Chronic Pain - Related Resources

Cochrane reviews

Topical low concentration capsaicin cream may not have a clinically significant effect over placebo in reducing chronic neuropathic pain, and it appears to cause frequent adverse events Topical Capsaicin (Low Concentration) for Chronic Neuropathic Pain in Adults.
For patients with inadequate pain relief and intolerable adverse effects when using an opioid for chronic pain, a switch to an alternative opioid seems to be an effective option although there is no evidence from controlled trials Opioid Switching to Improve Pain Relief and Drug Tolerability.
Intravenous lidocaine and its oral derivatives are effective and safe drugs for neuropathic pain Systemic Administration of Local Anesthetics to Relieve Neuropathic Pain.
Lamotrigine appears not to be beneficial in chronic pain conditions and neuropathic pain Lamotrigine for Acute and Chronic Pain.
Antipsychotics may be used as an add-on therapy for treatment resistant pain. Adverse effects, especially the extrapyramidal and sedating effects, have to be considered Antipsychotics for Acute and Chronic Pain.
Cognitive behavioural therapy may have small to moderate effects on pain, disability, mood and catastrophising immediately post-treatment compared to usual care/waiting in adults with chronic painPsychological Therapies for the Management of Chronic Pain in Adults.

National Institute for Health and Clinical Excellence. Pain (chronic neuropathic or ischaemic) - spinal cord stimulation. 2008. (NICE Technology appraisal No 159.) http://www.nice.org.uk/Guidance/TA159
National Institute for Health and Clinical Excellence. Neuropathic pain: the pharmacological management of neuropathic pain in adults in non-specialist settings. http://guidance.nice.org.uk/CG96

Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, Nurmikko T. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 2010 Sep;17(9):1113-e88. [PubMed]
Freynhagen R, Bennett MI. Diagnosis and management of neuropathic pain. BMJ 2009 Aug 12;339():b3002. [PubMed]
Kemler MA, Barendse GA, van Kleef M, de Vet HC, Rijks CP, Furnée CA, van den Wildenberg FA. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med 2000 Aug 31;343(9):618-24. [PubMed]
SBU (Swedish Council on Technology Assessment in Health Care). Methods of treating chronic pain. Systematic review. SBU Report No. 177/1+2, 2006 http://www.sbu.se/upload/Publikationer/Content1/1/chronic_pain_summary.pdf
North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery 2005;56(1):98-106; discussion 106-7. [PubMed]
Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, Thomson S, O'Callaghan J, Eisenberg E, Milbouw G, Buchser E, Fortini G, Richardson J, North RB. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain 2007 Nov;132(1-2):179-88. [PubMed]

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