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Latest & greatest articles for pain
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Transcutaneous electrical nerve stimulation (TENS) for chronic pain - an overview of Cochrane Reviews. Chronic pain, considered to be pain lasting more than three months, is a common and often difficult to treat condition that can significantly impact upon function and quality of life. Treatment typically includes pharmacological and non-pharmacological approaches. Transcutaneous electrical nerve stimulation (TENS) is an adjunct non-pharmacological treatment commonly recommended by clinicians (...) and often used by people with pain.To provide an overview of evidence from Cochrane Reviews of the effectiveness of TENS to reduce pain in adults with chronic pain (excluding headache or migraine).To provide an overview of evidence from Cochrane Reviews of the safety of TENS when used to reduce pain in adults with chronic pain (excluding headache or migraine).To identify possible sources of inconsistency in the approaches taken to evaluating the evidence related to TENS for chronic pain (excluding
Does a Rehabilitation Program of Aerobic and Progressive Resisted Exercises Influence HIV-Induced Distal Neuropathic Pain? Distal symmetrical polyneuropathy is a common neurological sequela after HIV, which leads to neuropathic pain and functional limitations. Rehabilitation programs with exercises are used to augment pharmacological therapy to relieve pain but appropriate and effective exercises are unknown. This study explored the safety and effect of moderate-intensity aerobic exercises (...) and progressive resisted exercises for HIV-induced distal symmetrical polyneuropathy neuropathic pain.A randomized pretest, posttest of 12 wks of aerobic exercise or progressive resisted exercise compared with a control. Outcome measures were assessed using the subjective periphery neuropathy, brief peripheral neuropathy screening, and numeric pain rating scale. Pain was assessed at baseline, 6 and 12 wks. Data between groups were compared using Kruskal-Wallis, Mann-Whitney U test, and within-groups Friedman
Effectiveness of Shortwave Diathermy for Subacromial Impingement Syndrome and Value of Night Pain for Patient Selection: A Double-Blinded, Randomized, Placebo-Controlled Trial. The aim of this study was to investigate the effectiveness of short wave diathermy (SWD) in patients with subacromial impingement syndrome.In this double-blinded, randomized, placebo-controlled trial, 57 patients (aged 35-65 yrs) were classified into night pain positive (NP[+]) (n = 28) and night pain negative (NP[-]) (n (...) = 29) groups. Both groups were randomly assigned to SWD (NP[+], n = 14; NP[-], n = 14) and sham (NP[+], n = 15; NP[-], n = 14) subgroups. Visual analog scale, Constant-Murley Scale (CS), and Shoulder Disability Questionnaire (SDQ) scores were used for evaluation.There was only a significant difference in pain with activity at 1-mo (mean difference [MD], -1.65; 95% confidence interval, -3.01 to -0.28]) and 2-mo evaluations (MD, -2.1; 95% confidence interval, -3.51 to -0.69) between SWD versus sham
Effectiveness of a Group Physiotherapy Intervention in Nontraumatic, Inoperable Painful Shoulder: A Randomized Clinical Trial. The aim of the study was to assess the effectiveness of a group intervention in painful shoulder.This was a two-arm controlled clinical trial with a 5-wk follow-up and 1:1 allocation ratio with pretreatment and posttreatment assessments in a Spanish hospital in 2015-2016. This study comprised 74 patients with nontraumatic, inoperable painful shoulder. Patients were
Effects of Platelet-Rich Plasma on Pain and Muscle Strength in Patients With Knee Osteoarthritis. No studies comparing the effects of platelet-rich plasma (PRP) injection and placebo injection in bilateral knee osteoarthritis in the same patient, or discussing muscle strength after PRP injection, have been published.Twenty patients with bilateral knee osteoarthritis were eligible, and 40 knees were randomized into two groups: PRP (knees [right or left by a coin toss] receiving a single intra (...) Index pain and total scores compared with normal saline group (P < 0.05). Although a significantly greater percentage of knee strength (extensor > flexor) was found in the PRP group during a longer follow-up period, PRP treatment resulted in insignificant differences in muscle strength compared with normal saline.Platelet-rich plasma treatment significantly improves pain, stiffness, and disability in patients with knee osteoarthritis compared with normal saline treatment. Additional strength
