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Objective. Opioids are one of the most commonly prescribed medicines for chronic pain. However, their use for chronic pain has been controversial. The objective of this literature review was to identify the role of genetic polymorphisms on patient treatment parameters (opioid dose requirements, response, and adverse effects) for opioids used in malignant and nonmalignant chronic pain. The opioids that this review focuses on are codeine, morphine, oxycodone, tramadol, and fentanyl. Method. A literature search of databases Medline and Embase was carried out, and studies up to April 2016 were included in this review. Studies were included based on a combination of key words: chronic pain and related terms, pharmacogenetics and related terms, and opioids and related terms. Results. Among the 1,408 individual papers retrieved from the search in Medline and Embase, 32 original articles were included in this review, with none related to codeine. The 32 papers reported various study designs, opioids, and polymorphisms being studied for associations with treatment outcomes. This literature review reveals that variants in ABCB1, OPRM1, and COMT have been replicated for opioid dosing and variants in ABCB1 have been replicated for both treatment response and adverse effects. Conclusions. Currently, there are few validated studies to form a strong evidence base to support pharmacogenomics testing when initiating opioid therapy. However, the field of pharmacogenomics in chronic pain is likely to expand over the coming years, with the increasing number of treatment options available and larger cohorts being assembled in order to identify true associations. [ABSTRACT FROM AUTHOR]

Objective This systematic review assesses the effectiveness and side effects of celiac plexus neurolysis ( CPN) in the treatment of upper abdominal cancer pain, and evaluates whether there are any differences between the percutaneous and endoscopic ultrasound-guided ( EUS) denervation techniques. Methods Five databases were searched, expanded by assessing the reference lists of all retrieved papers. Sixty-six publications fulfilled the inclusion/exclusion criteria and were included in the systematic review. Randomized controlled trials were available for the percutaneous CPN, and therefore meta-analyses were performed for pain, opioid consumption, and specific side effects. The quality of life data were too heterogeneous to be assessed by a meta-analysis, and evidence for EUS CPN could only be evaluated by observational studies. Results Meta-analyses show that percutaneous CPN significantly improves pain in patients with upper abdominal cancer, with a decrease in opioid consumption and side effects. It is unclear whether there is any change in quality of life. Case series suggest that EUS CPN improves pain. No conclusion can be made about EUS CPN's influence on opioid consumption. Although CPN is a safe procedure, side effects and complications can occur with both the percutaneous and EUS techniques. Conclusions Following this review, evidence suggests that CPN should be considered in patients with upper abdominal cancer where the pain is not adequately controlled with systemic analgesics or when significant opioid-induced side effects are present. The percutaneous approach remains the standard technique as robust evidence for EUS CPN is lacking. [ABSTRACT FROM AUTHOR]

Objective. There has been no attempt to date to synthesize the available evidence for the efficacy of ginger for treating primary dysmenorrhea. This systematic review evaluates the current evidence for the effectiveness of ginger for treating primary dysmenorrhea. Methods. Literature searches were conducted using 12 electronic databases including PubMed, EMBASE, Cochrane Library, Korean databases, Chinese medical databases, and Indian scientific database. Search terms used were: "ginger" or "Zingiber officinale" and "dysmenorrhea" and "pain." Studies using ginger as a treatment of primary dysmenorrhea were considered for inclusion. The major outcome of primary dysmenorrhea was assessed using a pain visual analogue score (PVAS). Results. Initial searches yielded 29 articles. Of these original results, seven met specific selection criteria. Four of the RCTs compared the therapeutic efficacy of ginger with a placebo during the first 3-4 days of the menstrual cycle and were included in the meta analysis. The meta-analysis of these data showed a significant effect of ginger in reducing PVAS in subjects having primary dysmenorrhea (risk ratio, 21.85; 95% CI of 22.87, 20.84, P=0.0003). Six RCTs out of 7 exhibited low to moderate of risk of bias. Conclusion. Collectively these RCTs provide suggestive evidence for the effectiveness of 750-2000 mg ginger powder during the first 3-4 days of menstrual cycle for primary dysmenorrhea. [ABSTRACT FROM AUTHOR]

