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Annals of the Rheumatic Diseases Jul 2017While it is now clear that paracetamol is ineffective for spinal pain, there is not consensus on the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) for this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
While it is now clear that paracetamol is ineffective for spinal pain, there is not consensus on the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) for this condition. We performed a systematic review with meta-analysis to determine the efficacy and safety of NSAIDs for spinal pain.
METHODS
We searched MEDLINE, EMBASE, CINAHL, CENTRAL and LILACS for randomised controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain. Reviewers extracted data, assessed risk of bias and evaluated the quality of evidence using the Grade of Recommendations Assessment, Development and Evaluation approach. A between-group difference of 10 points (on a 0-100 scale) was used for pain and disability as the smallest worthwhile effect, as well as to calculate numbers needed to treat. Random-effects models were used to calculate mean differences or risk ratios with 95% CIs.
RESULTS
We included 35 randomised placebo-controlled trials. NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo. Six participants (95% CI 4 to 10) needed to be treated with NSAIDs, rather than placebo, for one additional participant to achieve clinically important pain reduction. When looking at different types of spinal pain, outcomes or time points, in only 3 of the 14 analyses were the pooled treatment effects marginally above our threshold for clinical importance. NSAIDs increased the risk of gastrointestinal reactions by 2.5 times (95% CI 1.2 to 5.2), although the median duration of included trials was 7 days.
CONCLUSIONS
NSAIDs are effective for spinal pain, but the magnitude of the difference in outcomes between the intervention and placebo groups is not clinically important. At present, there are no simple analgesics that provide clinically important effects for spinal pain over placebo. There is an urgent need to develop new drug therapies for this condition.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Back Pain; Humans; Low Back Pain; Neck Pain; Radiculopathy
PubMed: 28153830
DOI: 10.1136/annrheumdis-2016-210597 -
Ageing Research Reviews May 2017While hyperalgesia (increased pain sensitivity) has been suggested to contribute to the increased prevalence of clinical pain in Parkinson's disease (PD), experimental... (Meta-Analysis)
Meta-Analysis Review
While hyperalgesia (increased pain sensitivity) has been suggested to contribute to the increased prevalence of clinical pain in Parkinson's disease (PD), experimental research is equivocal and mechanisms are poorly understood. We conducted a meta-analysis of studies comparing PD patients to healthy controls (HCs) in their response to experimental pain stimuli. Articles were acquired through systematic searches of major databases from inception until 10/2016. Twenty-six studies met inclusion criteria, comprising 1292 participants (PD=739, HCs=553). Random effects meta-analysis of standardized mean differences (SMD) revealed lower pain threshold (indicating hyperalgesia) in PD patients during unmedicated OFF states (SMD=0.51) which was attenuated during dopamine-medicated ON states (SMD=0.23), but unaffected by age, PD duration or PD severity. Analysis of 6 studies employing suprathreshold stimulation paradigms indicated greater pain in PD patients, just failing to reach significance (SMD=0.30, p=0.06). These findings (a) support the existence of hyperalgesia in PD, which could contribute to the onset/intensity of clinical pain, and (b) implicate dopamine deficiency as a potential underlying mechanism, which may present opportunities for the development of novel analgesic strategies.
Topics: Dopamine; Humans; Hyperalgesia; Pain Perception; Parkinson Disease
PubMed: 28179128
DOI: 10.1016/j.arr.2017.01.005 -
Journal of Manipulative and... Jan 2023The purpose of this review was to compare types of Western massage therapy (MT) to other therapies, placebo, and no-treatment controls in neck pain (NP) in randomized... (Review)
Review
OBJECTIVE
The purpose of this review was to compare types of Western massage therapy (MT) to other therapies, placebo, and no-treatment controls in neck pain (NP) in randomized and nonrandomized clinical trials.
