There were no randomized clinical trials in the reviews that could provide unbiased estimates of the proportion of patients for whom the WHO guidelines would be efficacious.
In addition to critiquing previously published work for effectiveness of the guidelines, this review encompasses other pain measurement scales. A randomized, open-label, controlled trial.
Current Neurology. The four studies that used randomized samples were for the purposes of evaluating the necessity of Step 2 of the WHO analgesic ladder 30 — 32 Figure 1 or the use of mild opiates. Research studies of any methodological design were included in this review if they: Integrating Research: In an attempt to avoid using weak opioids, Nunes et al 32 found that a higher incidence of adverse effects occurred when the second step of the ladder was omitted and patients were administered morphine initially.
Petitti DB. Nonetheless, the implementation of RCT in studies of cancer pain management is not likely due to ethical and logistic reasons. Even the same type of scale may have had multiple interval labeling systems associated with them.
Acta Anaesthesiol Scand. Pain treatment and outcomes for patients with advanced cancer who receive follow-up care at home. The present study included searching more resources than databases and a manual search of reference lists.
Studies were included if they: RCTs are needed, however, when the effect and differences are smaller such as when comparing various drugs or routes. Glenview, IL: Advanced search. Two studies used the IPS.
The first debate about the effectiveness of the guidelines revolves around the utility of Step 2 of the WHO ladder. As the WHO guidelines endorse the use of other treatment modalities than the analgesic ladder if needed, the guidelines should be investigated in its entirety.
Symptoms during cancer pain treatment following WHO-guidelines: Undertreatment of medical inpatients with narcotic analgesics. J Opioid Manag. Cluster randomization is a possible alternative to overcome some of the challenges in getting RCTs regarding cancer pain relief.