Objectives Painful diabetic neuropathy (PDN) is a debilitating complication of diabetes that greatly affects the quality of life of those afflicted. There are many treatment options for neuropathic pain. Recent studies show a promising analgesic effect using botulinum toxin-A (BTX-A) for neuropathic pain. Methods This article is a meta-analysis of two studies using BTX-A in the treatment of neuropathic pain. Electronic searches of MEDLINE/PubMed, EMBASE, and Cochrane Libraries using the terms 'botulinum neurotoxin' and 'neuropathic pain' were conducted. Only class I and class II therapeutic trials, as classified by the American Academy of Neurology were included. The primary outcome measured was the difference in visual analogue scale (VAS) from pre-intervention and post-intervention after 1 month. Data were analyzed for biases and heterogeneity following Cochrane and PRISMA guidelines. Results Two studies on PDN were analyzed in the meta-analysis showing improvement of 1.96 VAS points (95% CI, −3.09 to −0.84; Z score = 3.43, P < 0.001) following treatment with BTX-A. This corresponds to clinically significant improvement of 'minimum change in pain.' The adverse effects of infection at injection site was not statistically significant ( P = 0.49). BTX-A may be effective for PDN. Conclusion Tests for significance, low overall risk of bias, and almost no statistical heterogeneity suggests that there is a correlation between BTX-A and improvement of pain scores in PDN. Further large-scale controlled trials are needed. [ABSTRACT FROM AUTHOR]

Objective Our aim was to systematically review and meta-analyze the effectiveness of therapeutic patient education for migraine. Methods A literature search of multiple electronic databases ( MEDLINE, EMBASE, PEDro, CINAHL, and PsychINFO) was conducted to identify randomized control trials ( RCTs) published in the English and Spanish languages up to and including May 2013. Two reviewers independently selected the studies, conducted the quality assessment ( Delphi list), and extracted the results. The Preferred Reporting Items for Systematic Reviews and Meta- Analyses method was used throughout the systematic review and meta-analysis. Standardized mean difference ( SMD) and 95% confidence intervals ( CIs) were calculated for relevant outcome measures (headache frequency, headache disability, self-efficacy, depressive symptoms, and quality of life) and pooled in a meta-analysis using the random effects model. Results Fourteen RCTs were included in the systematic review. Only nine studies were included in the meta-analysis. The median quality score was 6.14 ± 1.29 (range: 5-9). There was strong-moderate evidence for intermediate-term effectiveness of therapeutic patient education on headache frequency (five studies: N = 940, SMD = −0.24, 95% CI of −0.48 to −0.01, P = 0.03), headache disability (four studies: N = 799, SMD = −1.02, 95% CI of −1.95 to −0.08, P = 0.03), and quality of life (three studies: N = 674, SMD = 0.36, 95% CI of 0.05-0.67, P = 0.02). There was no evidence for either short-term or intermediate-term effectiveness of therapeutic patient education on self-efficacy or depressive symptoms. Conclusion This systematic review revealed strong-moderate evidence for intermediate-term effectiveness of therapeutic patient education for migraine. Further high-quality RCTs are required for conclusive determination of its effectiveness. [ABSTRACT FROM AUTHOR]