Intra-articular Triamcinolone Versus Hyaluronate Injections for Low Back Pain With Symptoms Suggestive of Lumbar Zygapophyseal Joint Arthropathy: A Pragmatic, Double-Blind Randomized Controlled Trial. The aim of the study was to compare hyaluronate with triamcinolone injections in treating chronic low back pain suggestive of lumbar zygopophyseal joint arthropathy.This was a prospective, double-blind, randomized controlled trial. Thirty subjects were randomly assigned to receive bilateral L3-S1 (...) lumbar zygopophyseal joint injections with triamcinolone (KA) or Synvisc-One (HA). Pain (visual analog scale) and Pain Disability Questionnaire scores at 1, 3, and 6 mos were evaluated.No significant intergroup differences (P > 0.05) in outcomes were noted in the 30 recruited subjects. For KA/HA (baseline; 1 mo; 3 mos; 6 mos), visual analog scale scores were the following: 70 (15)/74 (10); 58 (29)/45 (25); 58 (29)/56 (25); and 59 (28)/63 (24), respectively. Pain Disability Questionnaire scores were
Compounded Topical Pain Creams to Treat Localized Chronic Pain: A Randomized Controlled Trial. The use of compounded topical pain creams has increased dramatically, yet their effectiveness has not been well evaluated.To determine the efficacy of compounded creams for chronic pain.Randomized controlled trials of 3 interventions. (ClinicalTrials.gov: NCT02497066).Military treatment facility.399 patients with localized pain classified by each patient's treating physician as neuropathic (n = 133 (...) ), nociceptive (n = 133), or mixed (n = 133).Pain creams compounded for neuropathic pain (ketamine, gabapentin, clonidine, and lidocaine), nociceptive pain (ketoprofen, baclofen, cyclobenzaprine, and lidocaine), or mixed pain (ketamine, gabapentin, diclofenac, baclofen, cyclobenzaprine, and lidocaine), or placebo.The primary outcome measure was average pain score 1 month after treatment. A positive categorical response was a reduction in pain score of 2 or more points coupled with a score above 3 on a 5
Clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care unit: A Rapid Review ICU pain, agitation, delirium, sedation and mobilisation CPGs: A Rapid Review 1 Clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care unit: A Rapid Review Citation Corey Joseph & Angela Melder. April 2018. Clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care (...) unit: A Rapid Review. Centre for Clinical Effectiveness, Monash Health, Melbourne, Australia. Contact email@example.com Executive Summary Background The Program Medical Director for Critical Care has requested a review of clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care unit (ICU) to inform future implementation of a new clinical practice guideline in the ICU. Objectives The objective of this review was to review and summarise current
Effect of Intranasal Ketamine vs Fentanyl on Pain Reduction for Extremity Injuries in Children: The PRIME Randomized Clinical Trial Timely analgesia is critical for children with injuries presenting to the emergency department, yet pain control efforts are often inadequate. Intranasal administration of pain medications provides rapid analgesia with minimal discomfort. Opioids are historically used for significant pain from traumatic injuries but have concerning adverse effects. Intranasal (...) ketamine may provide an effective alternative.To determine whether intranasal ketamine is noninferior to intranasal fentanyl for pain reduction in children presenting with acute extremity injuries.The Pain Reduction With Intranasal Medications for Extremity Injuries (PRIME) trial was a double-blind, randomized, active-control, noninferiority trial in a pediatric, tertiary, level 1 trauma center. Participants were children aged 8 to 17 years presenting to the emergency department with moderate to severe
