mobic and Chronic-Pain

Pain is a common feature of childhood and adolescence around the world, and for many young people, that pain is chronic. The World Health Organization guidelines for pharmacological treatments for children's persisting pain acknowledge that pain in children is a major public health concern of high significance in most parts of the world. While in the past pain was largely dismissed and was frequently left untreated, views on children's pain have changed over time, and relief of pain is now seen as important.We designed a suite of seven reviews on chronic non-cancer pain and cancer pain (looking at antidepressants, antiepileptic drugs, non-steroidal anti-inflammatory drugs, opioids, and paracetamol) in order to review the evidence for children's pain utilising pharmacological interventions.As the leading cause of morbidity in the world today, chronic disease (and its associated pain) is a major health concern. Chronic pain (that is pain lasting three months or longer) can arise in the paediatric population in a variety of pathophysiological classifications (nociceptive, neuropathic, or idiopathic) from genetic conditions, nerve damage pain, chronic musculoskeletal pain, and chronic abdominal pain, as well as for other unknown reasons.Non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat pain, reduce fever, and for their anti-inflammation properties. They are commonly used within paediatric pain management. Non-steroidal anti-inflammatory drugs are currently licensed for use in Western countries, however they are not approved for infants under three months old. The main adverse effects include renal impairment and gastrointestinal issues. Common side effects in children include diarrhoea, headache, nausea, constipation, rash, dizziness, and abdominal pain.. To assess the analgesic efficacy and adverse events of NSAIDs used to treat chronic non-cancer pain in children and adolescents aged between birth and 17 years, in any setting.. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online, MEDLINE via Ovid, and Embase via Ovid from inception to 6 September 2016. We also searched the reference lists of retrieved studies and reviews, as well as online clinical trial registries.. Randomised controlled trials, with or without blinding, of any dose and any route, treating chronic non-cancer pain in children and adolescents, comparing any NSAID with placebo or an active comparator.. Two review authors independently assessed studies for eligibility. We planned to use dichotomous data to calculate risk ratio and number needed to treat for one additional event, using standard methods. We assessed GRADE and created three 'Summary of findings' tables.. We included seven studies with a total of 1074 participants (aged 2 to 18 years) with chronic juvenile polyarthritis or chronic juvenile rheumatoid arthritis. All seven studies compared an NSAID with an active comparator. None of the studies were placebo controlled. No two studies investigated the same type of NSAID compared with another. We were unable to perform a meta-analysis.Risk of bias varied. For randomisation and allocation concealment, one study was low risk and six studies were unclear risk. For blinding of participants and personnel, three studies were low risk and four studies were unclear to high risk. For blinding of outcome assessors, all studies were unclear risk. For attrition, four studies were low risk and three studies were unclear risk. For selective reporting, four studies were low risk, two studies were unclear risk, and one study was high risk. For size, three studies were unclear risk and four studies were high risk. For other potential sources of bias, seven studies were low risk. Primary outcomesThree studies reported participant-reported pain relief of 30% or greater, showing no statistically significant difference in pain scores between meloxicam and naproxen, celecoxib and naproxen, or rofecoxib and naproxen (P > 0.05) (low-quality evidence).One study reported participant-reported pain relief of 50% or greater, showing no statistically significant difference in pain scores between low-dose meloxicam (0.125 mg/kg) and high-dose meloxicam (0.25 mg/kg) when compared to naproxen 10 mg/kg (P > 0.05) (low-quality evidence).One study reported Patient Global Impression of Change, showing 'very much improved' in 85% of ibuprofen and 90% of aspirin participants (low-quality evidence). Secondary outcomesAll seven studies reported adverse events. Participants reporting an adverse event (one or more per person) by drug were: aspirin 85/202; fenoprofen 28/49; ibuprofen 40/45; indomethacin 9/30; ketoprofen 9/30; meloxicam 18/47; naproxen 44/202; and rofecoxib 47/209 (very low-quality evidence).All seven studies reported withdrawals due to adverse events. Participants withdrawn due to an adverse event by drug were: aspirin 16/120; celecoxib 10/159; fenoprofen 0/49; ibuprofen 0/45; indomethacin 0/30; ketoprofen 0/30; meloxicam 10/147; naproxen 17/285; and rofecoxib 3/209 (very low-quality evidence).All seven studies reported serious adverse events. Participants experiencing a serious adverse event by drug were: aspirin 13/120; celecoxib 5/15. We identified only a small number of studies, with insufficient data for analysis.As we could undertake no meta-analysis, we are unable to comment about efficacy or harm from the use of NSAIDs to treat chronic non-cancer pain in children and adolescents. Similarly, we cannot comment on our remaining secondary outcomes: Carer Global Impression of Change; requirement for rescue analgesia; sleep duration and quality; acceptability of treatment; physical functioning; and quality of life.We know from adult randomised controlled trials that some NSAIDs, such as ibuprofen, naproxen, and aspirin, can be effective in certain chronic pain conditions.

