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Non‐steroidal anti‐inflammatory drugs, including aspirin and paracetamol (acetaminophen) in people taking methotrexate for inflammatory arthritis

This summary of a Cochrane review describes what we know from research about any safety issues from using non‐steroidal anti‐inflammatory drugs, or NSAIDs, including aspirin, or paracetamol (acetaminophen), or both, along with methotrexate in people with inflammatory arthritis.

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

Version: 2011

Tramadol with or without paracetamol (acetaminophen) for cancer pain

No firm conclusions could be drawn about the effectiveness or harms of tramadol, alone or with paracetamol, in cancer pain.

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

Version: 2017

Low back pain: Medication for chronic back pain

Over-the-counter painkillers can sometimes relieve chronic low back pain. Studies have also found that some prescription painkillers like opioids may have a benefit. There is no proof that muscle relaxants or antidepressants help relieve chronic low back pain.Low back pain is one of the ten most common diagnoses made by family doctors. It often goes away on its own without treatment, but sometimes it persists or keeps coming back. The causes of chronic low back pain are usually unclear, and treating it is often difficult.Good-quality studies have so far found that only few treatments help. Besides medication, treatments such as exercise therapy, psychological therapy, physiotherapy and acupuncture are used. The medications used include over-the-counter and prescription painkillers, muscle relaxants and antidepressants.Because medication can have side effects – especially when taken over longer periods of time – experts recommend not taking it continuously, but rather only for a short while, for example if the pain is especially severe.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 2, 2015

Medication for migraines

Migraine attacks can be treated with painkillers or migraine medication. If needed, medicine for nausea and vomiting can be taken as well. But if painkillers are taken too often they themselves may cause headaches.Lying down in a dark, cool room may be enough to relieve mild migraines. Migraines are usually very painful, though, so most people take medication to get through them. Over-the-counter painkillers may be effective enough for moderate pain. Stronger medication is sometimes needed for severe migraines.  If you often have migraines, it is a good idea to have different kinds of medicine on hand.The following medications can be used to treat migraine:The group of painkillers known as NSAIDs (non-steroidal anti-inflammatory drugs) and acetaminophen (paracetamol)Anti-nausea medication Special migraine medication (triptans and ergotamines)

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 19, 2015

Medication for the treatment of rheumatoid arthritis

People with rheumatoid arthritis typically have permanent inflammation in several joints. The joints are painful and swollen, and gradually stiffen. Rheumatoid arthritis usually progresses slowly over many years. The aim of treatment with medication is to relieve the symptoms and prevent the progression of the disease as much as possible.In rheumatoid arthritis, various kinds of medication are used to relieve the symptoms, reduce the inflammation and to keep the joints working properly for as long as possible. There are two types of therapy: disease-modifying therapy and symptomatic therapy.Disease-modifying therapy: These medications are taken regularly for longer periods of time independent of any acute symptoms. They are known as “disease-modifying anti-rheumatic drugs” or “DMARDs” for short. Disease-modifying drugs inhibit inflammatory responses in the joints of people with rheumatoid arthritis. In this way they can at best stop – or at least delay – the progression of the disease, preventing damage to the joints. Their effect is often only noticeable after one to four months of treatment. DMARDs can be divided up into “conventional” and “biological” disease-modifying drugs.Symptomatic therapy: Medications used in symptomatic therapy are taken to relieve acute pain and inflammation. The main ones are non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen (also called paracetamol), and steroids (corticosteroids).

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 27, 2016

Use of drug and non‐drug interventions to reduce pain associated with rocuronium bromide injection in patients undergoing general anaesthesia

Rocuronium bromide is a muscle relaxant used as part of general anaesthesia for surgery. Muscle relaxants are used to relax the muscles of the airway to enable endotracheal intubation (placing a breathing tube in the windpipe to support the airway while the person is unconscious) and to facilitate the surgery. However, rocuronium bromide can cause intense pain as it is injected in some people. We wanted to find out whether giving another drug, such as a painkiller or another anaesthetic, or a non‐drug intervention, such as diluting the rocuronium, would be useful in reducing the pain experienced by some people on injection of rocuronium.

