scholarly journals A Systematic Review of Observational Studies on the Effectiveness of Opioid Therapy for Cancer Pain

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. E85-E102
Author(s):  
James Colson
Keyword(s):  
Systematic Review ◽  
Cancer Pain ◽  
Quality Assessment ◽  
Observational Studies ◽  
Randomized Trials ◽  
Case Reports ◽  
The United States ◽  
Opioid Therapy ◽  
Strong Recommendation ◽  
Level Ii

Background: The prevalence of cancer-related pain and residual pain in cancer survivors is high. Opioids serve as the gold standard for treating moderate to severe cancer pain. The evaluation of the effectiveness of opioids in chronic non-cancer pain has shown a lack of effectiveness, or rather weak evidence for some of the drugs. In contrast, in cancer pain, opioids are expected to be very effective. Due to the nature of the disease, there is evidence of a paucity of randomized trials investigating opioid effectiveness in cancer pain on a long-term basis. Consequently, the effectiveness of opioids in managing cancer-related pain warrants further evidence-based review beyond randomized trials, including observational studies and case reports. Methods: The comprehensive literature search was conducted for the period 1996 through June 2010. Databases for the search included PubMed, EMBASE, Cochrane Reviews, and clinicaltrails.gov, along with reviews and cross references. Methodologic quality assessment of the observational studies managing chronic cancer pain with opioids was conducted utilizing the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. Analysis of evidence included 5 levels of evidence developed by the United States Preventive Services Task Force (USPSTF) ranging from Level I to III with 3 subcategories in Level II. Grading recommendations were based on Guyatt et al’s recommendations with 6 levels: 3 in the strong category and 3 in the weak category. Results: This evaluation is of 18 manuscripts considered for inclusion; 7 manuscripts met the inclusion criteria based on AHRQ quality assessment. Level of evidence for opioid therapy in cancer pain was Level II-3, and recommendations were 1C/strong recommendation based on observational studies, which could change based on future evidence. Conclusion: This systematic review of observational studies indicates Level II3 evidence for effectiveness of opioids in cancer pain therapy, with 1C/strong recommendation based on observational studies, which could change based on future evidence. Key words: Chronic pain, cancer pain, non-cancer pain, randomized trials, observational studies, case reports, opioids, effectiveness

scholarly journals Intrathecal Infusion Systems for Long-Term Management of Chronic Non-Cancer Pain: An Update of Assessment of Evidence

2013 ◽  
Vol 2s;16 (2s;4) ◽  
pp. SE185-SE216
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Cancer Pain ◽  
Quality Assessment ◽  
Outcome Measures ◽  
Observational Studies ◽  
Randomized Trials ◽  
Infusion Systems ◽  
Term Management ◽  
Intrathecal Infusion

Background: Intrathecal infusion systems are often used for patients with intractable pain when all else fails, including surgery. There is, however, some concern as to the effectiveness and safety of this treatment. Study Design: A systematic review of intrathecal infusion systems for long-term management of chronic non-cancer pain. Objective: To evaluate and update the effect of intrathecal infusion systems in managing chronic non-cancer pain. Methods: The available literature on intrathecal infusion systems in managing chronic pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventative Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief with short-term relief < 12 months and long-term relief ≥ 12 months. Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: There were 28 studies identified for this systematic review. Of these, 21 were excluded from further review. A total of 7 non-randomized studies met inclusion criteria for methodological quality assessment. No randomized trials met the inclusion requirements. The evidence is limited based on observational studies. Limitations: The limitations of this systematic review include the paucity of literature. Conclusion: The evidence is limited for intrathecal infusion systems. Key words: Spinal pain, chronic low back pain, intrathecal infusion, intrathecal infusion systems, intrathecal drug delivery systems, intrathecal pumps, chronic non-cancer pain, chronic non-malignant pain, morphine, bupivacaine, ziconotide

scholarly journals A Systematic Review of Randomized Trials of Long-Term Opioid Management for Chronic Non-Cancer Pain

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. 91-121
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Cancer Pain ◽  
Systematic Reviews ◽  
Randomized Trials ◽  
Opioid Therapy ◽  
Functional Improvement ◽  
Controlled Trials ◽  
Chronic Opioid Therapy ◽  
Level Of Evidence

