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Treats various types of severe pain. Also used during anesthesia. This medicine is a narcotic analgesic (pain medicine).

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Results: 18

Does the administration of nalbuphine provide effective and safe postoperative pain treatment in children?

Postoperative pain is still a major problem following surgery in children. There is currently clear evidence that multimodal postoperative pain treatment is the best choice. This approach may involve using nonsteroidal anti‐inflammatory drugs (NSAIDs) and opioids. However, due to the fear of side effects such as respiratory depression (where the lungs cannot provide enough oxygen), opioids are not frequently used for postoperative pain treatment in children. Nalbuphine may provide effective pain relief without causing respiratory depression. In this review, we investigated how well nalbuphine worked, compared to placebo and other opioids, in children with postoperative pain. We also looked at the side effects. We performed a systematic literature search in July 2013. Ten randomised controlled trials with 658 patients were included. The patients were children aged from 0 ‐ 18 years and most did not have any other relevant medical conditions. The overall quality of evidence was low, so this review could not definitively show that nalbuphine is better than placebo. The same holds true for the comparison with other opioids (morphine, tramadol, pethidine, piritramid). We were not able to comment on side effects due to the small numbers of participants in the trials. Future studies need to address these issues, including more robust data for effectiveness and side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Mu‐opioid antagonists in the treatment of bowel dysfunction as a result of previous treatment by opioids

There is insufficient evidence to show that new opioid antagonists are effective in treating constipation due to strong analgesics. Opioids (morphine‐like drugs) are substances used to treat severe pain. They cause many side effects, and frequently affect the stomach and bowels. Opioid‐induced bowel dysfunction (OBD) is a recently coined term used to describe constipation, incomplete evacuation of the bowels, bloating, and increased reflux of stomach contents. OBD occurs both with short and long term use of opioids, in patients with many types of diseases, and causes increased disease and reduced quality of life. Traditional opioid antagonists (drugs that block the receptors which opioids bind to) can be used to reverse many of the side effects of opioids, including constipation, but because they block opioid receptors in the brain, they may also reverse reduction of pain. The search for opioid antagonists that act only in the gut ("peripherally active" antagonists), therefore not reversing reduction of pain, has produced two new drugs, methylnaltrexone and alvimopan, which are at an advanced phase of development. There is not enough information to make firm conclusions about the safety or effectiveness of traditional opioid antagonists in the treatment of OBD. Alvimopan and methylnaltrexone both show promise in treating OBD, but further data will be required to fully assess their effectiveness.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Chest Pain of Recent Onset: Assessment and Diagnosis of Recent Onset Chest Pain or Discomfort of Suspected Cardiac Origin [Internet]

Chest pain or discomfort caused by acute coronary syndromes (ACS) or angina has a potentially poor prognosis, emphasising the importance of prompt and accurate diagnosis. Treatments are available to improve symptoms and prolong life, hence the need for this guideline.

NICE Clinical Guidelines - National Clinical Guideline Centre for Acute and Chronic Conditions (UK).

Version: March 2010
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The use of opioid intramuscular and intravenous pain relieving drugs in labour

Pain during labour is normal and its management is influenced by an interaction between a woman's mental and emotional state and the physiological changes that occur during labour. The use of pain‐relieving drugs during labour is now part of standard care in many countries throughout the world. In recent years, many women in Western countries have chosen to have epidural analgesia to relieve pain. However, some women prefer not to have an epidural, or in some settings an epidural is not available. In many maternity units intramuscular injections of opioid drugs are widely used for pain relief in labour and options for intravenous infusions may also be available. The opioid drugs used include pethidine (also known as meperidine or demerol), diamorphine, nalbuphine, butorphanol, meptazinol, pentazocine, fentanyl and tramadol, and are relatively inexpensive. It is not clear how effective these drugs are, which opioid is best, and how unpleasant side effects (such as vomiting or sleepiness) or harm to women or their babies can be avoided.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Opioids for agitation in dementia

Opioids (such as morphine and codeine) are strong painkillers best known as treatments for post‐surgical and cancer pain. They are also used for long‐term painful conditions other than cancer and sometimes for symptoms other than pain. They have a number of important adverse effects and their use involves a balance of risks and benefits.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Acute Migraine Treatment in Emergency Settings

In response to a request from the public about treatment of adults with migraines in emergency departments (EDs) or other emergency settings, the Agency for Healthcare Research and Quality (AHRQ) funded the University of Alberta Evidence-based Practice Center to develop a systematic review of the literature to summarize the evidence regarding the comparative effectiveness of parenteral medicines for adults who present to the ED with migraine. The systematic review included 71 clinical studies published through January 5, 2012. This summary is provided to assist in decisionmaking along with a patient's values and preferences. Reviews of evidence should not be construed to represent clinical recommendations or guidelines. An online version of this summary provides links directly to the sections of the full report with references for individual findings, inclusion criteria for the studies, and an explanation of the methods for rating the studies and determining the strength of evidence for individual findings. The online version of this summary and the full report are available at www.effectivehealthcare.ahrq.gov/migraine-emergency.cfm.

Comparative Effectiveness Review Summary Guides for Clinicians [Internet] - Agency for Healthcare Research and Quality (US).

Version: September 19, 2013

Does the perioperative administration of tramadol provide effective and safe postoperative analgesia in children?

