical judgment was made as to whether each pain was nociceptive or neuropathic. Seven patients showed good analgesic responses (more than 70 mm pain relief on a visual-analogue scale) of pain at rest, two patients poor responses (less than 30 mm pain relief), and one a moderate response

1992 Lancet Controlled trial quality: uncertain

3368. Effects of desipramine, amitriptyline, and fluoxetine on pain in diabetic neuropathy. (Abstract)

Effects of desipramine, amitriptyline, and fluoxetine on pain in diabetic neuropathy. Amitriptyline reduces the pain caused by peripheral-nerve disease, but treatment is often limited by side effects related to the drug's many pharmacologic actions. Selective agents might be safer and more effective.We carried out two randomized, double-blind, crossover studies in patients with painful diabetic neuropathy, comparing amitriptyline with the relatively selective blocker of norepinephrine reuptake (...) desipramine in 38 patients, and comparing the selective blocker of serotonin reuptake fluoxetine with placebo in 46 patients. Fifty-seven patients were randomly assigned to a study as well as to the order of treatment, permitting comparison among all three drugs and placebo as the first treatment. The patients rated the degree of pain present each day using verbal descriptors, and they also assessed the extent of pain relief globally at the end of each treatment period.After individual dose titration

1992 NEJM Controlled trial quality: uncertain

3369. Comparison of continuous subcutaneous and intravenous hydromorphone infusions for management of cancer pain. (Abstract)

Comparison of continuous subcutaneous and intravenous hydromorphone infusions for management of cancer pain. To compare the safety and efficacy of subcutaneous and intravenous infusion of opioid analgesics, a randomised, double-blind, crossover trial was carried out in inpatients. 15 patients with severe cancer pain received two 48 h infusions of hydromorphone--one subcutaneously and one intravenously in randomly allocated order. The study was made double-blind by the use of two infusion pumps (...) throughout; during the active subcutaneous infusion the intravenous pump delivered saline and vice versa. Serial measurements of pain intensity, pain relief, mood, and sedation by means of visual analogue scales showed no clinically or statistically significant difference between the two infusion routes. Side-effects were slight, and the mean number of morphine injections for breakthrough pain did not differ significantly between the routes (4.8 [SD 4.5] for intravenous vs 5.3 [5.6] for subcutaneous

1991 Lancet Controlled trial quality: uncertain

3370. A controlled trial of corticosteroid injections into facet joints for chronic low back pain. (Abstract)

A controlled trial of corticosteroid injections into facet joints for chronic low back pain. Chronic low back pain is a common problem with many treatments, few of which have been rigorously evaluated. This randomized, placebo-controlled trial was designed to evaluate the efficacy of injections of corticosteroid into facet joints to treat chronic low back pain.Patients with chronic low back pain who reported immediate relief of their pain after injections of local anesthetic into the facet (...) joints between the fourth and fifth lumbar vertebrae and the fifth lumbar and first sacral vertebrae were randomly assigned to receive under fluoroscopic guidance injections of either methylprednisolone acetate (20 mg; n = 49) or isotonic saline (n = 48) in the same facet joints. Ninety-five patients were followed for six months and their condition assessed with scales of pain severity, back mobility, and limitation of function.After one month, none of the outcome measures evaluating pain, functional

1991 NEJM Controlled trial quality: predicted high

3371. Patient-controlled analgesia. Does a concurrent opioid infusion improve pain management after surgery? (Abstract)

Patient-controlled analgesia. Does a concurrent opioid infusion improve pain management after surgery? --To assess the influence of a continuous (basal) morphine infusion as part of a patient-controlled analgesia (PCA) system on the postoperative analgesic requirement and on recovery parameters following abdominal hysterectomy.--Single-center, randomized, controlled protocol.--University medical center.--A total of 230 adult women were randomly assigned to receive no morphine infusion (control (...) group) or a continuous 0.5-, 1.0-, or 2.0-mg/h morphine infusion. Each patient was able to self-administer supplemental intravenous bolus doses of morphine (1 to 2 mg) using a PCA infuser.--Use of the PCA device, opioid-related side effects, recovery times, and the patients' assessment of pain and sedation on linear visual analog scales were recorded during the 72-hour study period. Follow-up questionnaires were completed by the patients and their health care professionals to assess the overall

1991 JAMA Controlled trial quality: uncertain

3372. Back pain - causes, diagnosis, treatment

Back pain - causes, diagnosis, treatment Back pain - causes, diagnosis, treatment Back pain - causes, diagnosis, treatment Nachemson A Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Nachemson A. Back pain - causes, diagnosis, treatment. Stockholm: Swedish Council on Technology Assessment in Health Care (SBU) 1991 Authors' objectives

To summarise the current scientific knowledge on the causes, diagnosis and treatment of back pain.

