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Paracetamol (acetaminophen) alone, or in combination with codeine or dihydrocodeine, for neuropathic pain in adults

There is no good evidence to support or refute the suggestion that paracetamol alone, or in combination with codeine or dihydrocodeine, works in any neuropathic pain condition.

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

Version: 2017

Single dose oral codeine, as a single agent, for acute postoperative pain in adults

This review assessed evidence from 2411 adults with moderate to severe postoperative pain in studies comparing single doses of codeine 60 mg with placebo. The number of individuals achieving a clinically useful amount of pain relief (at least 50%) with codeine compared to placebo was low. In all types of surgery combined, 12 participants would need to be treated with codeine 60 mg for one to experience this amount of pain relief who would not have done so with placebo. The need for use of additional analgesia within 4 to 6 hours was 38% with codeine compared with 46% with placebo, and the mean time to the use of additional analgesia was only slightly longer with codeine (2.7 hours) than with placebo (2 hours). More individuals experienced adverse events with codeine than with placebo, but the difference was not significant and none were serious or led to withdrawal. Other commonly used analgesics, alone and in combination with codeine 60 mg, provide better pain relief. Higher doses of codeine were not investigated in these studies.

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

Version: 2011

Use of antimotility drugs (Loperamide, Diphenoxylate, Codeine) to control prolonged diarrhoea in people with HIV/AIDS.

People with HIV/AIDS often develop prolonged diarrhoea which are sometimes not caused by infections. This is more so in the sub‐Saharan Africa where drugs for controlling HIV itself i.e. antiretroviral drugs (ARV) may not be widely available or affordable. prolonged diarrhoea often results in prolonged illness and death due to loss of fluids, if not treated effectively and on time. Antimotility drugs and adsorbents are readily available and are used to try to control this condition while efforts are made to receive ARVs. We did not find enough evidence to support or refute their use in controlling this condition.

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

Version: 2008

Single dose oral ibuprofen plus codeine for acute postoperative pain in adults

Acute pain is often felt soon after injury. Most people who have surgery have moderate or severe pain afterwards. Painkillers are tested in people with pain, often following the removal of wisdom teeth. This pain is usually treated with painkillers taken by mouth. Results can be applied to other forms of acute pain.

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

Version: 2016

Codeine, alone and with paracetamol (acetaminophen), for cancer pain

Codeine is an opioid medication commonly used worldwide to treat pain including cancer pain. Oral codeine, either alone or in combination with paracetamol, provided good pain relief for some people with cancer pain, based on limited amounts of information.

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

Version: 2016

Single dose oral paracetamol (acetaminophen) plus codeine for postoperative pain relief in adults

Pain is commonly experienced after surgical procedures, and is not always well controlled. Combining analgesics from different classes has the potential to provide adequate pain relief with reduced dose‐dependent adverse events. This review assessed data from twenty‐six studies comparing paracetamol plus codeine with placebo, and fourteen studies comparing paracetamol plus codeine with the same dose of paracetamol alone. The combination provided effective pain relief for about 40% of participants experiencing moderate to severe pain after an operation with 600 to 650 mg paracetamol plus 60 mg codeine, the dose most commonly used in these studies, and about 50% of participants with 800 to 1000 mg paracetamol plus 60 mg codeine, the dose most commonly used in clinical practice. The addition of codeine provided effective pain relief to about 10% more participants than the same dose of paracetamol alone. These single dose studies did not associate paracetamol plus codeine with any serious side effects.

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

Version: 2016

Codeine for the treatment of chronic cough in children

We sought to answer the question of whether codeine (or medications produced from codeine) are safe and effective in the treatment of chronic cough (four weeks or longer) in children.

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

Version: 2016

Impact of morphine, fentanyl, oxycodone or codeine on patient consciousness, appetite and thirst when used to treat cancer pain

Care pathways are packages of care designed to ensure that patients have appropriate and effective care in particular situations. Such pathways are commonly used, and often produce good results, but they can also be used as a tick box solution that acts as a barrier to good care. Care pathways have been used to ensure appropriate care for people who are dying in hospice settings.

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

Version: 2015

Dihydrocodeine in a single dose in the treatment of acute postoperative pain

This review assessed the efficacy of single‐dose dihydrocodeine in adults with moderate/severe postoperative pain using information from randomised placebo controlled trials. There was a lack of data that could be included in the analyses; all assessed the oral form of the drug and none assessed dihydrocodeine 60 mg. The results were not robust. The implication was that single‐dose oral dihydrocodeine 30 mg was more effective than placebo, but was inferior to ibuprofen 400 mg. Dizziness, drowsiness and confusion were commonly reported.

