scholarly journals Efficacy of Pain Relief in Different Postherpetic Neuralgia Therapies: A Network Meta-Analysis

2018 ◽  
Vol 1 (21;1) ◽  
pp. 19-32
Author(s):  
Yulian Wei
Keyword(s):  
Pain Relief ◽  
Magnesium Sulfate ◽  
Postherpetic Neuralgia ◽  
Meta Analysis ◽  
Pain Scores ◽  
Online Databases ◽  
Direct Head ◽  
Standardized Mean Difference ◽  
Key Words Postherpetic Neuralgia ◽  
Different Levels

Background: Postherpetic neuralgia (PHN) is a nerve pain disease usually controlled by different therapies, i.e., topical therapies, antiepileptics, analgesics, antipsychotics, antidepressants, anti-dementia drugs, antivirals, amitriptyline, fluphenazine, and magnesium sulfate. It is believed that different therapies may lead to different levels of pain relief. Objectives: We proposed this study to compare the efficacy of PHN treatments. Study Design: We conducted a systematic review of the current literature. All relevant studies were retrieved from online databases. The standardized mean difference (SMD) was used for pain relief measurement in different PHN therapies. Setting: A conventional meta-analysis and a network meta-analysis (NMA) were carried out together with the surface under the cumulative ranking curve (SUCRA) for each therapy calculated regarding their efficacy. Results: A pairwise meta-analysis suggested that 4 treatment classes, including topical therapies, antiepileptics, analgesics, and antidepressants, exhibited better pain relief results than placebo. Likewise, a NMA suggested that patients with 4 treatment classes exhibited significant improvements in pain scores compared to those with placebo. Limitations: There is a lack of direct head-to-head comparisons of some treatments, especially for antivirals, anti-dementia drugs, and magnesium sulfate. Secondly, the specific agents belonging to the same class of therapies might exhibit different effects (gabapentin and carisbamate) with different mechanisms (opioids and ketamine) on reducing pain, and some agents were hard to find in literatures and were not involved in our study, which may influence our results. Conclusions: Analgesics were preferable to other treatments with respect to pain relief for PHN, while antivirals appeared to be less effective than other therapies. Key words: Postherpetic neuralgia, topical agents, antiepileptics, analgesics, antipsychotics, antidepressants

scholarly journals Efficacy of Platelet-rich Plasma for Low Back Pain: A Systematic Review and Meta-analysis

2020 ◽  
Vol 81 (06) ◽  
pp. 529-534 ◽  
Author(s):  
Zhaopeng Xuan ◽  
Wenjun Yu ◽  
Yichen Dou ◽  
Tao Wang
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Patient Satisfaction ◽  
Back Pain ◽  
Pain Relief ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Low Back ◽  
Pain Scores ◽  
Control Intervention

Abstract Background Platelet-rich plasma (PRP) may be beneficial for patients with low back pain. However, the results remain controversial. We conducted a systematic review and meta-analysis to explore the efficacy of PRP for low back pain. Methods PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases were searched systematically. Randomized controlled trials (RCTs) assessing the effect of PRP on low back pain were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome was pain scores within 8 weeks. Meta-analysis was performed using the random-effects model. Results Three RCTs involving 131 patients were included in the meta-analysis. Overall, compared with control intervention for low back pain, PRP injection was found to reduce pain scores significantly (mean difference: − 1.47; 95% confidence interval [CI], − 2.12 to − 0.81; p < 0.0001), improve the number of patients with > 50% pain relief at 3 months (risk ratio [RR]: 4.14; 95% CI, 2.22–7.74; p < 0.00001), and offer relatively good patient satisfaction (RR: 1.91; 95% CI, 1.04–3.53; p = 0.04). No increase in adverse events was reported after PRP injection (RR: 1.92; 95% CI, 0.94-3.91; p = 0.07). Conclusions Compared with control intervention for low back pain, PRP injection was found to improve pain relief and patient satisfaction significantly with no increase in adverse events.

scholarly journals Postoperative Pain Relief after Pancreatic Resection: Systematic Review and Meta-Analysis of Analgesic Modalities

2021 ◽  
Author(s):  
Nasreen Akter ◽  
Bathiya Ratnayake ◽  
Daniel B. Joh ◽  
Sara-Jane Chan ◽  
Emily Bonner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pain Relief ◽  
Delayed Gastric Emptying ◽  
Meta Analysis ◽  
Bile Leak ◽  
Perioperative Outcomes ◽  
Respiratory Morbidity ◽  
Opioid Use ◽  
Randomized Controlled ◽  
Pain Scores