METHODS
An electronic, systematic search was performed in 7 English and 2 Turkish databases (PubMed, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Physiotherapy Evidence-Based Database, ULAKBIM National Medical Database, and the Reference Directory of Turkey). The search terms "NP" and "massage" were used. Studies published between January 2012 and July 2021 were searched. Methodological quality was evaluated with Downs and Black Scale and version 2 of the Cochrane risk-of-bias tool.
RESULTS
A total of 932 articles were identified; 8 of them were eligible. The Downs and Black score ranged from 15 to 26 points. Two studies were rated as "fair," 3 studies as "good," and 3 studies as "excellent." According to version 2 of the Cochrane risk-of-bias tool, 3 studies had a low risk of bias, 3 studies had some concerns, and 2 studies had a high risk of bias. Fair evidence found that myofascial release therapy improved pain intensity and pain threshold compared to no intervention in the short term. Excellent evidence found that connective tissue massage with exercise improved pain intensity and pain threshold compared to exercise alone in the short term. No Western MTs were superior to other active therapies according to short-term and immediate effects.
CONCLUSION
This review suggests that Western MTs (myofascial release therapy and connective tissue massage) may improve NP, but studies are limited. This review showed that Western MTs were not superior to other active therapies for improving NP. The reviewed studies reported only immediate and short-term effects of Western MT; thus, high-quality randomized clinical trials investigating the long-term effects of Western MT are needed.
Topics: Humans; Neck Pain; Massage; Physical Therapy Modalities; Exercise
PubMed: 37422753
DOI: 10.1016/j.jmpt.2023.05.003 -
RMD Open May 2023To provide an extensive review on the associations between knee inflammation and altered pain perception mechanisms in people with knee osteoarthritis (OA). MEDLINE, Web... (Review)
Review
To provide an extensive review on the associations between knee inflammation and altered pain perception mechanisms in people with knee osteoarthritis (OA). MEDLINE, Web of Science, EMBASE and Scopus were searched up to 13 December 2022. We included articles reporting associations between knee inflammation (measured by effusion, synovitis, bone marrow lesions (BMLs) and cytokines) and signs of altered pain processing (assessed by quantitative sensory testing and/or questionnaire for neuropathic-like pain) in people with knee OA. Methodological quality was evaluated using the National Heart, Lung and Blood Institute Study Quality Assessment Tool. Level of evidence and strength of conclusion were determined using the Evidence-Based Guideline Development method. Nine studies were included, comprising of 1889 people with knee OA. Signs of greater effusion/synovitis may be positively associated with lower knee pain pressure threshold (PPT) and neuropathic-like pain. Current evidence could not establish an association between BMLs and pain sensitivity. Evidence on associations between inflammatory cytokines and pain sensitivity or neuropathic-like pain was conflicting. There are indications of a positive association between higher serum C reactive protein (CRP) levels and lower PPT and presence of temporal summation. Methodological quality varied from level C to A2. Signs of effusion/synovitis may be positively associated with neuropathic-like pain and pain sensitivity. There are indications of a possible positive association between serum CRP levels and pain sensitivity. Given the quality and the small amount of included studies, uncertainty remains. Future studies with adequate sample size and follow-up are needed to strengthen the level of evidence.PROSPERO registration number: CRD42022329245.
Topics: Humans; Osteoarthritis, Knee; Pain; Inflammation; Pain Perception; Synovitis; Cytokines
PubMed: 37225282
DOI: 10.1136/rmdopen-2022-002945 -
Regional Anesthesia and Pain Medicine Apr 2023Chronic neuropathic pain is often debilitating and can have a significant impact on sleep health and quality of life. There is limited information on the impact of... (Meta-Analysis)
Meta-Analysis Review
Evaluating the impact of cannabinoids on sleep health and pain in patients with chronic neuropathic pain: a systematic review and meta-analysis of randomized controlled trials.
BACKGROUND
Chronic neuropathic pain is often debilitating and can have a significant impact on sleep health and quality of life. There is limited information on the impact of cannabinoids on sleep health when treating neuropathic pain.
