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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To determine the effectiveness of naproxen in the treatment of osteoarthritis of the knee joint, a double-blind cross-over study against placebo was carried out on 61 patients. Statistically significant positive therapeutic effects were observed, including analgesia, increased mobility, decrease in joint swelling and improvement in activities of daily living. Side effects were infrequent, mild and disappeared rapidly.
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PMID:Double-blind study of Naproxen in osteoarthritis of the knee joint. 77 86

Intraarticular morphine inhibits pain after knee surgery without overt toxicity. This study examined intraarticular morphine in chronic arthritis. We undertook a randomized double-blind comparison between intraarticular morphine (3 mg), dexamethasone (4 mg) and saline (3 ml) in 44 patients with chronic inflammatory arthritis or osteoarthritis of the knee. Pain (the primary outcome measure) was assessed at rest and during activity for 6 days using a visual analog scale (VAS) and the McGill pain questionnaire. Before drug injections and on day 6 synovial leukocyte counts (the secondary outcome measure) were taken. During the first 6 h after injection both morphine and dexamethasone significantly reduced VAS and pain rating indices (PRI) in comparison to saline. Both substances also produced a significant reduction of PRI compared to saline during the subsequent 5 days. No patient displayed untoward side effects. Synovial leukocyte counts were lower after morphine than after saline. In conclusion, intraarticular morphine produces analgesia of similar magnitude to dexamethasone and it may have antiinflammatory actions in chronic arthritis.
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PMID:Intraarticular morphine versus dexamethasone in chronic arthritis. 1056 61

In ten large, well-controlled, randomised trials (n = 203 to 1089), valdecoxib, a selective inhibitor of cyclo-oxygenase-2, was significantly more effective than placebo in the treatment of osteoarthritis, rheumatoid arthritis and pain associated with primary dysmenorrhoea, and for postsurgical analgesia. Valdecoxib 1.25 to 10mg twice daily and valdecoxib 10mg once daily were more effective than placebo for the relief of pain in patients with osteoarthritis of the knee, and dosages above 5mg twice daily were similar in efficacy to naproxen 500mg twice daily. Similarly, valdecoxib 5 and 10 mg/day were as effective for osteoarthritis of the hip as naproxen 500mg twice daily. In patients with rheumatoid arthritis, valdecoxib 10, 20 or 40 mg/day was significantly more effective than placebo, and similar in efficacy to naproxen 500mg twice daily; there were no significant differences in efficacy between the three dosages of valdecoxib. Valdecoxib 20 or 40mg administered 1 to 3 hours before and 12, 24 and 36 hours after hip arthroplasty provided significantly better analgesia than placebo, and significantly reduced the amount of morphine taken by patients. Single doses of valdecoxib 10 to 80mg administered before foot or oral surgery provided significantly better analgesia than placebo; when administered after oral surgery, valdecoxib 20 or 40mg provided greater sustained analgesia than oxycodone 10mg/paracetamol 1000mg or rofecoxib 50mg. In contrast to three nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), valdecoxib 40mg twice daily did not cause significant changes in platelet function and bleeding times. Chronic users of NSAIDs who were switched to valdecoxib 10 or 20 mg/day for 12 weeks experienced significantly fewer gastroduodenal erosions or ulcers than patients receiving ibuprofen 2400 mg/day or diclofenac 150 mg/day for 12 weeks. Valdecoxib was generally well tolerated in clinical trials, with a similar incidence of adverse events to placebo.
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PMID:Valdecoxib. 1226 50

Acupuncture treatment has been accepted worldwide. Many clinical trials have been conducted especially in analgesia. The present review includes almost all the important trials since 1970. Among all the pain conditions, postoperative pain, lower back pain, osteoarthritis of the knee and chronic headache are the most popular topics. We found that there are diverse conclusions in each condition; however, most trials agree that acupuncture is an effective therapeutic strategy for analgesia. As with regard to the placebo effect, there is no consensus. In chronic headache treatment, the placebo effect of acupuncture seems to be large. However, in osteoarthritis, the placebo effect is minimal. Another issue is the non-specific physiologic response to piercing the skin. We believe that this effect produces analgesia in some heterogeneous syndrome such as lower back pain. However, this effect is not superior to the specific therapeutic effect of acupuncture based on TCM theory in all the pain conditions reviewed here. We also notice that the design of the sham acupuncture or the placebo has great impact on the result. Rigorous design can minimize the non-specific and placebo effects of acupuncture. Therefore, the real effect of acupuncture can be investigated well. We conclude that acupuncture is a proven treatment for relieving pain. This conclusion is based on specific effects of acupuncture rather than placebo.
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PMID:Review: acupuncture analgesia in clinical trials. 1922 7

