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The Clinical Journal of Pain Feb 2022The aim was to examine research on the impact of spinal cord stimulation (SCS) on the reduction of preimplantation opioid dose and what preimplantation opioid dose is...
OBJECTIVE
The aim was to examine research on the impact of spinal cord stimulation (SCS) on the reduction of preimplantation opioid dose and what preimplantation opioid dose is associated with a reduction or discontinuation of opioid use postimplantation.
METHODS
Systematic review of literature from PubMed, Web of Science, and Ovid Medline search of "opioid" and "pain" and "spinal cord stimulator." Inclusion criteria included original research providing data on SCS preimplantation opioid dosing and 12 months postimplantation opioid dosing or that correlated specific preimplantation opioid dose or opioid dose cutoff with significantly increased likelihood of opioid use discontinuation at 12 months postimplantation.
RESULTS
Systematic review of the literature yielded 17 studies providing data on pre-SCS and post-SCS implantation dose and 4 providing data on the preimplantation opioid dose that significantly increased likelihood of opioid use discontinuation at 12 months postimplantation. Data from included studies indicated that SCS is an effective tool in reducing opioid dose from preimplantation levels at 12 months postimplantation. Data preliminarily supports the assertion that initiation of SCS at a preimplantation opioid dose of ≤20 to ≤42.5 morphine milligram equivalents increases the likelihood of postimplantation elimination of opioid use.
DISCUSSION
SCS is an effective treatment for many types of chronic pain and can reduce or eliminate chronic opioid use. Preimplantation opioid dose may impact discontinuation of opioid use postimplantation and the effectiveness of SCS in the relief of chronic pain. More research is needed to support and strengthen clinical recommendations for initiation of SCS use at lower daily opioid dose.
Topics: Analgesics, Opioid; Chronic Pain; Humans; Neuralgia; Opioid-Related Disorders; Pain Management; Spinal Cord; Spinal Cord Stimulation; Treatment Outcome
PubMed: 35132028
DOI: 10.1097/AJP.0000000000001021 -
The Cochrane Database of Systematic... Jun 2024Persistent visceral pain is an unpleasant sensation coming from one or more organs within the body. Visceral pain is a common symptom in those with advanced cancer.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Persistent visceral pain is an unpleasant sensation coming from one or more organs within the body. Visceral pain is a common symptom in those with advanced cancer. Interventional procedures, such as neurolytic sympathetic nerve blocks, have been suggested as additional treatments that may play a part in optimising pain management for individuals with this condition.
OBJECTIVES
To evaluate the benefits and harms of neurolytic sympathetic nerve blocks for persistent visceral pain in adults with inoperable abdominopelvic cancer compared to standard care or placebo and comparing single blocks to combination blocks.
SEARCH METHODS
We searched the following databases without language restrictions on 19 October 2022 and ran a top-up search on 31 October 2023: CENTRAL; MEDLINE via Ovid; Embase via Ovid; LILACS. We searched trial registers without language restrictions on 2 November 2022: ClinicalTrials.gov; WHO International Clinical Trials Registry Platform (ICTRP). We searched grey literature, checked reference lists of reviews and retrieved articles for additional studies, and performed citation searches on key articles. We also contacted experts in the field for unpublished and ongoing trials. Our trial protocol was preregistered in the Cochrane Database of Systematic Reviews on 21 October 2022.
SELECTION CRITERIA
We searched for randomised controlled trials (RCTs) comparing any sympathetic nerve block targeting sites commonly used to treat abdominal pelvic pain from inoperable malignancies in adults to standard care or placebo.
DATA COLLECTION AND ANALYSIS
We independently selected trials based on predefined inclusion criteria, resolving any differences via adjudication with a third review author. We used a random-effects model as some heterogeneity was expected between the studies due to differences in the interventions being assessed and malignancy types included in the study population. We chose three primary outcomes and four secondary outcomes of interest. We sought consumer input to refine our review outcomes and assessed extracted data using Cochrane's risk of bias 2 tool (RoB 2). We assessed the certainty of evidence using the GRADE system.
