bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral tramadol in postoperative pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Clinical bottom line. Tramadol is an effective analgesic in postoperative pain. A single 100 mg oral dose of tramadol is equivalent to 1000 mg paracetamol. A dose of 100 mg had an NNT of 4.6 (3.6–6.4) for at least 50% pain relief over 4–6 h in patients with moderate to severe pain compared with placebo. At doses of 50 and 100 mg incidence of adverse effects (headache, nausea, vomiting, dizziness and somnolence) was similar to comparator drugs. In dental trials there was increased incidence of vomiting, nausea, dizziness and somnolence.
Paracetamol plus tramadol for acute pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Clinical bottom line. Based on somewhat limited information, a combination of paracetamol plus tramadol is an effective analgesic in acute postoperative pain. The NNT compared with placebo over 6 h was about 2.7. The combination of tramadol with paracetamol is not commonly available for prescription, but has recently (2002) become available in the USA. The exact dosage strengths in the combinations may vary from country to country, so affecting its efficacy.
Oral rofecoxib in postoperative pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Clinical bottom line. Rofecoxib is an effective analgesic in acute pain. The NNT for rofecoxib 50 mg for at least 50% pain relief over 6 h was 2.3 (95% confidence interval 2.0–2.6). The weighted mean remedication time was 1.9 h for placebo (126 patients), 7.4 h for ibuprofen 400 mg (97 patients) and 13.6 h for rofecoxib 50 mg (322 patients). Rofecoxib is a COX-2 inhibitor that has been shown to be an effective analgesic in osteoarthritis and rheumatoid arthritis at single daily doses of 12.5 or 25 mg. At these (and higher) doses it has also been shown to reduce the incidence of gastrointestinal bleeding on chronic use for arthritis compared with NSAIDs, in both a systematic review and a separate large randomised trial.
Transcutaneous electrical nerve stimulation (TENS) in acute postoperative pain and labour pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Clinical bottom line. TENS is not effective in the relief of postoperative pain. Patients should be offered effective methods of pain relief. TENS neither alleviates labour pain nor reduces the use of additional analgesics. Women should be offered effective interventions for relief of labour pain. TENS was originally developed as a way of controlling pain through the ‘gate’ theory. There is conflicting professional opinion about the use of TENS in acute postoperative pain. For example, the Agency for Health Care Policy and Research recommend TENS as effective in reducing pain and improving physical function, whilst the UK College of Anaesthetists’ working party states that TENS is not effective as the sole treatment of moderate or severe pain after surgery.
Other acute pain interventions with evidence of efficacy
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
This section looks at a number of other interventions for acute pain where there is some evidence that they work. What is not included are interventions that could come under the heading of complementary therapy, which are dealt within a later section. The format is a title, clinical bottom line, reference, and a brief commentary for each. Clinical bottom line. Incisional local anaesthetic is effective in relieving postoperative pain after inguinal herniotomy up to about 7 h. For hysterectomy, cholecystectomy and other major/minor surgical procedures, there was a lack of evidence for effectiveness. This may be due in part to inadequate trial design, and further trials are needed before recommendations can be made.
Introduction
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
This chapter is going to deal mainly with migraine, the most common form of headache apart from common headache or headache associated with other illness. Migraine is common. It affects about 1 adult woman in 5 and 1 adult man in 20. To investigate the prevalence of migraine, studies were looked for that used International Headache Society (IHS) criteria for migraine in large samples of adults. The results of individual studies are shown in Table 3.1.1 and Figure 3.1.1.
Paracetamol for acute Migraine
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Paracetamol is often recommended as the first line of treatment for acute migraine attacks, and patients frequently self-medicate with over-the-counter drugs. There is only a single study on paracetamol in acute migraine that fulfils IHS criteria for the diagnosis of migraine, and with useful outcomes. The study is described, and a brief review of additional studies on migraine from a systematic review added.
Ibuprofen for acute migraine
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Ibuprofen is sometimes recommended for treatment for acute migraine attacks, and patients frequently self-medicate. There is only a single study on ibuprofen in acute migraine that fulfils IHS criteria for the diagnosis of migraine, and with useful outcomes. The study is described, and a brief review of additional studies on migraine from a systematic review added. Inclusion criteria were: treatment of acute migraine with ibuprofen by any route; randomised allocation to treatment groups; double-blind design; adult population and headache outcomes.
