Assay Sensitivity of Pain Intensity Versus Pain Relief in Acute Pain Clinical Trials: ACTTION Systematic Review and Meta-Analysis

Background: Ginger has been proposed as a complementary treatment for musculoskeletal pain. However, efficacy, type, and safety remains unclear. Objectives: To determine the effectiveness of consumption or topical application of ginger for pain relief and knee function improvement in patients with knee osteoarthritis. Study Design: Systematic review with meta-analysis of randomized clinical trials. Methods: An electronic search was performed on Medline, Central, CINAHL, PEDro, SPORTDiscus, and LILACS databases. The eligibility criteria for selecting studies included clinical trials that compared consumption and/or topical ginger with placebo or other interventions for the pain relief and knee function in patients with medical diagnosis of knee osteoarthritis. Results: Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 4 studies were included. For the comparison capsules versus placebo, mean difference for pain was −7.88 mm; 95% confidence interval (CI), 11.92 to 3.85 (P = 0.00), and standard mean difference for knee function was −1.61 points; 95% CI, −4.30 to −1.09 (P = 0.24). For the comparison of topical ginger versus standard treatment, standard mean difference for pain was 0.79 mm; 95% CI, −1.97 to 0.39 (P = 0.19), and standard mean difference for knee function was −0.51 points; 95% CI, −1.15 to 0.13 (P = 0.12). Limitations: The current evidence is heterogeneous and has a poor methodologic quality. Conclusions: There is insufficient evidence to support the use of oral ginger compared with placebo in the pain relief and function improvement in patients with knee osteoarthritis. For other comparisons, no statistically significant differences were found. Key words: Osteoarthritis, knee osteoarthritis, ginger, pain, randomized clinical trial, systematic review

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Dry Needling for the Treatment Of Tension-Type, Cervicogenic, or Migraine Headaches: a Systematic Review and Meta-Analysis

Physical Therapy ◽

10.1093/ptj/pzab068 ◽

2021 ◽

Author(s):

Mohammadreza Pourahmadi ◽

Jan Dommerholt ◽

César Fernández-de-Las-Peñas ◽

Bart Willem Koes ◽

Mohammad Ali Mohseni-Bandpei ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Pain Intensity ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Dry Needling ◽

Short Term ◽

Patient Will ◽

Headache Pain ◽

Better Than

Abstract Objective Dry needling is a treatment technique used by clinicians to relieve symptoms in patients with tension-type headache (TTH), cervicogenic headache (CGH), or migraine. This systematic review's main objective was to assess the effectiveness of dry needling on headache pain intensity and related-disability in patients with TTH, CGH, or migraine. Methods Medline/PubMed, Scopus, Embase®, PEDro, WoS, Ovid, AMED/EBSCO, CENTRAL, Google Scholar, and trial registries were searched until April 1, 2020, along with reference lists of eligible studies and related reviews. Randomized clinical trials or observational studies that compared the effectiveness of dry needling with any other interventions were eligible for inclusion. Three reviewers independently selected studies, extracted data, and assessed risk of bias. Random-effects meta-analyses were performed to produce pooled-effect estimates (Morris’s dppc2) and their respective confidence intervals. Results Of 2715 identified studies, 11 randomized clinical trials were eligible for qualitative synthesis and 9 for meta-analysis. Only four trials were of high quality. Very low-quality evidence suggested that dry needling is not statistically better than other interventions for improving headache pain intensity at short-term in patients with TTH (SMD −1.27, 95% CI −3.56 to 1.03, n = 230), CGH (SMD −0.41, 95% CI −4.69 to 3.87, n = 104), or mixed headache (TTH and migraine; SMD 0.03; 95% CI −0.42 to 0.48, n = 90). Dry needling provided significantly greater improvement in related-disability at short-term in patients with TTH (SMD −2.28, 95% CI −2.66 to −1.91, n = 160) and CGH (SMD −0.72, 95% CI −1.09 to −0.34, n = 144). The synthesis of results showed that dry needling could significantly improve headache frequency, health-related quality of life, trigger point tenderness, and cervical range of motion in TTH and CGH. Conclusions Dry needling produces similar effects to other interventions for short-term headache pain relief, whereas dry needling seems to be better than other therapies for improvement in related-disability in the short-term. Impact Although further high methodological quality studies are warranted to provide a more robust conclusion, our systematic review suggested that for every one to two patients with TTH treating by dry needling, one patient will likely show decreased headache intensity (NNT = 2; large effect) and improved related-disability (NNT = 1; very large effect). In CGH, for every three to four patients treating by dry needling, one patient will likely exhibit decreased headache intensity (NNT = 4; small effect) and improved related-disability (NNT = 3; medium effect).