OBJECTIVE
The objectives of this systematic review and meta-analysis were to determine the effect of cannabinoids on sleep quality, pain intensity, and patient impression of treatment efficacy in patients with neuropathic pain.
EVIDENCE REVIEW
Nine available medical literature databases were searched for randomized controlled trials comparing synthetic and natural cannabinoids to placebo in patients with neuropathic pain syndromes. Data on validated tools for sleep quality, pain intensity, patients' global impression of change (PGIC), and incidence of adverse effects of cannabinoids were extracted and synthesized.
FINDINGS
Of the 3491 studies screened, eight randomized controlled trials satisfied the inclusion criteria for this review. Analyses were performed using R -4.1.2. using the package and are interpreted using alpha=0.05 as the threshold for statistical significance. Validated measures for sleep health were not used in most studies. Meta-analysis of data from six studies showed that cannabinoids were associated with a significant improvement in sleep quality (standardized mean difference (SMD): 0.40; 95% CI: 0.19 to -0.61, 95% prediction interval (PI): -0.12 to 0.88, p-value=0.002, I=55.26, τ=0.05, Q-statistic=16.72, GRADE: moderate certainty). Meta-analysis of data from eight studies showed a significant reduction in daily pain scores in the cannabinoid (CB) group (SMD: -0.55, 95% CI:-0.69 to -0.19, 95% PI: -1.51 to 0.39, p=0.003, I=82.49, τ=0.20, Q-statistic=47.69, GRADE: moderate certainty). However, sleep health and analgesic benefits were associated with a higher likelihood of experiencing daytime somnolence, nausea, and dizziness.
CONCLUSIONS
Cannabinoids have a role in treating chronic neuropathic pain as evidenced by significant improvements in sleep quality, pain intensity, and PGIC. More research is needed to comprehensively evaluate the impact of cannabinoids on sleep health and analgesic efficacy.
PROSPERO REGISTRATION NUMBER
CRD42017074255.
Topics: Humans; Cannabinoids; Chronic Pain; Quality of Life; Randomized Controlled Trials as Topic; Neuralgia; Analgesics; Sleep
PubMed: 36598058
DOI: 10.1136/rapm-2021-103431 -
Acupuncture in Medicine : Journal of... Aug 2017To assess the efficacy of manual acupuncture (MA) in the treatment of myofascial pain syndrome (MPS). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the efficacy of manual acupuncture (MA) in the treatment of myofascial pain syndrome (MPS).
METHODS
We searched for randomised controlled trials (RCTs) comparing MA versus sham/placebo or no intervention in patients with MPS in the following databases from inception to January 2016: PubMed; Cochrane Library; Embase; Web of Science; and China Biology Medicine. Two reviewers independently screened the literature extracted data and assessed the quality of the included studies according to the risk of bias tool recommended by the Cochrane Handbook (V.5.1.0). Then, a meta-analysis was performed using RevMan 5.3 software.
RESULTS
Ten RCTs were combined in a meta-analysis of MA versus sham, which showed a favourable effect of MA on pain intensity after stimulation of myofascial trigger points (MTrPs; standardised mean difference (SMD) -0.90, 95% CI -1.48 to -0.32; p=0.002) but not traditional acupuncture points (p>0.05). Benefit was seen both after a single treatment (SMD -1.05, 95% CI -1.84 to -0.27; p=0.009) and course of eight sessions (weighted mean difference (WMD) -1.96, 95% CI -2.72 to -1.20; p<0.001). We also found a significant increase in pressure pain threshold following MA stimulation of MTrPs (WMD 1.00, 95% CI 0.32 to 1.67; p=0.004). Two of the included studies reported mild adverse events (soreness/haemorrhage) secondary to MA.
CONCLUSIONS
Through stimulation of MTrPs, MA might be efficacious in terms of pain relief and reduction of muscle irritability in MPS patients. Additional well-designed/reported studies are required to determine the optimal number of sessions for the treatment of MPS.