MAIN RESULTS
We included 17 studies with 1025 participants in this review. Fifteen studies with a total of 951 participants contributed to the quantitative analysis. Single block versus standard care Primary outcomes No included studies reported our primary outcome, 'Proportion of participants reporting no worse than mild pain after treatment at 14 days'. The evidence is very uncertain about the effect of sympathetic nerve blocks on reducing pain to no worse than mild pain at 14 days when compared to standard care due to insufficient data (very low-certainty evidence). Sympathetic nerve blocks may provide small to 'little to no' improvement in quality of life (QOL) scores at 14 days after treatment when compared to standard care, but the evidence is very uncertain (standardised mean difference (SMD) -0.73, 95% confidence interval (CI) -1.70 to 0.25; I² = 87%; 4 studies, 150 participants; very low-certainty evidence). The evidence is very uncertain about the risk of serious adverse events as defined in our review as only one study contributed data to this outcome. Sympathetic nerve blocks may have an 'increased risk' to 'no additional risk' of harm compared with standard care (very low-certainty evidence). Secondary outcomes Sympathetic nerve blocks showed a small to 'little to no' effect on participant-reported pain scores at 14 days using a 0 to 10 visual analogue scale (VAS) for pain compared with standard care, but the evidence is very uncertain (mean difference (MD) -0.44, 95% CI -0.98 to 0.11; I² = 56%; 5 studies, 214 participants; very low-certainty evidence). There may be a 'moderate to large' to 'little to no' reduction in daily consumption of opioids postprocedure at 14 days with sympathetic nerve blocks compared with standard care, but the evidence is very uncertain (change in daily consumption of opioids at 14 days as oral milligrams morphine equivalent (MME): MD -41.63 mg, 95% CI -78.54 mg to -4.72 mg; I² = 90%; 4 studies, 130 participants; very low-certainty evidence). The evidence is very uncertain about the effect of sympathetic nerve blocks on participant satisfaction with procedure at 0 to 7 days and time to need for retreatment or treatment effect failure (or both) due to insufficient data. Combination block versus single block Primary outcomes There is no evidence about the effect of combination sympathetic nerve blocks compared with single sympathetic nerve blocks on the proportion of participants reporting no worse than mild pain after treatment at 14 days because no studies reported this outcome. There may be a small to 'little to no' effect on QOL score at 14 days after treatment, but the evidence is very uncertain (very low-certainty evidence). The evidence is very uncertain about the risk of serious adverse events with combination sympathetic nerve blocks compared with single sympathetic nerve blocks due to limited reporting in the included studies (very low-certainty evidence). Secondary outcomes The evidence is very uncertain about the effect of combination sympathetic nerve blocks compared with single sympathetic nerve blocks on participant-reported pain score and change in daily consumption of opioids postprocedure, at 14 days. There may be a small to 'little to no' effect, but the evidence is very uncertain (very low-certainty evidence). There is no evidence about the effect on participant satisfaction with procedure at 0 to 7 days and time to need for retreatment or treatment effect failure (or both) due to these outcomes not being measured by the studies. Risk of bias The risk of bias was predominately high for most outcomes in most studies due to significant concerns regarding adequate blinding. Very few studies were deemed as low risk across all domains for any outcome.
AUTHORS' CONCLUSIONS
There is limited evidence to support or refute the use of sympathetic nerve blocks for persistent abdominopelvic pain due to inoperable malignancy. We are very uncertain about the effect of combination sympathetic nerve blocks compared with single sympathetic nerve blocks. The certainty of the evidence is very low and these findings should be interpreted with caution.
