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The Cochrane Database of Systematic... Jan 2011Non-antiepileptic drugs have been used in the management of trigeminal neuralgia since the 1970s. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Non-antiepileptic drugs have been used in the management of trigeminal neuralgia since the 1970s.
OBJECTIVES
The objective was to systematically review the efficacy and tolerability of non-antiepileptic drugs for trigeminal neuralgia.
SEARCH STRATEGY
For this updated review we searched the Cochrane Neuromuscular Disease Group Specialized Register (30 April 2010). We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), MEDLINE (January 1966 to April 2010), EMBASE (January 1980 to April 2010), LILACS (January 1982 to April 2010) and the Chinese Biomedical Retrieval System (1978 to April 2010). We handsearched 10 Chinese journals.
SELECTION CRITERIA
We searched for double-blind randomized or quasi-randomized controlled trials in which the active drug was used for at least two weeks.
DATA COLLECTION AND ANALYSIS
Two authors decided which trials fitted the inclusion criteria and independently graded risk of bias.
MAIN RESULTS
Four trials involving 139 participants were included. The primary outcome measure in each was pain relief. Three trials with an unclear risk of bias compared one of the non-antiepileptic drugs tizanidine, tocainide or pimozide with carbamazepine. In a trial of tizanidine involving 12 participants (one dropped out due to unrelated disease) one of five treated with tizanidine and four of six treated with carbamazepine improved, risk ratio 0.30 (95% CI 0.05 to 1.89). Few side effects were noted with tizanidine. In a study involving 12 participants there was an improvement in mean pain scores with tocainide similar to that with carbamazepine, but significant side effects limited its use. In the pimozide study more participants improved on pimozide (48/48) than with carbamazepine (27/48) (risk ratio 1.76, 95% CI 1.37 to 2.26). Up to 83% of participants reported adverse effects but these did not lead to withdrawal from the study. A trial with low risk of bias involving 47 participants compared 0.5% proparacaine hydrochloride eyedrops with placebo but did not show any significant benefits or side effects.
AUTHORS' CONCLUSIONS
Of the four studies identified, one had low and three an unclear risk of bias. There is insufficient evidence from randomized controlled trials to show significant benefit from non-antiepileptic drugs in trigeminal neuralgia. More research is needed.
Topics: Amitriptyline; Analgesics; Baclofen; Carbamazepine; Clomipramine; Clonidine; Humans; Pimozide; Propoxycaine; Randomized Controlled Trials as Topic; Tocainide; Trigeminal Neuralgia
PubMed: 21249658
DOI: 10.1002/14651858.CD004029.pub3 -
The Cochrane Database of Systematic... Dec 2013Trigeminal neuralgia was defined by the International Association for the Study of Pain as a sudden, usually unilateral, severe, brief, stabbing recurrent pain in the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Trigeminal neuralgia was defined by the International Association for the Study of Pain as a sudden, usually unilateral, severe, brief, stabbing recurrent pain in the distribution of one or more branches of the fifth cranial nerve. Standard treatment is with anti-epileptic drugs. Non-antiepileptic drugs have been used in the management of trigeminal neuralgia since the 1970s. This is an update of a review first published in 2006 and previously updated in 2011.
OBJECTIVES
To systematically review the efficacy and tolerability of non-antiepileptic drugs for trigeminal neuralgia.
SEARCH METHODS
On 20 May 2013, for this updated review, we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL (2013, Issue 4), MEDLINE (January 1966 to May 2013), EMBASE (January 1980 to May 2013), LILACS (January 1982 to May 2013) and the Chinese Biomedical Retrieval System (1978 to May 2013). We searched clinical trials registries for ongoing trials.
SELECTION CRITERIA
We included double-blind, randomised controlled trials in which the active drug was used either alone or in combination with other non-antiepileptic drugs for at least two weeks.
DATA COLLECTION AND ANALYSIS
Two authors decided which trials fitted the inclusion criteria and independently graded risk of bias. We assessed the quality of the evidence according to the GRADE criteria for this update.