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Prolonging the duration of single-shot intrathecal labour analgesia with morphine: A systematic review

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2016.06.010 ◽

2016 ◽

Vol 13 (1) ◽

pp. 36-42 ◽

Cited By ~ 4

Author(s):

Hadeel Al-Kazwini ◽

Irene Sandven ◽

Vegard Dahl ◽

Leiv Arne Rosseland

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Side Effects ◽

Pain Relief ◽

Beneficial Effect ◽

Intrathecal Morphine ◽

Meta Analysis ◽

Labour Analgesia ◽

Single Shot ◽

Standardized Mean Difference

AbstractBackground and aimsSingle-shot spinal with bupivacaine plus fentanyl or sufentanil is commonly used as analgesia during labour, but the short duration limits the clinical feasibility. Different drugs have been added to prolong the analgesic duration. The additional effect of intra-thecal morphine has been studied during labour pain as well as after surgery. We assessed whether adding morphine to intra-thecal bupivacaine + fentanyl or sufentanil prolongs pain relief during labour.MethodsMeta-analysis of placebo-controlled randomized clinical trials of analgesia prolongation after single-shot intrathecal morphine ≤250µg during labour when given in combination with bupivacaine + fentanyl or sufentanil. After identifying 461 references, 24 eligible studies were evaluated after excluding duplicate publications, case reports, studies of analgesia after caesarean delivery, and epidural labour analgesia. Mean duration in minutes was the primary outcome measure and was included in the calculation of the standardized mean difference. Duration was defined as the time between a single shot spinal until patient request of rescue analgesia. All reported side effects were registered. Results of individual trials were combined using a random effect model. Cochrane tool was used to assess risk of bias.ResultsFive randomized placebo-controlled clinical trials (286 patients) were included in the metaanalysis. A dose of 50–250µg intrathecal morphine prolonged labour analgesia by a mean of 60.6 min (range 3–155 min). Adding morphine demonstrated a medium beneficial effect as we found a pooled effect of standardized mean difference = 0.57 (95% CI: –0.10 to 1.24) with high heterogeneity (I2 =88.1%). However, the beneficial effect was statistically non-significant (z =1.66, p = 0.096). The lower-bias trials showed a small statistically non-significant beneficial effect with lower heterogeneity. In influential analysis, that excluded one study at a time from the meta-analysis, the effect size appears unstable and the results indicate no robustness of effect. Omitting the study with highest effects size reduces the pooled effect markedly and that study suffers from inadequate concealment of treatment allocation and blinding. Trial quality was generally low, and there were too few trials to explore sources of heterogeneity in meta-regression and stratified analyses. In general, performing meta-analyses on a small number of trials are possible and may be helpful if one is aware of the limitations. As few as one more placebo-controlled trial would increase the reliability greatly.ConclusionsEvidence from this systematic review suggests a possible beneficial prolonging effect of adding morphine to spinal analgesia with bupivacaine + fentanyl or +sufentanil during labour. The study quality was low and heterogeneity high. No severe side effects were reported. More adequately-powered randomized trials with low bias are needed to determine the benefits and harms of adding morphine to spinal local anaesthetic analgesia during labour.ImplicationsEpidural analgesia is documented as the most effective method for providing pain relief during labour, but from a global perspective most women in labour have no access to epidural analgesia. Adding morphine to single shot spinal injection of low dose bupivacaine, fentanyl or sufentanil may be efficacious but needs to be investigated.

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Onset of Action and Efficacy of Ibuprofen Liquigel as Compared to Solid Tablets: A Systematic Review and Meta-Analysis

Journal of Pharmacy & Pharmaceutical Sciences ◽

10.18433/j3b897 ◽

2016 ◽

Vol 19 (3) ◽

pp. 301 ◽

Cited By ~ 4

Author(s):

Hanan Al Lawati ◽

Fakhreddin Jamali

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Pain Relief ◽

Comparative Studies ◽

Analgesic Effect ◽

Meta Analysis ◽

Data Bases ◽

Onset Of Action ◽

Over The Counter ◽

Significant Difference

Purpose. Ibuprofen liquigel has been believed to provide faster analgesic effect. However, comparative studies evaluating the efficacy of liquigel versus regular tablets are not available. Hence, we carried out a systematic review and a meta-analysis to compare the onset of action and efficacy of over-the-counter doses of ibuprofen liquigel (IBULG) vs ibuprofen tablets (IBUT). Methods. Published clinical trials of IBULG and IBUT were identified through a systematic search of various data bases up to October, 2015. Results. In total 18 eligible studies on IBUT and 4 on IBULG were found. There was no significant difference in the median time to the first perceptible pain relief or the proportion of patients with more than 50% pain relief between the two products. However, IBULG yielded significantly greater odd ratios in meaningful pain relief at 60, 90 and 120 min, but not at 30 min, as compared with IBUT. Conclusion. The available evidence, although not overwhelming, suggest a faster onset of analgesia for liquigel as compared with tablets. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

