The Journal of rheumatology. Supplement
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To determine the efficacy and safety of opioid analgesics in inflammatory arthritis (IA). ⋯ Based on 11 heterogeneous studies of short duration and high risk of bias, there is weak evidence that opioids are effective analgesics in RA. AE are common and may offset the benefits. The relative risks and benefits of opioids in IA beyond 6 weeks are unknown.
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Review Comparative Study
Pain pharmacotherapy in patients with inflammatory arthritis and concurrent cardiovascular or renal disease: a Cochrane systematic review.
Pain in inflammatory arthritis (IA) is common and often multifactorial, and many different pharmacotherapeutic agents are routinely used for pain management. There are concerns that some current pain pharmacotherapies may increase the risk of adverse events in patients with concurrent cardiovascular (CV) or renal disease. ⋯ Our review has highlighted a lack of specific evidence to guide clinicians in the management of pain in patients with IA and coexistent CV or renal disease. In the absence of this evidence, we suggest clinicians use nonsteroidal antiinflammatory drugs (NSAID) with caution in patients with preexisting CV disease or ≥ 2 CV risk factors. There is currently no evidence to advise clinicians considering other pain pharmacotherapies in the context of CV comorbidities. Current guidelines regarding the use of NSAID and opioids in moderate to severe renal impairment should also be applied to the IA population.
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Review
The efficacy and safety of muscle relaxants in inflammatory arthritis: a Cochrane systematic review.
To determine the efficacy and safety of muscle relaxants in pain management in patients with inflammatory arthritis (IA). ⋯ Based upon the currently available evidence in patients with IA, benzodiazepines (diazepam and triazolam) do not appear to be beneficial in improving pain over 24 hours or 1 week. The non-benzodiazepine agent zopiclone also did not significantly reduce pain over 2 weeks. However, even short-term muscle relaxant use (24 hours to 2 weeks) is associated with significant adverse events, predominantly drowsiness and dizziness.
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Review
Efficacy and safety of neuromodulators in inflammatory arthritis: a Cochrane systematic review.
To determine the efficacy and safety of neuromodulators for pain management in patients with inflammatory arthritis. ⋯ Based on 3 small trials, which were all at high risk of bias, there is weak evidence that nefopam and capsaicin are superior to placebo in reducing pain in patients with RA, but both are associated with a significant side effect profile. There are no available data for other types of IA or for newer agents such as gabapentin or pregabalin.
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Review
Combination therapy for pain management in inflammatory arthritis: a Cochrane systematic review.
To assess the efficacy and safety of combination pain therapy for people with inflammatory arthritis (IA). ⋯ Based on 23 trials, all at high risk of bias, there is insufficient evidence to establish the value of combination therapy over monotherapy for pain management in IA. Well-designed trials are needed to address this question.