Oral naratriptan for acute Migraine
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Comprehensive searches of the following databases were made: MEDLINE (1966–July 2001), EMBASE (1980–June 2001), Cochrane Library (Issue 3, 2001), PubMed (to September 2001) and the Oxford Pain Relief Database (1950–1994). A series of free text searches were undertaken, using generic and trade names. There was no restriction to language. Retrieved reports were searched for additional trials. Neither individual authors nor pharmaceutical companies were contacted for unpublished data.
Oral rizatriptan for acute Migraine
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Comprehensive searches of the following databases were made: MEDLINE (1966–July 2001), EMBASE (1980–June 2001), Cochrane Library (Issue 3, 2001), PubMed (to September 2001) and the Oxford Pain Relief Database (1950–1994). A series of free text searches were undertaken, using generic and trade names. There was no restriction to language. Retrieved reports were searched for additional trials. Neither individual authors nor pharmaceutical companies were contacted for unpublished data.
Oral eletriptan for acute Migraine
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Comprehensive searches of the following databases were made: MEDLINE (1966–July 2000), EMBASE (1980–June 2000), Cochrane Library (Issue 3, 2000) and the Oxford Pain Relief Database (1950–1994). A series of free text searches were undertaken, using generic and trade names. There was no restriction to language. Retrieved reports were searched for additional trials. Pfizer Inc provided data from seven unpublished trials, one of which has subsequently been published.
Topical capsaicin for pain relief
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Capsaicin is an alkaloid derived from chillies. It first entered European knowledge after Columbus’ second voyage to the New World in 1494. There is evidence that capsaicin can deplete substance P in local nerve sensory terminals. Substance P is thought to be associated with initiation and transmission of painful stimuli, as well as a number of diseases including arthritis, psoriasis and inflammatory bowel disease. Inclusion criteria were randomised, double-blind, placebo-controlled trials of topical capsaicin for pain relief; data extractable to show proportion of patients showing improvement. Reviewers calculated odds ratios. We have calculated relative benefits and NNT (with 95% confidence intervals) for some benefit with capsaicin. Reviewers noted that blinding may not be complete owing to the irritant effects of capsaicin when applied to the skin.
Back pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
The evidence from Britain and elsewhere is that back pain is becoming a bigger problem – not that there is any evidence of changing pathology, but rather due to changed attitudes and expectations. This trend has been particularly noticeable since the mid-1980s. The total number of days in Britain for back incapacity obtained through sickness and invalidity benefit has risen dramatically in recent years (Figure 4.7.2). The British experience is by no means unusual, with other countries seeing an even steeper rise to higher levels.
Intravenous regional sympathetic blockade for reflex sympathetic dystrophy
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Clinical bottom line. There is no evidence from existing trials that guanethidine used in intravenous regional sympathetic blockade (IRSB) reduces the pain associated with reflex sympathetic dystrophy (RSD). Based on a small number of patients, there is weak evidence that ketanserin and bretylium may provide some relief. Reflex sympathetic dystrophy describes the constellation of chronic pain conditions associated with hyperactivity of the sympathetic nervous system. Pain is usually constant, severe and unresponsive to conventional analgesics. Intravenous regional sympathetic blockade is an intervention where a drug known to block the sympathetic nervous system is given in high local concentration in the painful limb isolated with a tourniquet.
Treatments for intermittent Claudication
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Inclusion criteria were randomised controlled trials of exercise for intermittent claudication due to peripheral arterial occlusive disease in the lower extremities; walking distance as an outcome; use of treadmill for evaluations. Reviewers extracted data on pain-free or maximum walking times or distances, and used pre- and post intervention scores to calculate a percent change from baseline. All of the included trials were small, with group sizes ranging from seven to 25, and exercise interventions varied in intensity, duration and content. Five of 10 trials had an untreated control group (no intervention or placebo drug), and the remaining trials had an active intervention, either pharmacological, surgical or strength training of lower extremities only.
Arthritis and joints
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
There has been a major change in the conduct of clinical trials in arthritis with the advent of COX-2 selective inhibitors (called, for convenience, coxibs). Previously, trials were characterised by being small, short, and having uncertain outcomes. Subsequently they have become large, of long duration, and often have many outcomes measured, though few reported. A view of outcomes reported in trials before the late 1980s can be gained from a study of reporting outcomes up to 1998 [1]. A search was made for all randomised double-blind trials that compared two of the 22 NSAIDs available in Denmark published up to August 1998. The final sample was 144 trial reports.