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The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief: a systematic review with meta-analysis

European Spine Journal ◽

10.1007/s00586-015-3821-5 ◽

2015 ◽

Vol 24 (4) ◽

pp. 702-714 ◽

Cited By ~ 26

Author(s):

Magdalena Rzewuska ◽

Manuela Ferreira ◽

Andrew J. McLachlan ◽

Gustavo C. Machado ◽

Christopher G. Maher

Keyword(s):

Systematic Review ◽

Pain Relief ◽

Conservative Treatment ◽

Acute Pain ◽

Meta Analysis ◽

Compression Fractures ◽

Osteoporotic Compression Fractures

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Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials

BMJ ◽

10.1136/bmj.n1034 ◽

2021 ◽

pp. n1034 ◽

Cited By ~ 3

Author(s):

Li Wang ◽

Patrick J Hong ◽

Curtis May ◽

Yasir Rehman ◽

Yvgeniy Oparin ◽

...

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Clinical Trials ◽

Pain Relief ◽

Physical Functioning ◽

Meta Analysis ◽

Medical Cannabis ◽

Increased Risk ◽

Small Improvement

Abstract Objective To determine the benefits and harms of medical cannabis and cannabinoids for chronic pain. Design Systematic review and meta-analysis. Data sources MEDLINE, EMBASE, AMED, PsycInfo, CENTRAL, CINAHL, PubMed, Web of Science, Cannabis-Med, Epistemonikos, and trial registries up to January 2021. Study selection Randomised clinical trials of medical cannabis or cannabinoids versus any non-cannabis control for chronic pain at ≥1 month follow-up. Data extraction and synthesis Paired reviewers independently assessed risk of bias and extracted data. We performed random-effects models meta-analyses and used GRADE to assess the certainty of evidence. Results A total of 32 trials with 5174 adult patients were included, 29 of which compared medical cannabis or cannabinoids with placebo. Medical cannabis was administered orally (n=30) or topically (n=2). Clinical populations included chronic non-cancer pain (n=28) and cancer related pain (n=4). Length of follow-up ranged from 1 to 5.5 months. Compared with placebo, non-inhaled medical cannabis probably results in a small increase in the proportion of patients experiencing at least the minimally important difference (MID) of 1 cm (on a 10 cm visual analogue scale (VAS)) in pain relief (modelled risk difference (RD) of 10% (95% confidence interval 5% to 15%), based on a weighted mean difference (WMD) of −0.50 cm (95% CI −0.75 to −0.25 cm, moderate certainty)). Medical cannabis taken orally results in a very small improvement in physical functioning (4% modelled RD (0.1% to 8%) for achieving at least the MID of 10 points on the 100-point SF-36 physical functioning scale, WMD of 1.67 points (0.03 to 3.31, high certainty)), and a small improvement in sleep quality (6% modelled RD (2% to 9%) for achieving at least the MID of 1 cm on a 10 cm VAS, WMD of −0.35 cm (−0.55 to −0.14 cm, high certainty)). Medical cannabis taken orally does not improve emotional, role, or social functioning (high certainty). Moderate certainty evidence shows that medical cannabis taken orally probably results in a small increased risk of transient cognitive impairment (RD 2% (0.1% to 6%)), vomiting (RD 3% (0.4% to 6%)), drowsiness (RD 5% (2% to 8%)), impaired attention (RD 3% (1% to 8%)), and nausea (RD 5% (2% to 8%)), but not diarrhoea; while high certainty evidence shows greater increased risk of dizziness (RD 9% (5% to 14%)) for trials with <3 months follow-up versus RD 28% (18% to 43%) for trials with ≥3 months follow-up; interaction test P=0.003; moderate credibility of subgroup effect). Conclusions Moderate to high certainty evidence shows that non-inhaled medical cannabis or cannabinoids results in a small to very small improvement in pain relief, physical functioning, and sleep quality among patients with chronic pain, along with several transient adverse side effects, compared with placebo. The accompanying BMJ Rapid Recommendation provides contextualised guidance based on this body of evidence. Systematic review registration https://osf.io/3pwn2

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