Topics: Adolescent; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Juvenile; Arthritis, Rheumatoid; Aspirin; Celecoxib; Child; Child, Preschool; Chronic Disease; Chronic Pain; Fenoprofen; Humans; Ibuprofen; Lactones; Meloxicam; Methoxsalen; Naproxen; Randomized Controlled Trials as Topic; Sulfones; Thiazines; Thiazoles

Nonsteroidal anti-inflammatory drugs (NSAIDs) are most commonly used to treat acute and chronic pain in locomotor system (LMS) diseases. However, their administration may be accompanied by the development of dangerous complications as organic and functional disorders of the cardiovascular system (CVS) and gastrointestinal tract (GIT). Physicians have currently a wide range of NSAIDs at their disposal; but none of the representatives of this group can be considered the best. Thus, highly selective cyclooxygenase-2 inhibitors (Coxibs) are substantially safer for GIT; however, their use is clearly associated with the increased risk of severe cardiovascular events. Nonselective NSAIDs, such as naproxen or ketoprofen, are safer for CVS, but more frequently cause significant GIT organic and functional disorders. Moderately selective NSAIDs, such as meloxicam (movalis), conceivably could be the most acceptable choice for treating the majority of patients in this situation. This drug has been long and extensively used in global clinical practice and has gained the confidence of physicians and patients. The major benefits of meloxicam are its proven efficacy, convenient treatment regimen, relatively low risk of complications as organic and functional disorders of the GIT and CVD and good compatibility with low-dose aspirin.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Cardiovascular Diseases; Chronic Pain; Cyclooxygenase 2 Inhibitors; Gastrointestinal Diseases; Humans; Meloxicam; Musculoskeletal Diseases; Musculoskeletal Pain; Patient Outcome Assessment; Risk Adjustment; Thiazines; Thiazoles

Breast cancer surgery is known to cause severe acute postoperative pain, which can persist for a long time. We administered nefopam preventively to patients undergoing lumpectomy with axillary lymph node dissection or sentinel lymph node biopsy, and evaluated its efficacy on acute and chronic postoperative pain.Enrolled patients were assigned to the nefopam (n = 41) or the control (n = 42) group. Before initiating the operation, 20 mg of nefopam was given to the patients of the nefopam group, and normal saline was used in the control group. Ketorolac was given at the end of surgery, and meloxicam was prescribed in the postoperative period to all patients in both groups. Pain was assessed using a numerical rating scale (NRS), and the rescue analgesic drug was given when the NRS was >5. Implementation of postoperative chemotherapy, radiotherapy (RT), or hormone therapy was evaluated.The NRS of postoperative pain was significantly lower in the nefopam than in the control group in the postanesthetic care unit (4.5 ± 2.2 vs 5.7 ± 1.5, respectively; P = 0.01), at postoperative 6 h (3.0 ± 1.6 vs 4.5 ± 1.3, respectively; P < 0.001), and at postoperative 24 h (3.1 ± 1.1 vs 3.8 ± 1.5, respectively; P = 0.01) with reduced use of rescue analgesic drugs. Significantly fewer patients suffered from chronic postoperative pain in the nefopam than in the control group at postoperative 3 months (36.6% vs 59.5%, P = 0.04). Considering only the cohort without postoperative adjuvant RT, the difference in the proportion of patients reporting chronic pain increased (23.5% in the nefopam group vs 61.5% in the control group, P = 0.04).Preventive nefopam was helpful in reducing the acute postoperative pain, with reduced use of rescue analgesic drugs, and it contributed to reduced occurrence of chronic pain at postoperative 3 months after breast cancer surgery.

Topics: Acute Pain; Adult; Aged; Analgesics, Non-Narcotic; Axilla; Breast Neoplasms; Chemoradiotherapy, Adjuvant; Chronic Pain; Cyclooxygenase Inhibitors; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Ketorolac; Mastectomy, Segmental; Meloxicam; Middle Aged; Nefopam; Pain Measurement; Pain, Postoperative; Preoperative Care; Prospective Studies; Sentinel Lymph Node Biopsy; Thiazines; Thiazoles