Lifestyle and exercise
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
With many bone and joint problems, exercise or other lifestyle interventions are recommended. This is not a bad thing. There is abundant evidence that taking moderate exercise, like walking, improves wellbeing and reduces the risk of cardiovascular problems. A reasonably brisk walk of a mile a day is sufficient. Again, diet, including a reasonable amount of fruit and vegetables, whole grain bread or rice, and regular fish, protects both against cardiovascular disease, but also cancer. People who adopt a healthy lifestyle live longer and better. The Bandolier 10 tips for healthy living summarise the recommendations from the evidence, and are reproduced in section 9.3.
Topically applied non-steroidal anti-inflammatory drugs for chronic pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Inclusion criteria were randomised controlled trials of NSAIDs with pain outcomes; chronic pain conditions (arthritic and rheumatic); full journal publication and unpublished drug company trials. Trials in vaginitis, oral and buccal conditions, thrombophlebitis and experimental pain were excluded. Dichotomous data on pain outcomes were extracted from trials for analysis.At least 50% pain relief was regarded as a clinically relevant outcome. From the dichotomous data, information on the proportion, and then the number of patients who achieved at least 50% pain relief were calculated. A NNT for at least 50% pain relief and the relative risk and benefit of the treatment were then calculated. The review also included a meta-analysis of topical NSAID use in acute pain.
Adverse effects of NSAIDs and coxibs
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
A retrospective case-control survey of emergency admissions for upper gastrointestinal disease in two English general hospitals covering 1% of the UK population (in Rotherham and Stockport) gives some good estimates [3]. Records of all community deaths attributed to upper gastrointestinal disease were also surveyed. Matched controls were identified from emergency admissions for other causes. There were 620 emergency admissions over one year in 1990/91, with controls for 460 cases. Controls were matched for GP practice, sex, age and date of admission. Unmatched cases were retained in the analysis.
Sulfasalazine for rheumatoid arthritis
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
More patients on sulfasalazine discontinued because of adverse effects (rash, abnormal liver function tests) than on placebo, but lack of efficacy discontinuations were many fewer than with placebo. Morning stiffness, pain, the number of tender and swollen joints and patient global assessment were all significantly better with sulfasalazine. The majority of the studies used 2 g of sulfasalazine a day, and results are also given for 3 g a day in two studies. There are also comparisons with other treatments for rheumatoid arthritis (hydroxychloroquinine, penicillamine, and gold), but in few studies with limited numbers of patients.
Complementary and alternative therapies
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
This is a difficult topic for all sorts of reasons. Most importantly, it is different things to different people. For some, it is the one thing that seems to bring some relief in incredibly difficult situations. For others it is a sort of health fashion accessory. Most frustrating is the continual shifting of goal posts, as evidence for or against one variant of a therapy is talked down because of some slight difference in therapy delivery – different acupuncture points, or homeopathy dilution, or ways of doing massage. Most obviously is the blindingly obvious – that for most complementary or alternative therapies (CAT for convenience), or diagnostic procedures, there is absolutely no evidence whatsoever.
Acupuncture
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Acupuncture is commonly used as a routine treatment in many parts of eastern Asia, and is becoming more commonly available in western societies. It is often used for chronic painful conditions, and there are standards for using and performing acupuncture. There is more than one type of acupuncture technique, and this age-old method is now becoming technological, with different types of acupuncture needles, and stimulation (heat, electric current), as well as different acupuncture points representing different schools of thought.
Cancer and palliative care
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
For advanced cancer, pain control relies on morphine (though not necessarily alone). There is no systematic review of morphine clinical trials that we know of, and precious few trials. Therefore, in this introduction, two systematic reviews on morphine clinical pharmacology are offered. The first is a systematic review of factors affecting the ratios of morphine and its major metabolites. The second is a systematic review of the maximum plasma concentration of morphine (and the time at which the maximum occurs). The final section reviews the trials of oral morphine in the cancer pain setting. In the conclusion we set out the areas where we think there is a clear research agenda, and the lessons we have learned about the design and conduct of future trials in cancer pain management.