This study compares the efficacy of pain control using continuous femoral nerve block (FNB) and multimodal periarticular soft tissue injection. This is a randomized, crossover, clinical trial. Sixteen patients having bilateral osteoarthritis of the knee scheduled for staged total knee arthroplasty were randomized to receive either FNB (0.2% ropivacaine), via indwelling catheter for 72 hours, or multimodal periarticular soft tissue injection in the first stage. In the second stage, they received the opposite treatment. The primary outcome measure was morphine consumption by patient-controlled analgesia in the first 72 hours postoperatively. Cumulative morphine consumption as well as rest pain and motion pain in the first 72 hours was comparable between the 2 groups. The functional outcomes did not differ significantly. We conclude that multimodal periarticular soft tissue injection provides comparable analgesia to continuous FNB after total knee arthroplasty.
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PMID:Multimodal periarticular injection vs continuous femoral nerve block after total knee arthroplasty: a prospective, crossover, randomized clinical trial. 2232 63

Osteoarthritis is one of the most common joint diseases and is a major cause of chronic disability in the elderly, second only to cardiovascular disease. Although, in addition to important nonpharmacological measures, paracetamol is recommended as first-line therapy in osteoarthritis because of its analgesic efficacy and tolerability profile, its efficacy is often disappointing and the more recent guidelines from the European League Against Rheumatism (EULAR) highlight how NSAIDs may be a valid alternative in patients with an inadequate response to paracetamol. The American College of Rheumatology (ACR) 2000 guidelines state that NSAIDs may even be used as initial treatment in patients with osteoarthritis of the knee and moderate-to-severe pain and inflammation. Data from several clinical studies suggest that NSAIDs provide superior analgesia to paracetamol. Little evidence is available to distinguish one NSAID from another in terms of efficacy, whilst their gastrointestinal (GI) tolerability profile remains a main concern and a key discriminating factor in selecting a NSAID. Nimesulide is a NSAID with a multi-factorial mode of action which is particularly suitable in the symptomatic treatment of states characterised by acute pain, such as osteoarthritis flares. In particular, its proven efficacy, a fast onset of the analgesic action, its protective effect against the degradation of cartilage and a demonstrated low incidence of gastrointestinal adverse events compared with other NSAIDs make it a particularly valuable option in the symptomatic treatment of patients with joint osteoarthritis.
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PMID:Applying the evidence in osteoarthritis: strategies for pain management. 2339 87

The introduction of ultrasound guidance for regional anesthesia has resulted in an explosion of interest in its use for postoperative analgesia, particularly for orthopedic surgery. Regional anesthesia demonstrates unequivocal superiority compared with systemic opioids with respect to analgesia, reduced opioid consumption, increased patient satisfaction, and earlier achievement of discharge criteria. Improved acute postoperative analgesia can facilitate effective rehabilitation. Investigators are in the early stages of reporting the effects of regional anesthesia on functional outcome. Recent studies reporting functional outcomes have been plagued with sample sizes of inadequate power to generate meaningful results. Furthermore, the functional outcome measures are used inappropriately in terms of clinically meaningful difference, assessment intervals, and/or duration of follow-up. This report aims to address these issues by discussing functional outcomes used in the physiotherapy or orthopedic literature and their appropriate utilization, so that future research into the effects of regional anesthesia can be methodologically sound. Outcomes discussed include those that are physical-performance-based (ie, range of motion, quadriceps strength, Timed Up and Go test, 6-Minute Walk Test, Stair Time, and Self-paced Walk Test) and those that are self-reported (ie,Western Ontario and McMaster Universities Osteoarthritis Index, Knee Osteoarthritis Severity Score, Lower Extremity Function Scale).
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PMID:Reporting functional outcome after knee arthroplasty and regional anesthesia: a methodological primer. 2378 64