Articles: acute-pain.
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Cochrane Db Syst Rev · Mar 2012
Review Meta AnalysisSingle dose oral celecoxib for acute postoperative pain in adults.
This is an update of a review published in The Cochrane Library 2008, Issue 4. Celecoxib is a selective cyclo-oxygenase-2 (COX-2) inhibitor usually prescribed for the relief of chronic pain in osteoarthritis and rheumatoid arthritis. Celecoxib is believed to be associated with fewer upper gastrointestinal adverse effects than conventional non-steroidal anti-inflammatory drugs (NSAIDs). Its effectiveness in acute pain was demonstrated in the earlier reviews. ⋯ Single-dose oral celecoxib is an effective analgesic for postoperative pain relief. Indirect comparison suggests that the 400 mg dose has similar efficacy to ibuprofen 400 mg.
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Although opioids are widely accepted as standard therapy for treating acute postoperative pain, the frequent occurrence of adverse events (AEs) and the substantial burden on the patient and the costs of care are a barrier to optimal dosing and adherence to prescribed treatment. Coadministration of two opioids is not often recommended as a multimodal treatment option for moderate to severe acute pain because of lack of knowledge about the potential benefit of such combinations and due to potential concerns about side effects and doubts about the added benefits. Study results on the coadministration of two or more opioids demonstrate synergistic analgesia with a similar or lower incidence of opioid-related AEs. One such combination is morphine and oxycodone. ⋯ Thus, the dual-opioid combination product, morphine/oxycodone 3/2, compared with equianalgesic monotherapy doses of oxycodone or morphine may provide effective relief of moderate or severe post-surgical pain, while reducing the impact of AEs on patients and prescribers.
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Contemp Clin Trials · Mar 2012
Randomized Controlled Trial Multicenter Study Comparative StudyClinical trial implementation and recruitment: lessons learned from the early closure of a randomized clinical trial.
The NHLBI-sponsored Sickle Cell Disease Clinical Research Network (SCDCRN) conducted a multi-center, acute intervention randomized clinical trial of two methods of Patient Controlled Analgesia for acute pain. This trial was terminated early due to low enrollment. We analyzed the perceived barriers and recruitment difficulties as reported by the coordinators and principal investigators. ⋯ We identified multiple barriers to patient accrual including short duration of enrollment period, protocol design, complex dosing schedule, requirement for staff availability during week-end and after hours, multiple departments' involvement, protocol acceptance, eligibility criteria, competing protocols, and limited staff. Each of these areas should be targeted for intervention in order to plan and conduct successful future clinical trials.