Authors' conclusions It is important to carefully investigate and document information on patients suffering from back pain to ensure that the problems are not being caused by an injury or organic disease. X-ray or specialised examinations are not necessary during the first two weeks of back pain, unless special illness or injury is suspected. For most patients, it is currently impossible to establish

1991 Health Technology Assessment (HTA) Database.

3373. Relaxation technique and postoperative pain in patients undergoing cardiac surgery. (Abstract)

Relaxation technique and postoperative pain in patients undergoing cardiac surgery. A two-group pretest and posttest quasi-experimental design was used to determine the effectiveness of a slow, deep-breathing relaxation technique in relieving postoperative pain after coronary artery bypass graft surgery. A convenience sample of 29 subjects was divided into an experimental group (n = 15), who received relaxation training on the evening before surgery and performed the technique after surgery (...) , and a control group (n = 14), who did not receive relaxation training. Analysis of variance was used to analyze the data. Significant decreases were demonstrated as a result of relaxation, in blood pressure, heart rate, respiratory rate, and report of pain on the visual descriptor scale. No significant differences were seen in analgesic use or visual analogue scale scores. Eleven subjects (73.3%) said the technique was helpful in their pain management. All experimental subjects stated that the relaxation

1990 Heart & lung : the journal of critical care

3374. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. Full Text available with Trip Pro

Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin.Randomised controlled trial. Allocation to chiropractic or hospital management by minimisation to establish groups for analysis of results according to initial referral clinic, length of current episode, history, and severity of back pain. Patients were followed up for up two (...) years.Chiropractic and hospital outpatient clinics in 11 centres.741 Patients aged 18-65 who had no contraindications to manipulation and who had not been treated within the past month.Treatment at the discretion of the chiropractors, who used chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilisation or manipulation, or both.Changes in the score on the Oswestry pain disability questionnaire and in the results of tests of straight leg raising and lumbar

1990 BMJ Controlled trial quality: uncertain

3375. A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain. (Abstract)

A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain. A number of treatments are widely prescribed for chronic back pain, but few have been rigorously evaluated. We examined the effectiveness of transcutaneous electrical nerve stimulation (TENS), a program of stretching exercises, or a combination of both for low back pain. Patients with chronic low back pain (median duration, 4.1 years) were randomly assigned to receive daily treatment (...) with TENS (n = 36), sham TENS (n = 36), TENS plus a program of exercises (n = 37), or sham TENS plus exercises (n = 36). After one month no clinically or statistically significant treatment effect of TENS was found on any of 11 indicators of outcome measuring pain, function, and back flexion; there was no interactive effect of TENS with exercise. Overall improvement in pain indicators was 47 percent with TENS and 42 percent with sham TENS (P not significant). The 95 percent confidence intervals

1990 NEJM Controlled trial quality: predicted high

3377. Early "step down" transfer of low-risk patients with chest pain

Early "step down" transfer of low-risk patients with chest pain Early "step down" transfer of low-risk patients with chest pain Early "step down" transfer of low-risk patients with chest pain Weingarten S, Ermann B, Bolus R, Riedinger M S, Rubin H, Green A, Karns K, Ellrodt A G Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed (...) by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Use of triage criteria. Type of intervention Treatment. Study population Very low risk patients from coronary and intermediate care units without complications or unstable comorbidity, and not requiring intervention. Patients with chest pain or diagnosis of myocardial infarction were excluded. Setting The study was carried out in the USA. Dates to which data relate It seems that price related

1990 NHS Economic Evaluation Database.

3378. Clinical trial of intensive muscle training for chronic low back pain. (Abstract)

Clinical trial of intensive muscle training for chronic low back pain. 105 patients who had chronic low back pain without clinical signs of lumbar nerve root compression or radiological evidence of spondylolysis or osteomalacia were randomised to three treatments: 30 sessions of intensive dynamic back extensor exercises over three months; a similar programme at one-fifth the exercise intensity; or one month of thermotherapy, massage, and mild exercises. The results consistently favoured

1989 Lancet Controlled trial quality: uncertain

3379. Transdermal fentanyl for postoperative pain management. A double-blind placebo study. (Abstract)

Transdermal fentanyl for postoperative pain management. A double-blind placebo study. A double-blind, placebo-controlled, randomized design was used to evaluate the safety and efficacy of transdermal fentanyl citrate for postoperative pain management in 42 healthy adult patients undergoing major shoulder surgery. Transdermal systems rated to deliver fentanyl citrate at a rate of 75 micrograms/h were applied to the skin immediately prior to surgery and worn for 24 hours. Patients in the active

1989 JAMA Controlled trial quality: uncertain

3380. The problem of back pain. Proceedings from a conference

The problem of back pain. Proceedings from a conference The problem of back pain. Proceedings from a conference The problem of back pain. Proceedings from a conference Feldt K-O, Astrand P-O, Nachemson A, Mikaelsson B, Kilbom A, Videman T, Hemmingsson A, Weber H, Hemborg B, Blomberg L, Hagberg M Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database (...) . Citation Feldt K-O, Astrand P-O, Nachemson A, Mikaelsson B, Kilbom A, Videman T, Hemmingsson A, Weber H, Hemborg B, Blomberg L, Hagberg M. The problem of back pain. Proceedings from a conference. The Swedish Council on Health Technology Assessment (SBU). 1989 Authors' objectives Proceedings of a conference held in 1989 in Stockholm to address different perspectives on the problem of back pain and present new information from scientific studies. Project page URL Indexing Status Subject indexing assigned

1989 Health Technology Assessment (HTA) Database.