Topics: Acupuncture Points; Acupuncture Therapy; Humans; Myofascial Pain Syndromes; Randomized Controlled Trials as Topic
PubMed: 28115321
DOI: 10.1136/acupmed-2016-011176 -
Rheumatology International Dec 2018Mirtazapine is commonly used to treat major depressive disorder. Due to its effects on multiple neurotransmitters, it has been investigated for possible benefits in... (Review)
Review
Mirtazapine is commonly used to treat major depressive disorder. Due to its effects on multiple neurotransmitters, it has been investigated for possible benefits in patients with fibromyalgia. The objective of this systematic review is to assess the efficacy and safety of mirtazapine in the treatment of patients with fibromyalgia. Pubmed (1946-May 2018), Embase (1947-May 2018), CENTRAL, and ClinicalTrials.gov were queried using the search term combination: fibromyalgia, pain, chronic pain, neuralgia, neuropathic pain, chronic widespread pain, or chronic pain syndrome and mirtazapine. Studies appropriate to the objective were evaluated, including three randomized, placebo-controlled trials and one open-label trial, investigating the effect of mirtazapine in patients with fibromyalgia. In patients with fibromyalgia, treatment with mirtazapine resulted in improvements in pain, sleep, and quality of life. Study durations ranged from 6 to 13 weeks and studies used varying dosing strategies for mirtazapine. Minor occurrences of somnolence, weight gain, nasopharyngitis, dry mouth, and increased appetite were reported with mirtazapine use. Based on the reviewed literature, mirtazapine appears to be a promising therapy to improve pain, sleep, and quality of life in patients with fibromyalgia. These benefits were demonstrated in patients that were treatment naïve and those that had failed previous therapies. Additional clinical evidence through larger and longer length trials would be of benefit to further define the role of mirtazapine for patients with fibromyalgia.
Topics: Fibromyalgia; Health Status; Humans; Mirtazapine; Neurotransmitter Agents; Pain Threshold; Quality of Life; Sleep; Treatment Outcome
PubMed: 29860538
DOI: 10.1007/s00296-018-4068-3 -
Journal of Hypertension Sep 2017: Although antihypertensive medication is usually continued indefinitely, observations during wash-out phases in hypertension trials have shown that withdrawal of... (Review)
Review
: Although antihypertensive medication is usually continued indefinitely, observations during wash-out phases in hypertension trials have shown that withdrawal of antihypertensive medication might be well tolerated to do in a considerable proportion of people. A systematic review was completed to determine the proportion of people remaining normotensive for 6 months or longer after cessation of antihypertensive therapy and to investigate the safety of withdrawal. The mean proportion adjusted for sample size of people remaining below each study's threshold for hypertension treatment was 0.38 at 6 months [95% confidence interval (CI) 0.37-0.49; 912 participants], 0.40 at 1 year (95% CI 0.40-0.40; 2640 participants) and 0.26 at 2 years or longer (95% CI 0.26-0.27; 1262 participants). Monotherapy, lower blood pressure before withdrawal and body weight were reported as predictors for successful withdrawal. Adverse events were more common in those who withdrew but were minor and included headache, joint pain, palpitations, oedema and a general feeling of being unwell. Prescribers should consider offering patients with well controlled hypertension a trial of withdrawal of antihypertensive treatment with subsequent regular blood pressure monitoring.
Topics: Antihypertensive Agents; Humans; Hypertension
PubMed: 28486271
DOI: 10.1097/HJH.0000000000001405 -
BMJ Open May 2021To identify available literature on prevalence, severity and contributing factors of scan-associated anxiety ('scanxiety') and interventions to reduce it. (Review)
Review
OBJECTIVES
To identify available literature on prevalence, severity and contributing factors of scan-associated anxiety ('scanxiety') and interventions to reduce it.
DESIGN
Systematic scoping review.
DATA SOURCES
Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Scopus, EBSCO CINAHL and PubMed up to July 2020.
STUDY SELECTION
Eligible studies recruited people having cancer-related non-invasive scans (including screening) and contained a quantitative assessment of scanxiety.