MAIN RESULTS
In this 2013 update, we updated the searches, but identified only two new ongoing studies. The review includes four trials involving 139 participants. The primary outcome measure in each was pain relief. Three trials compared one of the oral non-antiepileptic drugs tizanidine, tocainide or pimozide with carbamazepine. The quality of evidence for all outcomes for which data were available was low. In a trial of tizanidine involving 12 participants (one dropped out due to unrelated disease), one of five participants treated with tizanidine and four of six treated with carbamazepine improved (risk ratio (RR) 0.30, 95% confidence interval (CI) 0.05 to 1.89). Few side effects were noted with tizanidine. For pimozide, there was evidence of greater efficacy than carbamazepine at six weeks. Up to 83% of participants reported adverse effects but these did not lead to withdrawal; the report did not provide comparable data for carbamazepine. Limited data meant that we could not assess the effects of tocainide; however, data from non-randomised studies (not included in this review) indicate that serious haematological adverse events can occur. A trial involving 47 participants compared 0.5% proparacaine hydrochloride eyedrops with placebo but did not show any significant benefits, again according to low-quality evidence. The report did not mention adverse events. The proparacaine trial was at low risk of bias; the other trials were at unclear risk of bias overall.
AUTHORS' CONCLUSIONS
There is low-quality evidence that the effect of tizanidine is not significantly different than that of carbamazepine in treating trigeminal neuralgia. Pimozide is more effective than carbamazepine, although the evidence is of low quality and the data did not allow comparison of adverse event rates. There is also low-quality evidence that 0.5% proparacaine hydrochloride eye drops have no benefit over placebo. Limitations in the data for tocainide prevent any conclusions being drawn. There is insufficient evidence from randomised controlled trials to show significant benefit from non-antiepileptic drugs in trigeminal neuralgia. More research is needed.
Topics: Amitriptyline; Analgesics; Anticonvulsants; Baclofen; Carbamazepine; Clomipramine; Clonidine; Humans; Pimozide; Propoxycaine; Randomized Controlled Trials as Topic; Tocainide; Trigeminal Neuralgia
PubMed: 24297506
DOI: 10.1002/14651858.CD004029.pub4 -
The Cochrane Database of Systematic... Jul 2006Non-antiepileptic drugs have been used in trigeminal neuralgia management since the 1970s. (Review)
Review
BACKGROUND
Non-antiepileptic drugs have been used in trigeminal neuralgia management since the 1970s.
OBJECTIVES
The objective was to review systematically the efficacy of non-antiepileptic drugs for trigeminal neuralgia.
SEARCH STRATEGY
We searched the Cochrane Neuromuscular Disease Group Register, MEDLINE, EMBASE, and LILACS (all to August 2005) and the Chinese Biomedical Retrieval System, the database of the Chinese Cochrane Center (The Cochrane Library, Issue 1 2005), conference paper databases and checked bibliographies. We handsearched ten Chinese journals.
SELECTION CRITERIA
We searched for randomized or quasi-randomized controlled trials.
DATA COLLECTION AND ANALYSIS
Two authors decided which trials fitted the inclusion criteria and graded methodological quality independently.
MAIN RESULTS
Nine trials of different non-antiepileptic drugs involving 223 participants were included. Each trial investigated one non-antiepileptic drug. Two trials tested baclofen. In one, more people gained 50% reduction from baseline than with placebo (relative risk 15.00, 95% CI 0.97 to 231.84, P value = 0.05). In the other, slightly more participants on baclofen had a 75% reduction in attacks on the 10th day compared with carbamazepine (relative risk 2.38, 95% CI 0.83 to 6.85, P value = 0.11). One trial showed no significant difference in reduction in average daily frequency of attacks with L-Baclofen compared with racemic baclofen. Tizanidine was investigated in two trials. In one, the proportion of people with reduction in the average number of paroxysms per day increased with tizanidine compared with placebo (relative risk 8.00, 95% CI 1.21 to 52.69, P value = 0.03). In the other, one of five participants improved in visual analog scale score with tizanidine and four of six with carbamazepine (relative risk 0.30, 95% CI 0.05 to 1.89, P value = 0.20). One study showed that the improvement in mean values of pain scores with tocainide was similar to that of carbamazepine. In one study more participants improved during the pimozide than the carbamazepine period (relative risk 1.78, 95% CI 1.39 to 2.28). In one study, proparacaine hydrochloride 0.5% instillation into the eyes was not significantly different from placebo (relative risk 1.06, 95% CI 0.37 to 2.99, P value = 0.92). In another, there was moderate or marked improvement in seven of nine participants treated with clomipramine and three of nine with amitriptyline after a 12-week treatment (RR 2.33, 95% CI 0.87 to 6.27).
AUTHORS' CONCLUSIONS
There is insufficient evidence from randomized controlled trials to show significant benefit from non-antiepileptic drugs in trigeminal neuralgia. More research is needed.