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

Version: 2016

Does a local anaesthetic injection in children and young people having dental treatment under general anaesthetic reduce pain after treatment?

It can be difficult when giving dental treatment to children and young people to do it simply using a local anaesthetic (LA) injection. The problem is often that they are too anxious or that they need a lot of treatment at once: For example, they may need many teeth taken out at the same time. In these circumstances, a dental practitioner commonly uses a general anaesthetic (GA) and administers the treatment in a hospital. In England, there are over 30,000 hospital admissions per year for children who need teeth taken out under a GA.

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

Version: 2015

Using medication: The safe use of over-the-counter painkillers

Many painkillers are available from pharmacies without a prescription. They can provide effective pain relief, but might also cause side effects or complications. In order to use them safely, it is important to pay attention to the dose and interactions with other medicinal products.Over-the-counter painkillers available from pharmacies, such as ibuprofen or acetaminophen (paracetamol), can relieve acute pain. Their effectiveness will depend on things like the type and severity of the pain and the dose of the medication. Painkillers that are available without a prescription have been approved for the treatment of mild to moderate pain. They shouldn't be used for more than a few days in a row, and the specified maximum daily dose shouldn't be exceeded.Painkillers can have side effects and – in rare cases – lead to complications. In order to avoid adverse effects, it is important to make sure you use them properly. This is particularly true for people who have certain medical conditions or use painkillers regularly. A medication's package insert contains detailed information about its areas of use, the correct doses and how long you can use it for.  You can also ask your doctor or pharmacist about how to use it properly.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 6, 2016

Slipped disk: Non-surgical treatment options

Most people with a slipped disk are offered “conservative” treatment, meaning that the treatment does not involve surgery. This mainly involves exercise, relaxation and positioning, painkillers or local anesthetics, and manual and physical therapy.Some slipped disks don't cause any symptoms, whereas others lead to severe back pain. A slipped disk in the lumbar region of the spine (the lower back) can press on the sciatic nerve and cause pain that often radiates down one leg and into the foot. Most people recover from a slipped disk within six weeks without treatment. Until then there are a number of treatment options that aim to help relieve the pain and improve mobility.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 1, 2017

What are the treatment options for non-specific neck pain?

It is often not clear what is causing neck pain. If no clear cause can be found, there are a lot of treatment options that can be tried out. These include applying heat or cold, doing neck exercises and taking painkillers. But only a few of these treatments have been shown to help in good-quality studies.Neck pain usually goes away on its own within a few days or weeks. In most cases no clear cause can be found. It is then referred to as "non-specific neck pain." Sometimes neck pain lasts longer and may become chronic. It is considered to be chronic if it lasts longer than three months.Although non-specific neck pain is very common, only a few good-quality studies have looked at the various treatment options. None of the treatment options have been clearly shown to provide long-term neck pain relief.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 2, 2015

Noninvasive Treatments for Low Back Pain: A Summary of the Research for Adults

This summary will answer these questions: What is low back pain? How is low back pain treated? » Medicines » Nonmedicine treatments such as heat, exercise, and massage What have researchers found about treatments for low back pain? What are possible side effects of medicines to treat low back pain? What should I discuss with my health care professional about treating my low back pain?

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

Version: November 15, 2016

What is anti-clotting medication and how is it used safely?

Anti-clotting medication is used to prevent blood clots from forming, and therefore lower the risk of certain cardiovascular diseases like heart attacks and strokes. As the name suggests, they make sure that the blood does not clot as quickly.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 26, 2014

Testing Treatments: Better Research for Better Healthcare. 2nd edition

How do we know whether a particular treatment really works? How reliable is the evidence? And how do we ensure that research into medical treatments best meets the needs of patients? These are just a few of the questions addressed in a lively and informative way in Testing Treatments. Brimming with vivid examples, Testing Treatments will inspire both patients and professionals.