Children experience pain after surgery (‘postoperative pain’) and according to recently published trials the management of this pain is of major concern. A combination of drugs may be the best way to treat postoperative pain, for example drugs called ‘opioids’, like morphine and codeine. However, there are concerns about severe side effects (adverse events) when using opioids. Tramadol is a weak opioid that is used worldwide to treat children with moderate to severe acute or chronic pain. Tramadol can be given to children before surgery to help reduce pain afterwards. It is believed that tramadol administration might be associated with a lower risk for respiratory or haemodynamic depression and might therefore be the ideal analgesic drug for children in the perioperative period. Our systematic review assessed the efficacy and adverse events of tramadol administration compared to placebo or other opioids. In July 2014 we found 20 small randomised controlled trials involving 1170 patients. These small trials had limited data but tramadol may be better than placebo. In five trials, mostly preschool children undergoing minor surgery (for example tonsillectomy) were treated with tramadol or placebo before the start of surgery. Children needed less rescue medication in the postoperative care unit when given tramadol, indicating better analgesia with tramadol. Due to the low amount of usable data, the evidence focusing on the comparison of tramadol with other opioids (for example morphine, nalbuphine, pethidine, fentanyl) is currently unclear. Adverse events were generally only poorly reported in the trials so that the side effects as a result of tramadol administration were not clear.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Pain control in first trimester surgical abortion.

Multiple methods of pain control in first trimester surgical abortion at less than 14 weeks gestational age using electric or manual suction aspiration are available, and appear both safe and effective. Pain control methods can be divided in local anesthesia, conscious sedation, general anesthesia and non‐pharmacological methods. Data to support the benefit of the widely used local aneathetic is inadequate. While general anesthesia achieved complete pain control during the procedure, other forms of anesthesia such as conscious sedation with a paracervical block improved postoperative pain control.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Acute Migraine Treatment in Emergency Settings [Internet]

To compare the effectiveness and safety of parenteral pharmacological interventions to treat migraine headaches in adults presenting to the emergency department (ED).

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: November 2012
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Treating Severe Migraine Headaches in the Emergency Room: A Review of the Research for Adults

This summary will cover: What migraine headaches are Medicines to treat severe migraines in the ER What researchers have found about how well the medicines work Possible side effects of the medicines Things to talk about with the ER doctor

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: September 19, 2013

The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain

Chronic pain is common and use of long-term opioid therapy for chronic pain has increased dramatically. This report reviews the current evidence on effectiveness and harms of opioid therapy for chronic pain, focusing on long-term (≥1 year) outcomes.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: September 2014
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Sickle Cell Acute Painful Episode: Management of an Acute Painful Sickle Cell Episode in Hospital

This guideline addresses the management of an acute painful sickle cell episode in patients presenting to hospital until discharge. This includes the use of pharmacological and non-pharmacological interventions, identifying the signs and symptoms of acute complications, skills and settings for managing an acute painful episode, and the information and support needs of patients.

NICE Clinical Guidelines - National Institute for Health and Clinical Excellence (UK).

Version: June 2012
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Pain (PDQ®): Health Professional Version

Expert-reviewed information summary about pain as a complication of cancer or its treatment. Approaches to the management and treatment of cancer-associated pain are discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 16, 2015

Nitrous Oxide for the Management of Labor Pain [Internet]

The Vanderbilt Evidence-based Practice Center systematically reviewed evidence addressing the use of nitrous oxide for the management of labor pain.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: August 2012
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The Clinical Effectiveness and Cost-Effectiveness of Management Strategies for Sciatica: Systematic Review and Economic Model

Sciatica is a symptom characterised by well-localised leg pain with a sharp, shooting or burning quality that radiates down the back of the leg and normally to the foot or ankle. It is often associated with numbness or altered sensation in the leg.

Health Technology Assessment - NIHR Journals Library.

Version: November 2011
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Stable Angina: Methods, Evidence & Guidance [Internet]

Angina is pain or constricting discomfort that typically occurs in the front of the chest (but may radiate to the neck, shoulders, jaw or arms) and is brought on by physical exertion or emotional stress. It is the main symptomatic manifestation of myocardial ischaemia and is usually caused by obstructive coronary artery disease restricting oxygen delivery to the cardiac myocytes. Other factors may exacerbate angina either by further restricting oxygen delivery (for example severe anaemia) or by increasing oxygen demand (for example left ventricular hypertrophy). Angina symptoms are associated with other cardiac disease such as aortic stenosis but the management of angina associated with non-coronary artery disease is outside the scope of this guideline.

NICE Clinical Guidelines - National Clinical Guidelines Centre (UK).

Version: July 2011
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Induction of Labour

The purpose of this guideline is to review all aspects of the methodology of induction of labour and the appropriateness of different approaches in the various clinical circumstances that may call for such an intervention.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: July 2008
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Pharmacological treatment of post-anesthetic shivering: a systematic review and meta-analysis

This review concluded that meperidine, tramadol, clonidine, ketanserin, doxapram, and nalbuphine were effective for treating post-anaesthetic shivering within 15 minutes; drugs were generally tolerated. However, clonidine was not shown to be efficacious in the results of the review. This, along with other limitations, suggest the authors' conclusions should be interpreted cautiously as they do not appear to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Systematic Reviews in PubMed

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