Video-Game-Based Exercises for Older People With Chronic Low Back Pain: A Randomized Controlledtable Trial (GAMEBACK) Video game technology increases adherence to home exercise and could support self-management for older people with chronic low back pain (LBP).The objective was to investigate the effects of home-based video game exercises on pain self-efficacy and care-seeking in older people with chronic LBP.The study was a randomized controlled trial.The setting was a community and waiting (...) list.Sixty participants, aged > 55 years with chronic LBP, were randomized (1:1) to Wii Fit U exercises or to continue their usual activities for 8 weeks.The intervention was home-based Wii Fit U flexibility, strengthening, and aerobic exercises for 60 minutes, 3 times per week, with fortnightly calls from a physical therapist.Measurements included pain self-efficacy and care-seeking (primary outcomes), and physical activity, pain, function, disability, fear of movement/reinjury, falls efficacy
Evaluation of the Neuropathic Component of Chronic Low Back Pain Assessment of neuropathic pain in chronic low back syndromes is important. However, there is currently no gold standard for its diagnosis. The aim of this observational cross-sectional study was to assess the neuropathic component of pain in various chronic low back pain syndromes using a range of diagnostic tests.Included in this study were 63 patients with chronic axial low back pain (ALBP), 48 patients with chronic radicular (...) syndromes (CRS) comprising 23 with discogenic compression (CDRS) and 25 with lumbar spinal stenosis (LSS), and 74 controls. PainDETECT questionnaire (PDQ), quantitative sensory testing (QST), and skin biopsy with evaluation of intraepidermal nerve fiber density (IENFD) were used to assess the neuropathic pain component.Positive PDQ (≥19) was obtained more frequently in patients with CDRS and LSS (26.1% and 12.0%, respectively) compared with patients with ALBP (1.6%, P<0.001). The proportion of patients
Periarticular Knee Injection With Liposomal Bupivacaine and Continuous Femoral Nerve Block for Postoperative Pain Management After Total Knee Arthroplasty: A Randomized Controlled Trial Local periarticular infiltration (PAI) analgesia has emerged as an important component of multimodal approaches to treat total knee arthroplasty postoperative pain. Liposomal bupivacaine may provide prolonged analgesic duration when injected into the surrounding tissues. The purpose of this study was to compare (...) the analgesic efficacy and serum bupivacaine levels of a continuous femoral nerve block (CFNB) with bupivacaine to PAI with liposomal bupivacaine.Sixty-five patients undergoing primary unilateral total knee arthroplasty were randomized into 2 groups: (1) CFNB and PAI with bupivacaine (CFNB group) or (2) PAI with bupivacaine:liposomal bupivacaine mixture at the end of surgery (LB group). The primary outcome was pain intensity at maximum knee flexion 24 hours following surgery. Secondary outcomes included
Controlled intervention to compare the efficacies of manual pressure release and the muscle energy technique for treating mechanical neck pain due to upper trapezius trigger points This study aimed at comparing the clinical efficacies of two manual therapies to determine the most beneficial result-oriented physiotherapeutic approach for treating nonspecific neck pain due to myofascial trigger points (MTrPs).This was a randomized, controlled pretest-posttest experimental study that compared (...) manual pressure release (MPR), the muscle energy technique (MET), and a control condition. These techniques were compared using a convenience sample of 45 female participants with neck pain due to MTrPs (mean age±SD=21.49±3.66; age range=18-30 years). The visual analog scale, pressure pain threshold, Neck Disability Index Questionnaire, and a standardized measuring tape were used to assess the participants' neck pain, muscle tenderness, functional disability due to neck pain, and range of neck
Safety of oral methylnaltrexone for opioid-induced constipation in patients with chronic noncancer pain Oral methylnaltrexone was shown to be effective in treating opioid-induced constipation (OIC) in patients with chronic noncancer pain in a Phase III randomized controlled trial. This report provides a detailed safety analysis from that study.Adults (n=803) with chronic noncancer pain for ≥2 months and confirmed OIC while receiving opioid doses ≥50 mg morphine equivalent per day for ≥14 days (...) were randomized 1:1:1:1 to oral methylnaltrexone (150, 300, or 450 mg) or placebo once daily for 4 weeks, followed by as-needed use for 8 weeks. Safety was evaluated by examining treatment-emergent adverse events (TEAEs), clinical laboratory parameters, vital signs, electrocardiography, rescue-laxative and opioid use, Objective Opioid Withdrawal Scale (OOWS) and Subjective Opioid Withdrawal Scale (SOWS), and pain-intensity scores.TEAEs occurred at a similar incidence in the methylnaltrexone groups