Topics: Amitriptyline; Baclofen; Carbamazepine; Clomipramine; Clonidine; Humans; Pimozide; Propoxycaine; Randomized Controlled Trials as Topic; Tocainide; Trigeminal Neuralgia
PubMed: 16856027
DOI: 10.1002/14651858.CD004029.pub2 -
The Cochrane Database of Systematic... Jul 2007Cataract is defined as loss of transparency of the natural lens and is usually an age-related phenomenon. The only recognized treatment available for cataract involves... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cataract is defined as loss of transparency of the natural lens and is usually an age-related phenomenon. The only recognized treatment available for cataract involves surgery. An ideal anaesthetic should allow for pain-free surgery with no systemic or local complications. It should be cost effective and should facilitate a stress-free procedure for surgeon and patient alike. Topical anaesthesia involves applying anaesthetic eye drops to the surface of the eye prior to and during surgery. This has found large acceptance especially in the USA where it is used by 61% of cataract surgeons. Many surgeons who perform cataract surgery under topical anaesthesia also use intraoperative supplementary intracameral lidocaine (injected directly into the anterior chamber of the eye). The benefits and possible risks of intracameral lidocaine have been assessed by a number of randomized controlled trials, but the results have been conflicting and many of the endpoints have been heterogeneous.
OBJECTIVES
The primary objective of this systematic review was to assess pain during surgery and patient satisfaction with topical anaesthesia alone compared to topical anaesthesia with intracameral anaesthesia for phacoemulsification. The secondary objectives were to assess adverse effects and complications attributable to choice of anaesthesia and the need for additional anaesthesia during surgery.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 2), MEDLINE (1966 to May 2006), EMBASE (1980 to May 2006) and LILACs (1982 to 3 May 2006). We also searched the reference lists of the identified studies and the Science Citation Index. We did not have any language restriction.
SELECTION CRITERIA
We included only randomized controlled trials (RCTs) comparing topical anaesthesia alone to topical anaesthesia with intracameral lidocaine.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trial quality and extracted data. For dichotomous outcomes data were presented as odds ratios. For continuous outcomes the weighted mean difference was employed. A random-effects model was used unless there were fewer than three trials in a comparison, where a fixed-effect model was used. We explored heterogeneity between trial results using a chi-squared test.
MAIN RESULTS
A total of eight trials comprising of 1281 patients were identified for analysis. Our data comparison showed a significantly lower intraoperative pain perception in patient groups using supplementary intracameral lidocaine, although the difference was small. No significant difference was demonstrated between the groups receiving topical anaesthesia alone and topical combined with intracameral anaesthesia in terms of the need for supplemental anaesthesia, intraoperative adverse events or corneal toxicity.
AUTHORS' CONCLUSIONS
The use of intracameral unpreserved 1% lidocaine is an effective and safe adjunct to topical anaesthesia for phacoemulsification cataract surgery.
Topics: Anesthesia, Local; Anesthetics, Combined; Anesthetics, Local; Bupivacaine; Humans; Lidocaine; Phacoemulsification; Propoxycaine; Randomized Controlled Trials as Topic; Tetracaine
PubMed: 17636793
DOI: 10.1002/14651858.CD005276.pub2 -
The Journal of Emergency Medicine Nov 2015Despite the fact that topical anesthetics provide superb analgesia to the painful eye, they are not prescribed routinely to patients when they are discharged from the... (Review)
Review
BACKGROUND
Despite the fact that topical anesthetics provide superb analgesia to the painful eye, they are not prescribed routinely to patients when they are discharged from the emergency department because of concerns for delayed healing and corneal erosion.
OBJECTIVE
To summarize the evidence for the safety of topical proparacaine and tetracaine for pain relief in patients with corneal abrasions.
METHODS
This is a systematic review looking at the use of topical anesthetic agents in the treatment of corneal abrasions in the emergency department.
RESULTS
Our literature search produced two emergency department-based, randomized, double blind, placebo-controlled studies on human patients with corneal abrasions. Additionally, we found four studies that investigated the application of topical anesthetics in patients who underwent photorefractive keratectomy. All six studies demonstrated that a short course of dilute topical anesthetic provided efficacious analgesia without adverse effects or delayed epithelial healing.
CONCLUSION
Limited available data suggests that the use of dilute topical ophthalmologic proparacaine or tetracaine for a short duration of time is effective, though their safety for outpatient use is inconclusive.
Topics: Anesthetics, Local; Corneal Injuries; Eye Pain; Humans; Propoxycaine; Tetracaine; Wound Healing
PubMed: 26281814
DOI: 10.1016/j.jemermed.2015.06.069 -
The Cochrane Database of Systematic... Sep 2011Screening examinations for retinopathy of prematurity (ROP) are performed routinely in the neonatal intensive care unit and are a recognised cause of pain in the newborn. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Screening examinations for retinopathy of prematurity (ROP) are performed routinely in the neonatal intensive care unit and are a recognised cause of pain in the newborn.
