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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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Single dose dextropropoxyphene, alone and with paracetamol (acetaminophen), for postoperative pain. Patient surveys have shown that postoperative pain is often not managed well, and there is a need to assess the efficacy and safety of commonly used analgesics as newer treatments become available. Dextropropoxyphene is one example of an opioid analgesic in current use, and is widely prescribed for pain relief in combination with paracetamol under names such as Co-proxamol and Distalgesic.To (...) determine the analgesic efficacy and adverse effects of single dose oral Dextropropoxyphene alone and in combination with paracetamol (acetaminophen) for moderate to severe postoperative pain.Published reports were identified from: Medline (1966 - November 1996), Biological Abstracts (1985 - 1996), Embase (1980 - 1996), the Cochrane Library (Issue 4 1996), and the Oxford Pain Relief Database (1954 - 1994). Additional studies were identified from the reference lists of retrieved reports. Date of the most
Single dose oral ibuprofen and diclofenac for postoperative pain. Ibuprofen and diclofenac are two widely used non-steroidal anti-inflammatory (NSAID) analgesics. It is therefore important to know which drug should be recommended for postoperative pain relief. This review seeks to compare the relative efficacy of the two drugs, and also considers the issues of safety and cost.To assess the analgesic efficacy of ibuprofen and diclofenac in single oral doses for moderate to severe postoperative (...) pain.Randomised trials were identified by searching Medline (1966 to December 1996), Embase (1980 to January 1997), the Cochrane Library (Issue 3 1996), Biological Abstracts (January 1985 to December 1996) and the Oxford Pain Relief Database (1950 to 1994). Date of the most recent searches: July 1998.The inclusion criteria used were: full journal publication, postoperative pain, postoperative oral administration, adult patients, baseline pain of moderate to severe intensity, double-blind design, and random
Single dose paracetamol (acetaminophen), with and without codeine, for postoperative pain. Patient surveys have shown that postoperative pain is often not managed well, and there is a need to assess the efficacy and safety of commonly used analgesics as newer treatments become available. Paracetamol (acetaminophen) is an important non-opiate analgesic, commonly prescribed, as well as being available for retail sale. This review seeks to examine the efficacy of paracetamol alone (...) and in combination with codeine, and also considers adverse effects.To assess the analgesic efficacy and adverse effects of a single dose of oral paracetamol (acetaminophen) alone and in combination with codeine for moderate to severe postoperative pain.Published trials were identified from: Medline (1966 to May 1996), Embase (1980 to 1996), Cochrane Library (Issue 2 1996) and the Oxford Pain Relief Database (1950 to 1994). Additional trials were identified from reference lists of retrieved studies. Date of most
Radiotherapy for the palliation of painful bone metastases. Radiotherapy is used commonly to provide pain relief for painful bone metastases, and there is a perception that of the three-quarters of patients who achieve pain relief, half of these stay free from pain. However, the precise contribution from radiotherapy may be unclear because of difficulties in assessing the numbers of people achieving relief, the extent of relief and its duration, and the influence of other contemporaneous (...) interventions, such as analgesics.To assess pain relief from: 1. localised bone metastases achieved by radiotherapy, comparing the efficacy of different fractionation schedules 2. more generalised metastatic disease achieved by radiotherapy or radioisotopes.Studies were identified by searching Medline (1966 to August 1998), Embase (1980 to 1998), the Cochrane Library (1998 Issue 3) and the Oxford Pain Relief Database (1950 to 1994).The inclusion criteria used were: full journal publication, patients
Perioperative local anaesthesia for reducing pain following tonsillectomy. Pain relief after tonsillectomy is an important part of post-operative management. Sometimes local anaesthetics are administed to the tonsillar region, but their effectiveness in relieving pain has not been formally assessed.To assess the effects of pre- and post-operative local anaesthesia for pain reduction following tonsillectomy.Cochrane Controlled Trials Register, Medline, Embase and the Oxford Pain Database (...) in the English language literature between 1989 and 1997. Trials were excluded because procedures in addition to tonsillectomy were undertaken, inadequate randomisation techniques were used or because group sizes were inadequate. Of the six included studies, five involved local anaesthetic injection and one application of local anaesthetic spray. These studies used validated pain scores and measurement of supplemental analgesic intake for assessment of pain. However, some studies also included inappropriate