Pinter & Martin.

Version: 2011

Non‐surgical treatment for spinal stenosis with leg pain

We reviewed the evidence on the effectiveness of non‐surgical treatments for people with leg pain caused by pressure on the nerves in the spine.

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

Version: 2013

Pain tablets taken by mouth for post‐caesarean pain

Tablets are convenient and easy to take to ease the pain after caesarean section, which involves cutting through the abdomen and uterus to deliver the baby. We aimed to assess the effectiveness, safety and cost‐effectiveness of different types of tablets for the pain. Different types of pain tablets relieve the pain in different ways. Opioids decrease the feeling of pain, decrease reaction to pain as well as increase pain tolerance by their action on the nervous system. Some non‐opioid pain tablets act on the tissues to reduce the response to the inflammatory substances released at the site of tissue damage. Combination drugs (such as paracetamol and codeine) may have more pronounced effects because of the different mechanism of action of their components. We do not know how some other tablets, such as alpha‐2 agonists (clonidine) and gabapentin (usually used for nerve pain that follows shingles and long‐term pain) relieve pain. Good pain control may shorten the time spent in hospital after caesarean section, improve satisfaction and reduce healthcare costs.

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

Version: 2015

Migraine prevention in adults

The symptoms of migraine attacks can usually be relieved with painkillers or migraine medication. People who have migraines would usually prefer to stop them from happening in the first place, though. Keeping a migraine diary can help identify possible triggers. Preventive treatment can reduce the number of migraine attacks.Most people with migraine have a type known as episodic migraine, where the attacks occur more or less regularly. Fewer than 2% of people with migraine have a different type known as chronic migraine. This is where the migraine headaches occur on 15 or more days per month over a period of three months or more.Migraine attacks are very painful and can have a major impact on quality of life. Many people with migraine would like to do something themselves to prevent attacks from happening in the first place. A number of different preventive measures can be taken. For instance, some people try to avoid possible migraine triggers. Others learn relaxation techniques or try out an endurance sport. Taking preventive medicine every day is another option.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 18, 2015

Sipuleucel-T (Provenge) for metastatic prostate cancer: Overview

Sipuleucel-T (trade name: Provenge) has been approved in Germany since September 2013 for the treatment of metastatic prostate cancer in men who have no or only few symptoms and do not need chemotherapy yet.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 2, 2015

Sweet‐tasting solutions for needle‐related pain in infants up to one year of age

The use of needles that break the skin and cause pain is a common practice around the world with babies aged between one month and 12 months (Appendix 4). In this review we were interested in whether giving babies sugar‐based solutions to taste when the needle breaks the skin will help reduce their pain.  We found 14 separate studies that had asked this question. However, the differences between the studies were often too great to let us combine their findings.  Overall, the studies show that different types of sugar‐based solutions were effective but we were not able to confidently assert that there is strong evidence for this treatment in reducing pain.  We did find some evidence that babies may not cry for as long if given sugar‐based solutions. This review is broadly in agreement with two other reviews, one asking this question in younger children, and one in older children. There is a need for better studies in this field.

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

Version: 2016

Chickenpox: Overview

The typical signs of chickenpox are a very itchy skin rash with red blisters and a mild fever. This contagious viral infection mainly affects preschool and school-age children between the ages of two and ten. Chickenpox is unpleasant, but it rarely leads to any serious complications in otherwise healthy children.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 6, 2017

Managing Pain From a Broken Hip: A Guide for Adults and Their Caregivers

You or the person you care for is an older adult (more than 50 years old) who is in a hospital because of a hip fracture (a broken hip that occurs suddenly from an event like a fall).

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

Version: May 17, 2011

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