OBJECTIVES
To determine the effect of instillation of topical anaesthetic eye drops compared with placebo or no treatment on pain in infants undergoing ROP screening.
SEARCH STRATEGY
We used the standard search strategy of the Cochrane Neonatal Review Group. This included a search of the Cochrane Neonatal Group register and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 10, 2010). We identified relevant studies by searching the following: (1) computerised bibliographic databases: MEDLINE (1966 to October 2010), EMBASE (1988 to October 2010) and Web of Science (1975 to March 2010; (2) the Oxford Database of Perinatal Trials. We searched electronically abstracts from PAS from 2000 to 2010 and handsearched abstracts from ESPR from 2000 to 2009.
SELECTION CRITERIA
All randomised, or quasi-randomised controlled trials, or randomised cross-over trials.
DATA COLLECTION AND ANALYSIS
We used the standard methods of the Cochrane Neonatal Review Group.
MAIN RESULTS
We identified two studies for inclusion. Both studies were randomised cross-over trials performed in single centres. Both studies used the Premature Infant Pain Profile (PIPP) score as a measure of pain response. Different methods of evaluating PIPP scores are presented including the absolute PIPP score, a PIPP score > 10 or > 12 and an increase in PIPP ≥ 4 from the baseline value. There is a nonsignificant reduction in pain scores at one minute and a nonsignificant increase at five minutes post insertion of the speculum. PIPP score > 12 at one minute resulted in a statistically significant reduction in the number of patients who experienced pain (typical risk ratio (RR) 0.56, 95% CI 0.36 to 0.89; typical risk difference (RD) -0.23, 95% CI -0.39 to -0.86; number needed to treat to benefit (NNTB) 4). When pain was defined as an increase in PIPP > 4 there was a statistically significant reduction in the absolute number of patients who experienced pain at one minute (typical RR 0.70, 95% CI 0.52 to 0.94; typical RD -0.19, 95% CI -0.34 to -0.04; NNTB 5.3).
AUTHORS' CONCLUSIONS
The administration of topical proparacaine 30 seconds prior to the ophthalmological evaluation was associated with a reduction in pain scores especially at the time of speculum insertion. However, despite treatment, screening remains a painful procedure and the role of nonpharmacological and pharmacological intervention including different local anaesthetic agents should be ascertained in future randomised trials.
Topics: Anesthetics, Local; Eye Pain; Humans; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature; Ophthalmic Solutions; Ophthalmoscopy; Pain Measurement; Propoxycaine; Retinopathy of Prematurity
PubMed: 21901708
DOI: 10.1002/14651858.CD007645.pub2 -
Acta Paediatrica (Oslo, Norway : 1992) Mar 2010To assess whether non-pharmacological and/or pharmacological measures lead to decreased pain during an eye examination in preterm infants. (Review)
Review
AIM
To assess whether non-pharmacological and/or pharmacological measures lead to decreased pain during an eye examination in preterm infants.
DESIGN
Systematic review.
SUBJECTS
Premature infants meeting the criteria for screening eye examination for retinopathy.
INTERVENTION
Databases were searched through the Ovid interface. Randomized and quasi-randomized controlled trials were included. Data were assessed independently by three reviewers.
MAIN OUTCOME MEASURES
Pain assessed by Premature Infant Pain Profile (PIPP) or physiological changes.
RESULTS
Eight studies were included and grouped according to intervention: oral sucrose (group 1), anaesthetic eye drops (group 2) and non-pharmacological measures (group 3). For group 1, the mean PIPP score with sucrose was 1.38 (WMD) (95% CI: 0.41-2.35) lower than that of placebo (p = 0.005). For group 2, one study showed a reduction of two points on the PIPP score with topical proparacaine, whereas another showed no benefit. For group 3, developmental care improved developmental scores and salivary cortisol in one study.
CONCLUSION
Sucrose reduced pain during the eye examination, whereas the efficacy of proparacaine was not consistent in the studies included. However, PIPP scores remained relatively high in all the studies; thus further research is required to delineate better pain reduction strategies.
Topics: Administration, Topical; Anesthetics, Local; Humans; Infant, Newborn; Infant, Premature; Pain; Pain Measurement; Propoxycaine; Randomized Controlled Trials as Topic; Retinopathy of Prematurity; Sucrose; Vision Screening
PubMed: 19958293
DOI: 10.1111/j.1651-2227.2009.01612.x