Objective This study systematically reviewed the evidence regarding the effects of eye movement desensitization and reprocessing ( EMDR) therapy for treating chronic pain. Design Systematic review. Methods We screened MEDLINE, EMBASE, the Cochrane Library, CINHAL Plus, Web of Science, Psyc INFO, PSYNDEX, the Francine Shapiro Library, and citations of original studies and reviews. All studies using EMDR for treating chronic pain were eligible for inclusion in the present study. The main outcomes were pain intensity, disability, and negative mood (depression and anxiety). The effects were described as standardized mean differences. Results Two controlled trials with a total of 80 subjects and 10 observational studies with 116 subjects met the inclusion criteria. All of these studies assessed pain intensity. In addition, five studies measured disability, eight studies depression, and five studies anxiety. Controlled trials demonstrated significant improvements in pain intensity with high effect sizes ( Hedges' g: −6.87 [95% confidence interval ( CI95): −8.51, −5.23] and −1.12 [ CI95: −1.82, −0.42]). The pretreatment/posttreatment effect size calculations of the observational studies revealed that the effect sizes varied considerably, ranging from Hedges' g values of −0.24 ( CI95: −0.88, 0.40) to −5.86 ( CI95: −10.12, −1.60) for reductions in pain intensity, −0.34 ( CI95: −1.27, 0.59) to −3.69 ( CI95: −24.66, 17.28) for improvements in disability, −0.57 ( CI95: −1.47, 0.32) to −1.47 ( CI95: −3.18, 0.25) for improvements in depressive symptoms, and −0.59 ( CI95: −1.05, 0.13) to −1.10 ( CI95: −2.68, 0.48) for anxiety. Follow-up assessments showed maintained improvements. No adverse events were reported. Conclusions Although the results of our study suggest that EMDR may be a safe and promising treatment option in chronic pain conditions, the small number of high-quality studies leads to insufficient evidence for definite treatment recommendations. [ABSTRACT FROM AUTHOR]

Objective To compare the overall levels of physical activity of older adults with chronic musculoskeletal pain and asymptomatic controls. Review Methods A systematic review of the literature was conducted using a Cochrane methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses statement. Major electronic databases were searched from inception until December 2012, including the Cochrane Library, CINAHL, EBSCO, EMBASE, Medline, PubMed, PsycINFO, and the international prospective register of systematic reviews. In addition, citation chasing was undertaken, and key authors were contacted. Eligibility criteria were established around participants used and outcome measures focusing on daily physical activity. A meta-analysis was conducted on appropriate studies. Results Eight studies met the eligibility criteria, four of these reported a statistically lower level of physical activity in the older adult sampl e with chronic pain compared with the asymptomatic group. It was possible to perform a non-heterogeneous meta-analysis on five studies. This established that 1,159 older adults with chronic pain had a significantly lower level of physical activity (−0.20, confidence interval 95% = −0.34 to −0.06, p = 0.004) compared with 576 without chronic pain. Conclusion Older adults with chronic pain appear to be less active than asymptomatic controls. Although this difference was small, it is likely to be clinically meaningful. It is imperative that clinicians encourage older people with chronic pain to remain active as physical activity is a central non-pharmacological strategy in the management of chronic pain and is integral for healthy aging. Future research should prioritize the use of objective measurement of physical activity. [ABSTRACT FROM AUTHOR]

Background. Mindfulness-based interventions (MBIs) emphasizing a nonjudgmental attitude toward present moment experience are widely used for chronic pain patients. Although changing or con-trolling pain is not an explicit aim of MBIs, recent experimental studies suggest that mindfulness practice may lead to changes in pain tolerance and pain intensity ratings. Objective. The objective of this review is to investi-gate the specific effect of MBIs on pain intensity. Methods. A literature search was conducted using the databases PUBMED and PsyclNFO for relevant articles published from 1960 to December 2010. We additionally conducted a manual search of refer-ences from the retrieved articles. Only studies pro-viding detailed results on change in pain intensity ratings were included. Results. Sixteen studies were included in this review (eight uncontrolled and eight controlled trials). In most studies (10 of 16), there was significantly decreased pain intensity in the MBI group. Findings were more consistently positive for samples limited to clinical pain (9 of 11). In addition, most controlled trials (6 of 8) reveal higher reductions in pain inten-sity for MBIs compared with control groups. Results from follow-up assessments reveal that reductions in pain intensity were generally well maintained. Conclusions. Findings suggest that MBIs decrease the intensity of pain for chronic pain patients. We discuss implications for understanding mecha-nisms of change in MBIs. [ABSTRACT FROM AUTHOR]