Non-steroidal anti-inflammatory drugs for cancer pain
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Clinical bottom line. Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in relieving cancer pain. Single doses of an NSAID are effective at 6 h, and multiple doses of NSAID are effective at ten to 14 days. This review did not attempt to compare the efficacy of different NSAIDs. For single doses, NSAIDs appear to be as effective as intramuscular morphine 5–10 mg, weak opioids or opioid combinations and the same NSAID given at higher doses. For multiple doses, there was no difference between NSAIDs and weak opioids or opioid combinations. No other comparisons were possible. Upper gastrointestinal upset, dizziness and drowsiness were the most common adverse effects for single and multiple dose trials. In multiple dose trials, NSAIDs were associated with fewer adverse effects than intramuscular morphine 5–10 mg.
Radiotherapy for painful bone metastases
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Clinical bottom line. Radiotherapy can provide effective analgesia for painful bone metastases. Over 40% of patients can expect at least 50% pain relief, and just under 30% can expect complete pain relief at one month. There appears to be little difference in efficacy between the fractionation schedules and between different doses using the same schedule.
Radiotherapy is commonly used to provide pain relief for localised painful bone metastases. It is, however, difficult to provide accurate estimates of the proportion of patients achieving relief, and the extent and duration of relief owing to the variations within the condition and in the primary cancer itself. Contemporaneous interventions and supplementary analgesics further complicate the picture.
Better prescribing of NSAIDs
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Providing information to doctors about better prescribing, also called academic detailing, has been shown to be a good thing. A Cochrane review [1] of 18 randomised or quasi-randomised trials found positive effects on practice in all trials, but only one measured a patient outcome. A new study from Adelaide [2] demonstrates an apparent remarkable decrease in admissions for perforations, ulcers and gastrointestinal bleeding following detailing about appropriate use of NSAIDs.
Quality improvement by audit: Pain relief after day surgery
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
In an 8-week period in 1993, 150 adults having surgery in a day surgery unit in Cardiff (general surgery, gynaecology, ophthalmic or ENT) were audited using a postal questionnaire for pain at home after their operation. At 24 and 72 h they rated their pain as mild, moderate or severe, and recorded analgesic drugs used over three days. The hospital had an analgesic prescribing policy covering about half these patients.
Improving oral postoperative Analgesia
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
Successive initiatives in the 1990s at Stoke Mandeville Hospital had made progress in using new analgesic techniques like epidural, spinal, patient and nurse controlled analgesia. But management of subsequent ‘step-down’ prescribing of oral analgesics was not keeping pace. Patients’ postoperative care was not the best because of the inadequacy of the oral component. Prescribing at this stage was unstructured, with a wide range of oral analgesics in routine use, without any evidence base. Expenditure on oral analgesia was rising rapidly.
Do-it-yourself pain control
Authors: Moore Andrew , Edwards Jayne , Barden Jodie , McQuay Henry 
Published: October 2023

Abstract
The successful implementation of an acute pain service prompted questions about how pain control was managed for women after Caesarean section. Methods used there had evolved over time. Midwives and doctors thought it could be improved, but for different reasons, while no-one knew what mothers thought because they had not been asked. Two parallel paths of action were set in hand in 1996. One was a baseline audit to establish the nature of pain control being provided to mothers. The other was a review of the evidence about effective analgesic prescribing.
Providing health care: finance and regulation
Authors: Dolan Paul , Olsen Jan Abel 
Published: October 2023

Abstract
The previous two chapters set out the arguments for government intervention in the distribution of health care. This chapter turns the focus towards the supply side and discusses some key issues on the financing and regulation of health care provision. Market failures have implications for how a market should be regulated. The idea that an ‘invisible hand’ will take a market towards an efficient allocation of resources becomes untenable if that market is not capable of standing on its own two feet (that is, if it does not come close to satisfying the assumptions of perfect competition). Uncertainty about the incidence of illness, asymmetric information of various kinds between the providers and the users of health care, and externalities in consumption all mean that there is the need for extensive regulation of the provision of health care. Whilst private insurance markets can to some extent solve the problems associated with uncertainty, asymmetric information requires considerable government regulation to protect relatively uniformed users, and we have already seen that concerns for other people’s health have implications for how health services should be financed.
Discrepancies between diagnostic criteria and clinical practice
Authors: Wessely Simon 
Published: October 2023

Abstract
In this chapter I shall discuss the problem of classifying conversion disorders, and con- clude that there is a wide discrepancy between the official psychiatric classifications of conversion disorders and their use in clinical practice. This is partly a reflection of the dilemmas and ambiguities that underlie the concepts of conversion disorders, and partly because of the general problems of applying psychiatric thinking to non-psychiatric practice.