DATA EXTRACTION
Demographics and scanxiety outcomes were recorded, and data were summarised by descriptive statistics.
RESULTS
Of 26 693 citations, 57 studies were included across a range of scan types (mammogram: 26/57, 46%; positron-emission tomography: 14/57, 25%; CT: 14/57, 25%) and designs (observation: 47/57, 82%; intervention: 10/57, 18%). Eighty-one measurement tools were used to quantify prevalence and/or severity of scanxiety, including purpose-designed Likert scales (17/81, 21%); the State Trait Anxiety Inventory (14/81, 17%) and the Hospital Anxiety and Depression Scale (9/81, 11%). Scanxiety prevalence ranged from 0% to 64% (above prespecified thresholds) or from 13% to 83% ('any' anxiety, if no threshold). Mean severity scores appeared low in almost all measures that quantitatively measured scanxiety (54/62, 87%), regardless of whether anxiety thresholds were prespecified. Moderate to severe scanxiety occurred in 4%-28% of people in studies using descriptive measures. Nine of 20 studies assessing scanxiety prescan and postscan reported significant postscan reduction in scanxiety. Lower education, smoking, higher levels of pain, higher perceived risk of cancer and diagnostic scans (vs screening scans) consistently correlated with higher scanxiety severity but not age, gender, ethnicity or marital status. Interventions included relaxation, distraction, education and psychological support. Six of 10 interventions showed a reduction in scanxiety.
CONCLUSIONS
Prevalence and severity of scanxiety varied widely likely due to heterogeneous methods of measurement. A uniform approach to evaluating scanxiety will improve understanding of the phenomenon and help guide interventions.
Topics: Anxiety; Anxiety Disorders; Depression; Humans; Neoplasms
PubMed: 34039571
DOI: 10.1136/bmjopen-2020-043215 -
American Journal of Preventive Medicine Mar 2016Ovarian cancer is common and has significant morbidity and mortality, partly because it is often diagnosed at a late stage. This study sought to determine the accuracy... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Ovarian cancer is common and has significant morbidity and mortality, partly because it is often diagnosed at a late stage. This study sought to determine the accuracy of individual symptoms and combinations of symptoms for the diagnosis of ovarian cancer.
EVIDENCE ACQUISITION
MEDLINE was searched, identifying 2,492 abstracts, reviewing 71 articles in full, and ultimately identifying 17 studies published between 2001 and 2014 that met the inclusion criteria. Data were abstracted by two researchers, and quality was assessed using the QUADAS-2 criteria adapted to the study question. Bivariate random effects meta-analysis was used where possible, and heterogeneity and threshold effects were explored using receiver operating characteristic curves. Data were analyzed in 2015.
EVIDENCE SYNTHESIS
Most studies were at high risk of bias, primarily because of case-control design or differential verification bias. The highest positive likelihood ratios (LRs+) were found for presence of abdominal mass (LR+, 30.0); abdominal distension or increased girth (LR+, 16.0); abdominal or pelvic pain (LR+, 10.4); abdominal or pelvic bloating (LR+, 9.3); loss of appetite (LR+, 9.2); and a family history of ovarian cancer (LR+, 7.5). No symptoms were helpful at ruling out ovarian cancer when absent. The Ovarian Cancer Symptom Index was validated in five studies and (after excluding one outlier with different inclusion criteria) was 63% sensitive and 95% specific (LR+, 12.6; LR-, 0.39). Two other symptom scores had not been validated prospectively.
CONCLUSIONS
Several individual signs and symptoms significantly increase the likelihood of ovarian cancer when present. More work is needed to validate decision rules and develop new decision support tools integrating risk factors, symptoms, and possibly biomarkers to identify women at increased ovarian cancer risk.
Topics: Adult; Female; Humans; Ovarian Neoplasms; Physical Examination; Risk Factors; Symptom Assessment; United States
PubMed: 26541098
DOI: 10.1016/j.amepre.2015.09.023