Effects of a Patient-Centered Graded Exposure Intervention Added to Manual Therapy for Women With Chronic Pelvic Pain: A Randomized Controlled Trial To explore the effects of a 6-week patient-centered graded exposure intervention added to manual therapy in women with chronic pelvic pain (CPP) and fear of movement/(re)injury.Prospective 3-armed randomized controlled trial.Faculty of Health Sciences.A total of 49 women with CPP and substantial fear of movement were randomly allocated to 1 of 3 (...) groups: (1) patient-centered graded exposure intervention added to manual therapy; (2) manual therapy; (3) control group.The 6-week intervention consisted of 12 sessions in the group receiving manual therapy and 6 additional sessions of graded exposure therapy in the group receiving both interventions.Primary outcomes were fear-avoidance behavior assessed using the Fear-Avoidance Beliefs Questionnaire and pain interference and severity evaluated with the Brief Pain Inventory. The secondary outcome
Patient-delivered tDCS on chronic neuropathic pain in prior responders to TMS (a randomized controlled pilot study) Successful response to repetitive transcranial magnetic stimulation (rTMS) of the motor cortex requires continued maintenance treatments. Transcranial Direct Current Stimulation (tDCS) may provide a more convenient alternative.This pilot study aimed to examine the feasibility of a randomized, double-blind, double-crossover pilot study for patients to self-administer tDCS motor (...) cortex stimulation for 20 minutes/day over five consecutive days. Primary outcomes were as follows: usability of patient-administered tDCS, compliance with device, recruitment, and retention rates. Secondary outcomes were as follows: effect on overall pain levels and quality of life via Short Form-36 anxiety and depression via Hospital Anxiety and Depression Scale, and Mini-Mental State scores.A total of 24 subjects with neuropathic pain, who had previously experienced rTMS motor cortex stimulation
The Impact of 3 Different Distraction Techniques on the Pain and Anxiety Levels of Children During Venipuncture: A Clinical Trial Invasive procedures are important causes of pain and anxiety during hospitalization. This study aimed to evaluate the effect of 3 different distraction methods on the pain and anxiety levels of children during venipuncture.This was a randomized controlled trial conducted with 180 children of 6 to 10 years of age; data were collected in the months of August (...) to November 2016. Participants were randomized in 4 groups; the children in group 1 watched cartoon movies (CM), the children in group 2 played video games (VG), the children in group 3 were distracted by their parents' verbal interactions (PI), whereas no distraction method was used on the children in group 4 (control group). The levels of anxiety and pain perception were evaluated independently based on the feedback from the children, the nurse observer, and the parents. The Children Fear Scale was used
Duloxetine Reduces Pain and Improves Quality of Recovery Following Total Knee Arthroplasty in Centrally Sensitized Patients: A Prospective, Randomized Controlled Study Unexplained postoperative pain is one of the most feared complications of total knee arthroplasty (TKA). A persistent noxious peripheral stimulus, such as the pain of chronic knee osteoarthritis, can cause central sensitization in which the central nervous system becomes hyperexcitable, resulting in hypersensitivity to both (...) noxious and non-noxious stimuli. Patients with central sensitization may be more susceptible to unexplained pain after TKA. Duloxetine, a selective serotonin norepinephrine reuptake inhibitor (SNRI), can ameliorate the pain associated with central sensitization, and we aimed to determine whether it could reduce postoperative pain and improve quality of recovery after TKA in patients with central sensitization.Patients undergoing TKA were screened for central sensitization preoperatively with use