Background: Even though opioids have been used for pain for thousands of years, opioid therapy for chronic non-cancer pain is controversial due to concerns regarding the long-term effectiveness and safety, particularly the risk of tolerance, dependance, or abuse. While the debate continues, the use of chronic opioid therapy for chronic non-cancer pain has increased exponentially. Even though evidence is limited, multiple expert panels have concluded that chronic opioid therapy can be effective therapy for carefully selected and monitored patients with chronic non-cancer pain. Study Design: A systematic review of randomized trials of opioid management for chronic noncancer pain. Objective: The objective of this systematic review is to evaluate the clinical efficacy of opioids in the treatment of chronic non-cancer pain. Methods: A comprehensive evaluation of the literature relating to opioids in chronic non-cancer pain was performed. The literature was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs) and Jadad criteria. A literature search was conducted by using PubMed, EMBASE, Cochrane library, ECRI Institute Library, U.S. Food and Drug Administration (FDA) website, U.S. National Guideline Clearinghouse (NGC), Database of Abstracts of Reviews of Effectiveness (DARE), clinical trials, systematic reviews and cross references from systematic reviews. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF) and used by other systematic reviews and guidelines. Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, withdrawals, and adverse effects. Results: Based on the USPSTF criteria, the indicated level of evidence was fair for Tramadol in managing osteoarthritis. For all the drugs assessed, including Tramadol, for all other conditions, the evidence was poor based on either weak positive evidence, indeterminate evidence, or negative evidence. Limitations: A paucity of literature, specifically with follow-up beyond 12 weeks for all types of opioids with controlled trials for various chronic non-cancer pain conditions. Conclusions: This systematic review illustrated fair evidence for Tramadol in managing osteoarthritis with poor evidence for all other drugs and conditions. Thus, recommendations must be based on non-randomized studies. Key words: Chronic non-cancer pain, opioids, opioid efficacy, opioid effectiveness, significant pain relief, functional improvement, adverse effects, morphine, hydrocodone, hydromorphone, fentanyl, tramadol, buprenorphine, methadone, tapentadol, oxycodone, oxymorphone, systematic reviews, randomized trials

scholarly journals The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Claudia Cristina Biguetti ◽  
Joel Ferreira Santiago Junior ◽  
Matthew William Fiedler ◽  
Mauro Toledo Marrelli ◽  
Marco Brotto
Keyword(s):  
Systematic Review ◽  
Quantitative Analysis ◽  
Qualitative Analysis ◽  
Observational Studies ◽  
Skeletal Muscles ◽  
Case Reports ◽  
Meta Analysis ◽  
Toxic Effects ◽  
Drug Induced ◽  
Qualitative And Quantitative

AbstractThe aim of this systematic review was to perform qualitative and quantitative analysis on the toxic effects of chloroquine (CQ) and hydroxychloroquine (HCQ) on skeletal muscles. We designed the study according to PRISMA guidelines. Studies for qualitative and quantitative analyses were selected according to the following inclusion criteria: English language; size of sample (> 5 patients), adult (> age of 18) patients, treated with CQ/HCQ for inflammatory diseases, and presenting and not presenting with toxic effects on skeletal muscles. We collected data published from 1990 to April 2020 using PubMed, Cochrane Library, EMBASE, and SciELO. Risk of bias for observational studies was assessed regarding the ROBIN-I scale. Studies with less than five patients (case reports) were selected for an additional qualitative analysis. We used the software Comprehensive Meta-Analysis at the confidence level of 0.05. We identified 23 studies for qualitative analysis (17 case-reports), and five studies were eligible for quantitative analysis. From case reports, 21 patients presented muscle weakness and confirmatory biopsy for CQ/HCQ induced myopathy. From observational studies, 37 patients out of 1,367 patients from five studies presented muscle weakness related to the use of CQ/HCQ, and 252 patients presented elevated levels of muscle enzymes (aldolase, creatine phosphokinase, and lactate dehydrogenase). Four studies presented data on 34 patients with confirmatory biopsy for drug-induced myopathy. No study presented randomized samples. The chronic use of CQ/HCQ may be a risk for drug-induced myopathy. There is substantiated need for proper randomized trials and controlled prospective studies needed to assess the clinical and subclinical stages of CQ/HCQ -induced muscle myopathy.

