Pain Management

Apr 1, 2007 Issue
Are Opioids Effective in the Treatment of Neuropathic Pain? [Cochrane for Clinicians]

Eight to 60 days of opioid therapy for the treatment of neuropathic pain effectively reduces pain scores as measured by a visual analog scale. A lack of response to opioids in the first 24 hours should not be used to predict whether longer-term opioid therapy might be beneficial. There are no contro...

Dec 1, 2006 Issue
Opioids for Management of Breakthrough Pain in Cancer Patients [Cochrane for Clinicians]

Oral transmucosal fentanyl citrate (OTFC [Actiq]), a rapid-acting opioid, has been shown to be an effective treatment for breakthrough cancer pain. Other opioids, including immediate-release oral morphine (MSIR), also may be effective; however, evidence comparing these agents with OTFC is lacking.

Oct 15, 2006 Issue
Management of Common Opioid-Induced Adverse Effects [Article]

Opioid analgesics are useful agents for treating pain of various etiologies; however, adverse effects are potential limitations to their use. Strategies to minimize adverse effects of opioids include dose reduction, symptomatic management, opioid rotation, and changing the route of administration. N...

Jul 1, 2006 Issue
Systemic Lidocaine or Mexiletine for Neuropathic Pain [Cochrane for Clinicians]

Intravenous lidocaine and oral mexiletine provide a modest reduction in neuropathic pain with no indication of serious adverse effects. However, safety data are limited because most studies were of relatively short duration and fewer than 400 patients have been studied in total for each drug. Intrav...

May 1, 2006 Issue
Carbamazepine for Acute and Chronic Pain [Cochrane for Clinicians]

Two small trials have shown carbamazepine to be beneficial in the treatment of diabetic neuropathic pain. Carbamazepine shows similar clinical effect to gabapentin (Neurontin) and phenytoin (Dilantin), but there have been no head-to-head trials directly comparing these drugs. Carbamazepine is effect...

Feb 1, 2006 Issue
Gabapentin for Pain: Balancing Benefit and Harm [Cochrane for Clinicians]

At high dosages, gabapentin is moderately effective for neuropathic pain, although adverse effects are experienced as often as benefit.

Apr 1, 2005 Issue
Methadone Treatment for Pain States [Article]

Methadone is a synthetic opioid with potent analgesic effects. Although it is associated commonly with the treatment of opioid addiction, it may be prescribed by licensed family physicians for analgesia. Methadone's unique pharmacokinetics and pharmacodynamics make it a valuable option in the manage...

Mar 1, 2005 Issue
Oral Analgesics for Acute Nonspecific Pain [Article]

Physicians most often recommend or prescribe oral medication for relief of acute pain. This review of the available evidence supports the use of acetaminophen in doses up to 1,000 mg as the initial choice for mild to moderate acute pain. In some cases, modest improvements in analgesic efficacy can b...

Nov 1, 2004 Issue
NSAIDs vs. Opiates for Pain in Acute Renal Colic [Cochrane for Clinicians]

Data from randomized controlled trials comparing NSAIDs with opiates show that NSAIDs are associated with lower pain scores, less need for additional rescue medication, and less vomiting (particularly when compared with meperidine).

Mar 1, 2004 Issue
Cutting Back on High-Dosage Narcotics [Curbside Consultation]

Over the past decade, the promotion of narcotics for control of malignant and non-malignant pain has been advocated by specialists in the pain community. While most physicians accept the use of aggressive narcotic analgesia in patients with cancer-related pain, the use of opioids in chronic, nonterminal conditions remains highly controversial.

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