Pandemonium over painkillers persists

Cowan, David

doi:10.12968/bjcn.2007.12.4.23253

Br J Community Nurs

2007

DOI: 10.12968/bjcn.2007.12.4.23253

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Pandemonium over painkillers persists

David Cowan

Abstract: Chronic non-cancer pain remains under-treated. Five years ago it was highlighted that more research was needed into the safety and efficacy of NSAIDs and opioid drugs in older people (Cowan, 2002). Concerns remain over NSAID-induced pathology and now there are safety concerns over the continued use of supposedly safer COX-2 agents. There also remain concerns over the problematic use of opioids, including the potential for psychological and physical dependence. While more research is still needed to inform pres… Show more

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Cited by 3 publications

(1 citation statement)

References 25 publications

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“…Long-term, randomized, controlled studies are required to address the lack of evidence base for the optimum prescription of pain medications for people with osteoarthritis. 77 …”

mentioning

confidence: 99%

Review of the efficacy of green tea, isoflavones and aloe vera supplements based on randomised controlled trials

Williamson

Coppens²,

Serra-Majem

et al. 2011

Food Funct.

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We assess the evidence for health benefits of three commonly consumed plant food supplements (PFS), green tea, isoflavone and aloe vera, based on published systematic reviews of randomised controlled trials (RCTs). Whilst the potential benefits of green tea have been reported in a wide range of health areas, it is only in the area of the metabolic syndrome that the number of RCTs is approaching sufficient to judge such efficacy. Isoflavone supplements are widely used, and RCTs indicate that they affect bone resorption at lower doses in postmenopausal women undergoing estrogen-related bone loss, but this is only translated to attenuation of bone loss at higher doses of isoflavones. A systematic review on RCTs concluded that the effects of isoflavones on hot flashes in postmenopausal women were highly variable and no conclusions could be drawn. Despite the popularity of aloe vera as a PFS, the evaluation of its efficacy as a coadjuvant therapy for certain metabolic or digestive pathologies remains scarce; it constitutes a typical example of a naturally occurring ingredient whose efficacy in topical applications presupposes its efficacy in systemic applications. Nevertheless, its possible toxic effects on oral consumption call for caution in its utility as a PFS. Since 2007, efficacy evaluation of PFS in Europe has been covered by European Union Nutrition and Health Claims legislation. The European Food Safety Authority has adopted an approach relying on RCTs, while medicinal effects are accepted based on traditional use. In general, there are insufficient RCTs for claims to be made, and conclusive results on PFS should be obtained in the future by conducting studies with more homogeneous populations, by using supplements with optimised and measured bioavailability, and by conducting larger RCTs.

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“…Long-term, randomized, controlled studies are required to address the lack of evidence base for the optimum prescription of pain medications for people with osteoarthritis. 77 …”

mentioning

confidence: 99%

Review of the efficacy of green tea, isoflavones and aloe vera supplements based on randomised controlled trials

Williamson

Coppens²,

Serra-Majem

et al. 2011

Food Funct.

View full text Add to dashboard Cite

show abstract

Zingiber officinale: A Potential Plant against Rheumatoid Arthritis

2014

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Rheumatoid arthritis (RA) is an autoimmune disease particularly affecting elderly people which leads to massive bone destruction with consequent inflammation, pain, and debility. Allopathic medicine can provide only symptomatic relief. However, Zingiber officinale is a plant belonging to the Zingiberaceae family, which has traditionally been used for treatment of RA in alternative medicines of many countries. Many of the phytochemical constituents of the rhizomes of this plant have therapeutic benefits including amelioration of RA. This review attempts to list those phytochemical constituents with their reported mechanisms of action. It is concluded that these phytochemicals can form the basis of discovery of new drugs, which not only can provide symptomatic relief but also may provide total relief from RA by stopping RA-induced bone destruction. As the development of RA is a complex process, further research should be continued towards elucidating the molecular details leading to RA and drugs that can stop or reverse these processes by phytoconstituents of ginger.

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Oral Aloe vera as a treatment for osteoarthritis: a summary

Cowan

2010

Br J Community Nurs

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While pain relief is a basic tenet of health care, pain is under-treated in the UK (Davies and Mcvicar, 2000) and this issue remains unresolved. This paper suggests that oral Aloe vera could be used in the treatment of chronic non-cancer pain (CNCP), particularly that caused by osteoarthritis (OA). Despite being used as arthritis treatment for centuries (Yoo et al, 2008), evidence of effectiveness of Aloe vera is anecdotal or from small studies. The perceived benefits of prescribing Aloe vera for OA may be twofold: it has utility as an anti-inflammatory agent and also as a prophylactic against the gastrointestinal irritant effects of non-steroidal anti-inflammatory drugs (NSAIDs). Long-term, randomized, controlled studies are still needed to address the lack of evidence informing optimum prescribing of pain medication for people with OA (Cowan, 2007). There is no reason that so called 'nutraceutical' agents should not be subjected to the same rigorous randomized, controlled, double-blind trials as other 'mainstream' drugs. Therefore, it is appropriate to ask whether NSAID treatment and side effects can be improved by the addition of oral Aloe vera. Thus, we may then be in a more informed position to resolve the ongoing 'Pandemonium over Painkillers' (Cowan, 2007).

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Pandemonium over painkillers persists

Cited by 3 publications

References 25 publications

Review of the efficacy of green tea, isoflavones and aloe vera supplements based on randomised controlled trials

Review of the efficacy of green tea, isoflavones and aloe vera supplements based on randomised controlled trials

Zingiber officinale: A Potential Plant against Rheumatoid Arthritis

Oral Aloe vera as a treatment for osteoarthritis: a summary

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