This study aimed to characterize osteoarthritis (OA)-related chronic pain and disability in experimental cats with naturally occurring OA. Peak vertical ground reaction force (PVF), accelerometer-based motor activity (MA) and the von Frey anesthesiometer-induced paw withdrawal threshold were used to define OA and to test the efficacy of meloxicam. A diagnosis of OA was based on radiographic and orthopedic examinations. Cats with OA (n=39) and classified as non-OA (n=6) were used to assess the reliability and sensitivity of the parameters to assess OA over 3weeks while being administered placebo medication. A randomised parallel design study was then used to investigate the effects on OA of daily oral meloxicam treatment for 4weeks at different dose rates (0.025mg/kg, n=10mg/kg; 0.04mg/kg, n=10; 0.05mg/kg, n=9), compared to cats administered a placebo (n=10). The test-retest repeatability for each tool was good (intra-class correlation coefficient ⩾0.6). The PVF and the von Frey anesthesiometer-induced paw withdrawal threshold discriminated OA (P<0.05). Meloxicam did not add to the PVF improvement observed in placebo-treated cats during the treatment period (adj-P⩽0.01). The 0.025 and the 0.05mg/kg meloxicam-treated cats experienced a higher night-time (17:00-06:58h) MA intensity during the treatment period compared to the placebo period (adj-P=0.04, and 0.02, respectively) and this effect was not observed in the placebo group. The high allodynia rate observed in the 0.04mg/kg meloxicam-treated group may explain the lower responsiveness to the drug. The von Frey anesthesiometer-induced paw withdrawal threshold demonstrated no responsiveness to meloxicam. The results from this study indicated that daily oral meloxicam administration for 4weeks provided pain relief according to night-time MA.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Cat Diseases; Cats; Chronic Pain; Dose-Response Relationship, Drug; Female; Hyperalgesia; Male; Meloxicam; Osteoarthritis; Pain Measurement; Thiazines; Thiazoles

Osteoarthritis (OA) pain is the number one cause of chronic pain in dogs. Multimodal treatment, including combining safe and effective nutritional interventions with non-steroidal anti-inflammatory drugs (NSAIDs), is currently considered one of the most appropriate choices for managing OA pain. Palmitoyl-glucosamine is a feed material belonging to the ALIAmide family, whose parent molecule is the prohomeostatic lipid amide N-palmitoyl-ethanolamine. Curcumin is a promising plant antioxidant. The present study aimed at investigating whether 18-week dietary integration with palmitoyl-glucosamine co-micronized with curcumin was able to maintain pain relief in dogs with OA-associated chronic pain receiving meloxicam (1.5 mg/ml oral suspension) on a tapering regimen (progressive 25% decrease of the original 0.1 mg/kg/day dose, on a biweekly basis) during the first 8 weeks of treatment. Pain was assessed both by the owners and veterinary surgeons, with the first using both subjective evaluation and validated metrology instruments-i.e., Helsinki Chronic Pain Index (HCPI) and Canine Brief Pain Inventory (CBPI)-while the second rating the severity of lameness and pain on palpation on two previously used 5-point scales.. A total of fifty-eight dogs with OA chronic pain entered the uncontrolled study. Pain on HCPI was considered severe at baseline (range 18-39). Based on owner's assessment, 90% of dogs who responded to meloxicam at the full-dose regimen could reduce meloxicam up to 25% of the original dose without experiencing pain worsening. Moreover, 75% of dogs was assessed as having no pain increase ten weeks after meloxicam withdrawal. A statistically significant decrease of pain severity as scored by HCPI (P < 0.0001) was observed two and ten weeks after meloxicam withdrawal compared to study entry (17.0 ± 1.05 and 15.1 ± 1.02, respectively, vs 29.0 ± 0.74; mean ± SEM). After meloxicam withdrawal, no statistically significant change in the CBPI scores was recorded. Pain on palpation and lameness significantly changed to less severe distributions along the study period (P < 0.0001).. The findings appear to suggest that dietary integration with palmitoyl-glucosamine co-micronized with curcumin was able to maintain meloxicam-induced pain relief in dogs with severe OA chronic pain.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Chronic Pain; Curcumin; Dog Diseases; Dogs; Glucosamine; Lameness, Animal; Meloxicam; Osteoarthritis