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

Version: 2011

Single dose oral fenoprofen for acute postoperative pain in adults

Fenoprofen is a non‐steroidal anti‐inflammatory drug (NSAID) that is used as a painkiller (analgesic). Five studies looking at a total of 696 participants were included. Because fewer than 200 participants were treated with any one dose of fenoprofen within each study, results must be treated with caution. A good level of pain relief was experienced by better than one in two (over half; 57%) of those with moderate or severe postoperative pain after a single dose of fenoprofen 200 mg, compared to about 1 in 7 (14%) with placebo. This level of pain relief is comparable to that experienced with ibuprofen 400 mg. The frequency of adverse events did not differ between fenoprofen 200 mg and placebo in these studies.

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

Version: 2015

Oral aspirin for treatment of acute episodic tension‐type headache in adults

This review found only very low quality evidence that people with 2 to 14 tension‐type headaches a month get good pain relief from taking aspirin 1000 mg or lower doses. There are questions about how studies of this type of headache are conducted. These questions involve the type of people chosen for the studies, and the types of outcomes reported. This limits the usefulness of the results, especially for people who just have an occasional headache.

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

Version: 2017

Pain relief for after pains (uterine cramping/involution) after the baby's birth

Women may experience cramping pain and discomfort following the birth of their baby as the uterus contracts and returns to its pre‐pregnancy size. These after pains are caused by involutionary contractions and usually last for two to three days after childbirth. They are more evident for women who have previously had a baby. Breastfeeding stimulates the uterus to contract and increases the severity of after birth pains. This review is about pain relief for after pains experienced by women following vaginal birth.

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

Version: 2011

Opioid therapy for treating rheumatoid arthritis pain 

This summary of a Cochrane review presents what we know from research about the effect of opioids for treating rheumatoid arthritis pain.

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

Version: 2012

Interventions for cough in patients with cancer

Cough is a distressing symptom in patients with cancer and is difficult to manage in practice. Hence, the aim of this review was to assess and synthesise the available literature on the management of cough in cancer patients in order to improve practice recommendations. Studies with chemotherapy or radiotherapy were excluded. An extensive literature search yielded 17 studies for evaluation. For this update, we did not identify any additional studies for inclusion. Eight of the studies were about the use of brachytherapy (a technique where a radiation source is placed inside the bronchus in the lung for lung cancer or next to the area requiring treatment), use of laser resection or photodynamic therapy (a treatment that uses a drug plus a special type of light to kill cancer cells). Nine studies assessed the effects of a number of different medications, including codeine and morphine. Overall, the research was of poor quality with significant methodological problems, hence no credible evidence was available in the literature to guide practice. Acknowledging these limitations, brachytherapy in a variety of radiation doses was found to be helpful in selected patients. Some pharmacological treatments were found to be helpful, in particular morphine, codeine, dihydrocodeine, levodropropizine, sodium cromoglycate and butamirate citrate linctus (a cough syrup), although all studies had significant risk of bias and some reported side effects. No practice recommendations could be drawn from this review. There is an urgent need to increase the number and quality of studies evaluating the effects of interventions for the management of cough in cancer.

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

Version: 2015

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

Morphine‐like drugs for cancer pain

In about 19 of 20 people with moderate to severe pain from cancer, morphine‐like drugs (opioids) can probably reduce pain to mild or no pain within 14 days if they can tolerate the side effects. Most people will have side effects, and about 1 in 10 to 2 in 10 will need to change their treatment because of side effects.

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

Version: 2017

Oral painkillers available without prescription for acute pain

Acute pain is often felt soon after injury, and is of short duration. Most people who have surgery have moderate or severe pain afterwards. Painkillers (analgesics) are tested in people with pain, often following the removal of wisdom teeth. Study participants have to have at least moderate pain levels and the pain is usually treated with painkillers taken by mouth. This overview is useful mainly for acute pain lasting only a few days or weeks, and not for chronic pain lasting for many months. For this overview we have not included information from reviews on migraine, tension headache, or period pain.

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

Version: 2015

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

Opioids for cancer‐related pain in children and adolescents

There is no evidence from randomised controlled trials to support or contradict the suggestion that opioids in any dose will reduce cancer‐related pain in children or adolescents.

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

Version: 2017

Single dose oral aceclofenac for postoperative pain in adults

Pain is commonly experienced after surgical procedures. Acute postoperative pain of moderate or severe intensity is often used (as a model) to test whether or not drugs are effective painkillers. In this case we could find only a single study testing oral aceclofenac 150 mg against placebo, and aceclofenac was not statistically better than placebo. It is possible that other studies were done, possibly at larger or more effective doses, but not reported because they were used only to register aceclofenac with licensing authorities throughout the world. However, this leaves an important gap in our knowledge, and it means that we cannot be confident about using oral aceclofenac for acute painful conditions.

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

Version: 2011

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