Topics: Humans; Randomized Controlled Trials as Topic; Autonomic Nerve Block; Adult; Bias; Pelvic Neoplasms; Abdominal Neoplasms; Cancer Pain; Abdominal Pain; Pain Management; Nerve Block; Quality of Life
PubMed: 38842054
DOI: 10.1002/14651858.CD015229.pub2 -
Annals of Internal Medicine Nov 2020Opioids are frequently prescribed for acute musculoskeletal injuries and may result in long-term use and consequent harms. (Meta-Analysis)
Meta-Analysis
Predictors of Prolonged Opioid Use After Initial Prescription for Acute Musculoskeletal Injuries in Adults : A Systematic Review and Meta-analysis of Observational Studies.
BACKGROUND
Opioids are frequently prescribed for acute musculoskeletal injuries and may result in long-term use and consequent harms.
PURPOSE
To explore factors associated with persistent opioid use after its prescription for acute musculoskeletal injury.
DATA SOURCES
Searches of multiple electronic databases, without language restrictions, from inception to 6 January 2020, and reference lists of selected articles.
STUDY SELECTION
Observational studies of adults with opioid prescriptions for outpatient acute musculoskeletal injuries, in an adjusted model, that explored risk factors for prolonged use.
DATA EXTRACTION
6 reviewers, working in pairs, independently extracted data, rated the quality of studies, and evaluated the certainty of evidence.
DATA SYNTHESIS
14 cohorts with 13 263 393 participants were included. The overall prevalence of prolonged opioid use after musculoskeletal injury for high-risk populations (that is, patients receiving workers' compensation benefits, Veterans Affairs claimants, or patients with high rates of concurrent substance use disorder) was 27% (95% CI, 18% to 37%). The prevalence among low-risk populations was 6% (CI, 4% to 8%; for interaction < 0.001). Moderate-certainty evidence showed increased odds of persistent opioid use with older age (absolute risk increase [ARI] for every 10-year increase, 1.1% [CI, 0.7% to 1.5%]) and physical comorbidity (ARI, 0.9% [CI, 0.1% to 1.7%]). Low-certainty evidence suggested increased risk for persistent opioid use with past or current substance use disorder (ARI, 10.5% [CI, 4.2% to 19.8%]), prescriptions lasting more than 7 days (median ARI, 4.5%), and higher morphine milligram equivalents per day.
LIMITATION
Sparse, heterogeneous data with suboptimal adjustment for potential confounders.
CONCLUSION
Avoiding prescribing opioids for acute musculoskeletal injuries to patients with past or current substance use disorder, and restricting duration to 7 days or less and using lower doses when they are prescribed, are potentially important targets to reduce rates of persistent opioid use.
PRIMARY FUNDING SOURCE
National Safety Council. (PROSPERO: CRD42018104968).
Topics: Adult; Age Distribution; Analgesics, Opioid; Comorbidity; Drug Administration Schedule; Humans; Musculoskeletal System; Observational Studies as Topic; Opioid-Related Disorders; Prevalence; Risk Factors; Substance-Related Disorders
PubMed: 32805130
DOI: 10.7326/M19-3600 -
Journal of Hematology Apr 2021While pain is the hallmark of sickle cell disease (SCD), healthcare personnel are often ill-equipped to adequately treat patients who present in vaso-occlusive crisis...
BACKGROUND
While pain is the hallmark of sickle cell disease (SCD), healthcare personnel are often ill-equipped to adequately treat patients who present in vaso-occlusive crisis (VOC). Although symptom severity varies from individual to individual, SCD is characterized by intervallic pain as a result of oxygen deprivation in tissues and organs. Regardless of pain severity, SCD patients are often viewed as drug seekers by healthcare personnel who have concerns regarding patients' dependence on opioids which may lead to addiction. The objective was to assess the types and amount of opioids used to treat VOC in comparison to Centers for Disease Control opioid prescription guidelines.
METHODS
Literature search was conducted using CINAHL, PubMed, the Cochrane Library, Web of Science and hand search. Data were analyzed from 1999 to 2018. Randomized trials, observational, and case studies involved hospitalized adults with SCD who were prescribed opioids to treat VOC. Quality assessment was conducted using Downs and Black checklist. Meta-analysis was not conducted.