To evaluate the effectiveness of the effect of celecoxib and the combined vitamin complex of group B in comparison with meloxicam in patients with acute and chronic nonspecific lumbar pain (LP).. The effectiveness of the effect on acute (44%; acute pain syndrome (APS)) and chronic (56%; chronic pain syndrome (CPS)) LP of moderate intensity (according to VAS/MPQ) (APS 5.7±2.3/2.13±0.67 points; CPS 5.2±2.8/1.47±0.61 points), the leading component of which is sensory sensations (when APS is lower than in CBS; Kr-W=6.15,. It was found that celecoxib and meloxicam cause the same significant remitting decrease in the severity of APS and restoration of MF disorders in patients with APS, equally cause rare adverse events (gastropathy, increased blood pressure) in comorbid pathology. Celecoxib proved to be more effective in relieving CPS and improving MF (. The results of the study confirm the benefits of celecoxib in combination with a vitamin complex for the relief of CPS.. Оценить эффективность влияния целекоксиба и комбинированного витаминного комплекса группы B в сравнении с мелоксикамом у пациентов с острой и хронической неспецифической поясничной болью (ПБ).. Оценена эффективность влияния на острую (44%; острый болевой сисндром (ОБС)) и хроническую (56%; хронический болевой синдром (ХБС)) ПБ умеренной интенсивности (по ВАШ/MPQ) (ОБС — 5,7±2,3/2,13±0,67 балла; ХБС — 5,2±2,8/1,47±0,61 балла), ведущей составляющей которой являются сенсорные ощущения (при ОБС ниже, чем при ХБС; Kr-W=6,15,. Установлено, что целекоксиб и мелоксикам вызывают сопоставимое значимое снижение выраженности ОБС и восстановление нарушений ДФ у пациентов с ОБС, в равной степени вызывают редкие нежелательные явления (гастропатию, повышение артериального давления) при коморбидной патологии. Целекоксиб оказался эффективнее при купировании ХБС и для улучшения ДФ (. Результаты исследования подтверждают преимущества целекоксиба в сочетании с витаминным комплексом при купировании ХБС.

Topics: Adult; Celecoxib; Chronic Pain; Female; Humans; Low Back Pain; Male; Meloxicam; Middle Aged; Pain Measurement; Vitamin B Complex

Cervicobrachial pain (CBP) is often resistant to conventional oral analgesics. We hypothesized that the periradicular injection of meloxicam would produce a significant reduction in their intractable CBP. The secondary objective was to assess the impact of the treatment on functional recovery.. 48 patients with persistent CBP (>3 months of duration) despite multimodal analgesic therapy received 1-3 periradicular injections of meloxicam, 5-20 mg, at the dermatomal level(s) corresponding to their pain symptoms. Pain level (0=none to 10=severe), rescue analgesics, and functional activity were recorded at baseline and for 90d after the last injection. The injection was repeated if the pain score remained >3 or paresthesia persisted.. The mean pain score was reduced from a baseline of 8.9 (±1) to 1.7 (±2.2) at 90 days after the last meloxicam injection. Following meloxicam treatment(s), only 13% of the patients required oral analgesic rescue medication. All patients increased their functional activity level.. Cervical periradicular injection of meloxicam reduced CBP by 81% at 90-day follow-up and also improved functional recovery.

Topics: Adult; Aged; Aged, 80 and over; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Brachial Plexus Neuritis; Chronic Pain; Female; Humans; Male; Meloxicam; Middle Aged; Pain, Postoperative; Recovery of Function; Thiazines; Thiazoles

The aim of this study is to explore non-steroid anti-inflammation drugs (NSAIDs) potency for pelvic floor muscle pain by measuring local concentration in a rat model.. We used nine NSAIDs, including nabumetone, naproxen, ibuprofen, meloxicam, piroxicam, diclofenac potassium, etodolac, indomethacin, and sulindac, and 9 groups of female Wister rats. Each group of rats was fed with one kind of NSAID (2 mg/mL) for three consecutive days. Thereafter, one mL of blood and one gram of pelvic floor muscle were taken to measure drug pharmacokinetics, including partition coefficient, lipophilicity, elimination of half-life (T1/2) and muscle/plasma converting ratio (Css, muscle/Css, plasma).. Diclofenac potassium had the lowest T1/2 and the highest mean Css, muscle/Css, plasma (1.9 hours and 0.85±0.53, respectively). The mean Css, muscle/Css, plasma of sulindac, naproxen and ibuprofen were lower than other experimental NSAIDs.. Diclofenac potassium had the highest disposition in pelvic floor muscle in a rat model. The finding implies that diclofenac potassium might be the choice for pain relief in pelvic muscle.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Butanones; Chronic Pain; Diclofenac; Female; Meloxicam; Muscles; Nabumetone; Naproxen; Pelvic Floor; Pelvic Pain; Piroxicam; Rats; Rats, Wistar; Thiazines; Thiazoles

Hyponatremia (serum sodium level, <135 mmol/L) occasionally may develop in the course of treatment with nonsteroidal anti-inflammatory drugs, which are usually used in daily clinical practice. Nonsteroidal anti-inflammatory drugs diminish the normal inhibitory effect of prostaglandins on the activity of antidiuretic hormone and can therefore reduce free water excretion, leading to water retention and induction or exacerbation of hyponatremia. In this report, we present a case of hyponatremia in a 78-year-old man who had received meloxicam, a nonsteroidal anti-inflammatory drug.

Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Back Pain; Chronic Pain; Humans; Hyponatremia; Male; Meloxicam; Sodium; Thiazines; Thiazoles