Epidural versus non-epidural analgesia for pain relief in labour. Epidural analgesia is effective in reducing labour pain, but the possible adverse effects are not clear.The objective of this review was to assess the effects of epidural analgesia on pain relief and adverse effects in labour.The Cochrane Pregnancy and Childbirth Group trials register was searched.Randomised trials comparing epidural analgesia with other forms of analgesia not involving regional blockade (...) , or no intervention.Eligibility and trial quality were assessed by one reviewer. Study authors were contacted for additional information.Eleven studies involving 3157 women were included. Epidural analgesia was associated with greater pain relief than non-epidural methods, but also with longer first and second stages of labour, an increased incidence of fetal malposition, and increased use of oxytocin and instrumental vaginal deliveries. With new trial data included, no statistically significant effect on caesarean section
Therapeutic ultrasound for postpartum perineal pain and dyspareunia. Proponents of therapeutic ultrasound suggest it can decrease pain by resolution of inflammation processes and reducing the pressure on pain sensitive structures by haematoma and oedema.The objective of this review was to assess the effects of therapeutic ultrasound for treating acute perineal pain, persistent perineal pain and/or dyspareunia, following childbirth.The Cochrane Pregnancy and Childbirth Group trials register (...) , Embase, Cinahl (to May 1996), Physiotherapy Index (1985 to May 1996) and World Congress of Physical Therapy 1994 Conference Proceedings.Randomised and quasi-randomised trials comparing active therapeutic ultrasound with no treatment, placebo ultrasound, or any other 'standard' or active treatment for women with acute or persistent perineal pain and/or dyspareunia following childbirth.One reviewer assessed trial quality and extracted data.Four trials involving 659 women were included. The trials were
Types of intra-muscular opioids for maternal pain relief in labour. Pethidine is the most widely used intra-muscular opioid for the relief of labour pain. However concerns have been raised about its effectiveness and the possibility of depressing respiration in newborns.The objective of this review was to assess the effects of different opioids (and different doses of the same opioid) administered intra-muscularly in labour.We searched the Cochrane Pregnancy and Childbirth Group trials register (...) of the trials, and lack of consistency in the way various outcomes were reported. There was no evidence of a difference between pethidine and tramadol in terms of pain relief, interval to delivery, or instrumental or operative delivery. There appeared to be more adverse effects such as nausea and vomiting and drowsiness with pethidine. Maternal pain relief seemed almost identical between the meptazinol and pethidine groups, whether assessed as maternal satisfaction with pain relief, visual analogue scales
Massage for low back pain. Low back pain is one of the most common and costly musculoskeletal problems in modern societies. Proponents of massage therapy claim it can minimize pain and disability, and speed return to normal function.To assess the effects of massage therapy for non-specific low back pain.We searched Medline, Embase, Cochrane Controlled Trials Register, Healthstar, CINAHL and Dissertation abstracts from 1966 to 1999 with no language restrictions. References in the included (...) that massage is less effective than manipulation immediately after the first session and moderate evidence showing it is less effective than TENS during the course of sessions in relieving pain and improving activity. At the completion of treatment and at 3 weeks after discharge there is no difference among massage and manipulation, electrical stimulation or corsets, but this evidence is limited.Based on the studies reviewed, there is insufficient evidence to recommend massage as a stand-alone treatment
Electrical stimulation for preventing and treating post-stroke shoulder pain. Shoulder pain after stroke is common and disabling. The optimal management is uncertain, but electrical stimulation (ES) is often used to treat and prevent pain.The objective of this review was to determine the efficacy of any form of surface ES in the prevention and / or treatment of pain around the shoulder at any time after stroke.We searched the Cochrane Stroke Review Group trials register and undertook further (...) and extracted the data.Four trials (a total of 170 subjects) fitted the inclusion criteria. Study design and ES technique varied considerably, often precluding the combination of studies. Population numbers were small. There was no significant change in pain incidence (Odds Ratio (OR) 0.64; 95% CI 0.19 to 2.14) or change in pain intensity (Standardised Mean Difference (SMD) 0.13; 95% CI -1.0 to 1.25) after ES treatment compared to control. There was a significant treatment effect in favour of ES
Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Gastrointestinal paralysis, nausea and vomiting, and pain, are major clinical problems following abdominal surgery. Anaesthetic and analgesic techniques that reduce pain and postoperative nausea and vomiting (PONV), and prevent or reduce postoperative ileus, may reduce postoperative morbidity, duration of hospitalisation and hospital costs.To (...) compare effects of postoperative epidural local anaesthetic with regimens based on systemic or epidural opioids, on postoperative gastrointestinal function, postoperative pain, PONV and surgical/anaesthetic complications.Trials were identified by computerised searches of the Cochrane Controlled Trials Register, MEDLINE, EMBASE and by checking the reference lists of trials and review articles.Randomised controlled trials comparing the effects of postoperative epidural local anaesthetic with systemic
Single dose dihydrocodeine for acute postoperative pain. Dihydrocodeine is a synthetic opioid analgesic developed in the early 1900s. Its structure and pharmacokinetics are similar to that of codeine and it is used for the treatment of postoperative pain or as an antitussive. It is becoming increasingly important to assess the relative efficacy and harm caused by different treatments. Relative efficacy can be determined when an analgesic is compared with control under similar clinical (...) circumstances.To quantitatively assess the analgesic efficacy and adverse effects of single-dose dihydrocodeine compared with placebo in randomised trials in moderate to severe postoperative pain.Published reports were identified from a variety of electronic databases including Medline, Biological Abstracts, Embase, the Cochrane Library and the Oxford Pain Relief Database. Additional studies were identified from the reference lists of retrieved reports.The following inclusion criteria were used: full journal
Single dose oral aspirin for acute pain. Aspirin has been known to be an effective analgesic for many years and is commonly used throughout the world for many different pain conditions. It is important for both prescribers and patients to have the best possible information about the efficacy and safety of analgesics, and this need is reflected in patient surveys which show that postoperative pain is often poorly managed. We also need to benchmark relative efficacy and safety of current (...) analgesics so that we can compare them with new analgesics.To quantitatively assess the analgesic efficacy and adverse effects of a single-dose of aspirin in acute pain of moderate to severe intensity.Randomised trials were identified by searching Medline (1966 to March 1998), Embase (1980 to January 1998), the Cochrane Library (Issue 1,1998) and the Oxford Pain Relief Database (1950 to 1994).The inclusion criteria used were: full journal publication, postoperative pain or a mixture of postoperative
Progestagens and anti-progestagens for pain associated with endometriosis. Endometriosis is a gynaecological condition that presents either with the problem of infertility or with painful symptoms. The clinical observation of an apparent resolution of symptoms during pregnancy gave rise to the concept of treating patients with a pseudo-pregnancy regime. Initially combinations of high dose oestrogens and progestagens were used but this was subsequently replaced by progestogens alone. More (...) recently progestogens of both progestagens and anti-progestagens in the treatment of symptomatiprogestogenssisTo determine the effectiveness of both the progestagens and anti-progestagens in the treatment of painful symptoms ascribed to the diagnosis of endometriosis.The search strategy of the Menstrual Disorders and Subfertility Group was utilised to identify all publications which described or might have described randomised trials of any progestagen or any anti-progestagen in the treatment
Interventions for treating plantar heel pain. Ten percent of people may experience pain under the heel (plantar heel pain) at some time. Injections, insoles, heel pads, strapping and surgery have been common forms of treatment offered. The absolute and relative effectiveness of these interventions are poorly understood.The objective of this review was to identify and evaluate the evidence for effectiveness of treatment in treating plantar heel pain.MEDLINE (from 1966 to December 1997), EMBASE (...) and the Cochrane Library were searched. Three podiatry journals (The Foot, The Chiropodist (later The Journal of British Podiatric Medicine), and The British Journal of Podiatric Medicine) were handsearched. We contacted known investigators in the field to identify unpublished data or research in progress. Non English language reports were excluded from the review.Randomised and quasi randomised trials of interventions for plantar heel pain in adults.Two reviewers independently evaluated studies for inclusion
Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults. Multidisciplinary biopsychosocial rehabilitation programs are widely applied for chronic low back pain patients. The biopsychosocial approach for low back pain could also be considered to prevent chronicity by carrying out the rehabilitation if the acute pain is prolonged. Nevertheless multidisciplinary treatment programmes are often laborious and long processes and require good collaboration (...) between the patient, the rehabilitation team and the work place. By workplace visits and close relationship with occupational health care one might expect results in terms of patients working ability.The objective of this systematic review was to determine the effectiveness of multidisciplinary rehabilitation for subacute low back pain among working age adults.The reviewed studies for this structured Cochrane review were identified from electronic bibliographic databases, the Science Citation Index
Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults. Multidisciplinary biopsychosocial rehabilitation programs for neck and shoulder pain require substantial staff and financial resources. Despite questionable scientific evidence of their effectiveness, they are widely used. Neck and shoulder complaints are common among working age adults and they are often associated with physical work load and stress. Pain in the neck and shoulder area cause (...) biopsychosocial difficulties for the patient especially if disability due to pain is prolonged. To help patients with biopsychosocial problems or to prevent their development, multidisciplinary biopsychosocial programs are applied on rehabilitation for neck and shoulder pain patients. Nevertheless multidisciplinary treatment programmes are often laborious and rather long processes and require good collaboration between the patient, the rehabilitation team and the work place.The objective of this systematic
Psychological therapies for sickle cell disease and pain. Sickle cell disease comprises of a group of genetic blood disorders, and occurs when the sickle cell haemoglobin gene is inherited from both parents. The effects of the condition are: varying degrees of anaemia which if severe reduce the capacity for mobility; predisposition to obstruction of small blood capillaries causing pain in muscle and bone known as "crises"; damage to major organs such as the spleen, liver, kidneys, and lungs (...) assessed: pain, mood, coping, health service utilisation, general health, quality of life, and life satisfaction.Four trials which reported results were all found to be unsuitable for inclusion at the present time, owing to incomplete data in the published papers.Psychological approaches are commonly used in an attempt to improve coping ability in patients with sickle cell disease. No conclusions can be made about the use of specific psychological therapies in sickle cell disease from the information
Danazol for pelvic pain associated with endometriosis. Endometriosis is defined as the presence of endometrial tissue (stromal and glandular) outside the normal uterine cavity. Conventional medical and surgical treatments for endometriosis aim to remove or decrease deposits of ectopic endometrium. The observation that hyperandrogenic states (an excess of male hormone) induce atrophy of the endometrium has led to the use of androgens in the treatment of endometriosis. Danazol is one (...) of these treatments used. The efficacy of danazol is based on its ability to produce a high androgen/low estrogen environment (a pseudo menopause) which results in the atrophy of endometriotic implants and thus an improvement in painful symptoms.To determine the effectiveness of danazol compared to placebo or no treatment in the treatment of the symptoms and signs, other than infertility, of endometriosis in women of reproductive age.The Menstrual Disorders Group search strategy was used to identify randomised
Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Endometriosis is a common gynaecological condition that frequently presents with the symptom of pain. The precise pathogenesis (mode of development) of endometriosis is unclear but it is evident that endometriosis arises by the dissemination of endometrium to ectopic sites and the subsequent establishment of deposits of ectopic endometrium. The observation that endometriosis is rarely seen in the hypo-oestrogenic (...) stimulation of the ovary).To determine the effectiveness of Gonadotrophin Releasing Hormone analogues (GnRHas) in the treatment of the painful symptoms of endometriosis by comparing them with no treatment, placebo, other recognised medical treatments, and surgical interventions.The search strategy of the Menstrual Disorders and Subfertility review group (please see Review Group details) was used to identify all randomised trials of the use of GnRHas for the treatment of the painful symptoms