A Systematic Review of Randomized Trials on the Effectiveness of Opioids for Cancer Pain

2012 ◽  
Vol 3S;15 (3S;7) ◽  
pp. ES39-ES58 ◽  
Author(s):  
Lakshmi Koyyalagunta
Keyword(s):  
United States ◽  
Systematic Review ◽  
Side Effects ◽  
Pain Relief ◽  
Cancer Pain ◽  
Outcome Measures ◽  
Randomized Trials ◽  
Transdermal Fentanyl

Background: In all recommended guidelines put forth for the treatment of cancer pain, opioids continue to be an important part of a physician’s armamentarium. Though opioids are used regularly for cancer pain, there is a paucity of literature proving efficacy for long-term use. Cancer is no longer considered a “terminal disease”; 50% to 65% of patients survive for at least 2 years, and there are about 12 million cancer survivors in the United States. There is a concern about side effects, tolerance, abuse and addiction with long-term opioid use and a need to evaluate the effectiveness of opioids for cancer pain. Objective: The objective of this systematic review was to look at the effectiveness of opioids for cancer pain. Study Design: A systematic review of randomized trials of opioids for cancer pain. Methods: A comprehensive review of the current literature for randomized controlled trials (RCTs) of opioids for cancer pain was done. The literature search was done using PubMed, EMBASE, Cochrane library, clinical trials, national clearing house, Web of Science, previous narrative systematic reviews, and cross references. The studies were assessed using the modified Cochrane and Jadad criteria. Analysis of evidence was done utilizing the modified quality of evidence developed by United States Preventive Services Task Force (USPSTF). Outcome Measures: Pain relief was the primary outcome measure. Secondary outcome measures are quality of life (QoL) and side effects including tolerance and addiction. Results: The level of evidence for pain relief based on the USPSTF criteria was fair for transdermal fentanyl and poor for morphine, tramadol, oxycodone, methadone, and codeine. Limitations: Randomized trials in a cancer setting are difficult to perform and justify. There is a paucity of long-term trials and this review included a follow-up period of only 4 weeks. Conclusion: This systematic review of RCTs of opioids for cancer pain showed fair evidence for the efficacy of transdermal fentanyl and poor evidence for morphine, tramadol, oxycodone, methadone, and codeine. Key words: Opioids, pain relief, cancer pain, morphine, hydromorphone, methadone, fentanyl, oxymorphone, hydrocodone, oxycodone, buprenorphine.

scholarly journals Effect of revascularization on cognitive outcomes in intracranial steno-occlusive disease: a systematic review

2019 ◽  
Vol 46 (2) ◽  
pp. E14 ◽  
Author(s):  
Bradley Kolb ◽  
Hassan Fadel ◽  
Gary Rajah ◽  
Hamidreza Saber ◽  
Ali Luqman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Decline ◽  
Cognitive Performance ◽  
Observational Studies ◽  
English Language ◽  
Randomized Trials ◽  
Occlusive Disease ◽  
Cognitive Outcomes ◽  
Thomson Reuters ◽  
Before And After

OBJECTIVESteno-occlusive diseases of the cerebral vasculature have been associated with cognitive decline. The authors performed a systematic review of the existing literature on intracranial steno-occlusive disease, including intracranial atherosclerosis and moyamoya disease (MMD), to determine the extent and quality of evidence for the effect of revascularization on cognitive performance.METHODSA systematic search of PubMed/MEDLINE, the Thomson Reuters Web of Science Core Collection, and the KCI Korean Journal Database was performed to identify randomized controlled trials (RCTs) in the English-language literature and observational studies that compared cognitive outcomes before and after revascularization in patients with steno-occlusive disease of the intracranial vasculature, from which data were extracted and analyzed.RESULTSNine papers were included, consisting of 2 RCTs and 7 observational cohort studies. Results from 2 randomized trials including 142 patients with symptomatic intracranial atherosclerotic steno-occlusion found no additional benefit to revascularization when added to maximal medical therapy. The certainty in the results of these trials was limited by concerns for bias and indirectness. Results from 7 observational trials including 282 patients found some cognitive benefit for revascularization for symptomatic atherosclerotic steno-occlusion and for steno-occlusion related to MMD in children. The certainty of these conclusions was low to very low, due to both inherent limitations in observational studies for inferring causality and concerns for added risk of bias and indirectness in some studies.CONCLUSIONSThe effects of revascularization on cognitive performance in intracranial steno-occlusive disease remain uncertain due to limitations in existing studies. More well-designed randomized trials and observational studies are needed to determine if revascularization can arrest or reverse cognitive decline in these patients.

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