RESULTS
Five studies were conducted in the USA, Arabia and the Netherlands, and the USA and Canada were included. Participants were treated with either morphine or morphine milligram equivalent (MME). No study used the same method of opioid administration.
CONCLUSIONS
Patients with SCD who are hospitalized secondary to VOC mostly received opioids for pain well within the Centers for Disease Control and Prevention prescription guidelines. No uniform method exists. Additional research is warranted.
PubMed: 34007365
DOI: 10.14740/jh828 -
Nutrients Jul 2021Previous epidemiological studies have investigated the association of fish and marine n-3 polyunsaturated fatty acids (n-3 PUFA) consumption with cardiovascular disease... (Meta-Analysis)
Meta-Analysis
Previous epidemiological studies have investigated the association of fish and marine n-3 polyunsaturated fatty acids (n-3 PUFA) consumption with cardiovascular disease (CVD) mortality risk. However, the results were inconsistent. The purpose of this meta-analysis is to quantitatively evaluate the association between marine n-3 PUFA, fish and CVD mortality risk with prospective cohort studies. A systematic search was performed on PubMed, Web of Science, Embase and MEDLINE databases from the establishment of the database to May 2021. A total of 25 cohort studies were included with 2,027,512 participants and 103,734 CVD deaths. The results indicated that the fish consumption was inversely associated with the CVD mortality risk [relevant risk (RR) = 0.91; 95% confidence intervals (CI) 0.85-0.98]. The higher marine n-3 PUFA intake was associated with the reduced risk of CVD mortality (RR = 0.87; 95% CI: 0.85-0.89). Dose-response analysis suggested that the risk of CVD mortality was decreased by 4% with an increase of 20 g of fish intake (RR = 0.96; 95% CI: 0.94-0.99) or 80 milligrams of marine n-3 PUFA intake (RR = 0.96; 95% CI: 0.94-0.98) per day. The current work provides evidence that the intake of fish and marine n-3 PUFA are inversely associated with the risk of CVD mortality.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Cardiovascular Diseases; Diet; Eating; Fatty Acids, Omega-3; Female; Fishes; Heart Disease Risk Factors; Humans; Male; Middle Aged; Prospective Studies; Seafood; Young Adult
PubMed: 34371852
DOI: 10.3390/nu13072342 -
JBI Evidence Synthesis Aug 2020The objective of this review was to evaluate the effects of preoperative intrathecal morphine (ITM) in addition to patient-controlled analgesia with morphine (PCAM)... (Meta-Analysis)
Meta-Analysis
Effect of intrathecal morphine plus patient-controlled analgesia with morphine versus patient-controlled analgesia with morphine alone on total morphine dose 24 hours post-surgery: a systematic review.
OBJECTIVE
The objective of this review was to evaluate the effects of preoperative intrathecal morphine (ITM) in addition to patient-controlled analgesia with morphine (PCAM) versus PCAM without preoperative ITM on total morphine dose in the first 24 hours postoperatively in adult patients undergoing abdominal or thoracic surgery.
INTRODUCTION
Postoperative pain is a significant problem for patients undergoing major abdominal and thoracic surgery. Intrathecal morphine can reduce postoperative pain and reduce intravenous (IV) morphine requirements during the first 24 hours after surgery; however, the amount of IV morphine dose reduction achieved has not been well established. This knowledge could help anesthesia providers determine if ITM is an appropriate analgesic option for patients.
INCLUSION CRITERIA
This review included studies with participants 18 years of age or older receiving general anesthesia for abdominal or thoracic surgery. Studies were included that used the intervention of preoperative ITM in addition to PCAM versus PCAM without preoperative ITM. Total morphine dose in milligrams during the first 24 hours after surgery was the outcome of interest.
METHODS
A search of PubMed and CINAHL was conducted for studies published between January 1984 and October 2018 using the key terms intrathecal, morphine, postoperative, pain, patient-controlled analgesia and general anesthesia. Index terms and keywords from identified articles were used to search CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, ClinicalTrials.gov, Ovid MEDLINE, ProQuest Dissertations and Theses/Nursing and Allied Health Databases, and Scopus. The reference lists of articles that underwent critical appraisal were searched for additional studies. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Randomized Controlled Trials. Two independent reviewers assessed each selected article. Study results were pooled in statistical meta-analysis using the JBI System for the Unified Management, Assessment and Review of Information, and two studies were described in narrative form. Differences in IV morphine dose between the ITM plus PCAM and PCAM alone groups were calculated to produce the weighted mean difference (WMD) utilizing a 95% confidence interval (CI). Heterogeneity was assessed using χ and I values. Subgroup analysis was conducted on two studies that included IV non-opioid analgesia in addition to ITM and PCAM for postoperative analgesia.
RESULTS
Seven RCTs with a total sample size of 352 patients were included in this review. Five studies that evaluated postoperative total morphine dose in milligrams with and without preoperative ITM were included for statistical meta-analysis, with 277 participants from four countries. Total morphine dose was significantly reduced in patients who received ITM (WMD = -24.44 mg, 95% CI -28.70 to -20.18 mg) compared to PCAM without ITM. Subgroup analysis of two studies involving 112 participants using IV acetaminophen in addition to ITM and PCAM indicated no additional benefit after ITM was already administered (WMD = -25.93, 95% CI -32.05 to -19.80 mg). Two studies with 75 participants were described narratively because total morphine dose was reported as median rather than mean values.
CONCLUSIONS
In this review, ITM provided a significant decrease in overall total morphine dose during the first 24 hours after surgery in abdominal surgery patients. The addition of IV non-opioids to the postoperative analgesia protocol showed no additional reduction in postoperative IV morphine dose between groups.
SYSTEMATIC REVIEW REGISTRATION NUMBER
PROSPERO CRD42018100613.
Topics: Adolescent; Adult; Analgesia, Patient-Controlled; Analgesics, Non-Narcotic; Analgesics, Opioid; Humans; Morphine; Pain, Postoperative
PubMed: 32898361
DOI: 10.11124/JBISRIR-D-19-00199 -
Andrologia Dec 2020To assess the comparative efficacy and safety of drug treatments for premature ejaculation. A systemic review and Bayesian network meta-analysis were executed on... (Meta-Analysis)
Meta-Analysis
To assess the comparative efficacy and safety of drug treatments for premature ejaculation. A systemic review and Bayesian network meta-analysis were executed on randomised controlled trials of drug interventions for premature ejaculation. Intravaginal ejaculation latency time and related adverse effects were outcome measures. A total of 44 RCTs with 11,008 patients were included in our NMA. In therapy <8 weeks, the ranking of drug efficacy was topical creams >selective serotonin reuptake inhibitor (SSRI)+ phosphodiesterase 5 inhibitor (PDE5i) > PDE5i > sertraline > clomipramine > paroxetine > dapoxetine 60 milligram (mg) > dapoxetine 30 mg > fluoxetine>citalopram > duloxetine>placebo. In therapy ≥ 8 weeks, the ranking of drug efficacy was SSRI + PDE5i > topical creams > paroxetine > tramadol > PDE5i > fluoxetine > dapoxetine 60 mg > dapoxetine 30 mg > clomipramine>citalopram > placebo. For total adverse events, clomipramine, dapoxetine 30 mg, dapoxetine 60 mg, paroxetine, PDE5i, SSRI + PDE5i and tramadol had a higher risk than placebo. In conclusion, in ≥8 weeks of therapy, the drug combination of SSRI + PDE5i was the most effective PE therapy. In <8 weeks of therapy, the efficacy of local anaesthetics was best. All drug treatments were ranked better than placebo. In general, drugs with better effects had more obvious side effects.
Topics: Bayes Theorem; Ejaculation; Humans; Male; Network Meta-Analysis; Pharmaceutical Preparations; Premature Ejaculation; Selective Serotonin Reuptake Inhibitors; Treatment Outcome
PubMed: 32892379
DOI: 10.1111/and.13806