Abstract Background This systematic review explored the efficacy of different pain relief modalities used in the management of postoperative pain following pancreatoduodenectomy (PD) and distal pancreatectomy (DP) and impact on perioperative outcomes. Methods MEDLINE (OVID), Embase, Pubmed, Web of Science and CENTRAL databases were searched using PRISMA framework. Primary outcomes included pain on postoperative day 2 and 4 and respiratory morbidity. Secondary outcomes included operation time, bile leak, delayed gastric emptying, postoperative pancreatic fistula, length of stay, and opioid use. Results Five randomized controlled trials and seven retrospective cohort studies (1313 patients) were included in the systematic review. Studies compared epidural analgesia (EDA) (n = 845), patient controlled analgesia (PCA) (n = 425) and transabdominal wound catheters (TAWC) (n = 43). EDA versus PCA following PD was compared in eight studies (1004 patients) in the quantitative meta-analysis. Pain scores on day 2 (p = 0.19) and 4 (p = 0.18) and respiratory morbidity (p = 0.42) were comparable between EDA and PCA. Operative times, bile leak, delayed gastric emptying, pancreatic fistula, opioid use, and length of stay also were comparable between EDA and PCA. Pain scores and perioperative outcomes were comparable between EDA and PCA following DP and EDA and TAWC following PD. Conclusions EDA, PCA and TAWC are the most frequently used analgesic modalities in pancreatic surgery. Pain relief and other perioperative outcomes are comparable between them. Further larger randomized controlled trials are warranted to explore the relative merits of each analgesic modality on postoperative outcomes with emphasis on postoperative complications.

scholarly journals P-P08 Towards effective analgesia in acute pancreatitis: a systematic review of randomised controlled trials

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Navamayooran Thavanesan ◽  
Sophie White ◽  
Shiela Lee ◽  
Bathiya Ratnayake ◽  
John Leeds ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Pancreatitis ◽  
Pain Relief ◽  
Meta Analysis ◽  
Local Anaesthetics ◽  
Primary Outcome Measure ◽  
Significant Heterogeneity ◽  
Epidural Administration ◽  
Global Improvement ◽  
Pain Scores

Abstract Background The optimal analgesic strategy for patients with acute pancreatitis (AP) remains unknown. The present systematic review and meta-analysis aims to compare the efficacy of several analgesic modalities trialled in AP. Methods A systematic search of PubMed, MEDLINE and EMBASE was conducted up until June 2021, according to PRISMA Guidelines to identify all randomised control trials (RCTs) comparing analgesic modalities in AP.  The primary outcome measure was improvement in pain scores as reported on visual analogue scale (VAS) on day 0, day 1 and day 2. Results Twelve RCTs were identified including 542 patients. Seven trial drugs were compared: opiates, non-steroidal anti-inflammatories (NSAIDs), placebo, local anaesthetic, epidural, paracetamol and metamizole. A weighted single-arm effects estimate showed global improvement in VAS across all modalities from baseline to day 2. On visual inspection, epidural analgesia appears to provide the greatest improvement in pain scores within the first 24hrs, however at 48hrs it was comparable to opiates. Within the first 24hrs, NSAIDs offered similar pain-relief to opiates, while placebo also showed equivalence to other modalities but then plateaued. Local anaesthetics demonstrated least overall efficacy. VAS scores for opiate and non-opiate analgesics were comparable at baseline and day 1. The identified RCTs demonstrated significant heterogeneity in pain-relief reporting with relatively small datasets per study. Conclusions Given the incidence of AP there is remarkable paucity of level 1 evidence to guide pain management. Epidural administration is most effective analgesic modality within the first 24hrs of AP. NSAIDs are an effective opiate sparing alternative during the first 24hrs.

Prolonging the duration of single-shot intrathecal labour analgesia with morphine: A systematic review

2016 ◽  
Vol 13 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Hadeel Al-Kazwini ◽  
Irene Sandven ◽  
Vegard Dahl ◽  
Leiv Arne Rosseland
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Side Effects ◽  
Pain Relief ◽  
Beneficial Effect ◽  
Intrathecal Morphine ◽  
Meta Analysis ◽  
Labour Analgesia ◽  
Single Shot ◽  
Standardized Mean Difference

AbstractBackground and aimsSingle-shot spinal with bupivacaine plus fentanyl or sufentanil is commonly used as analgesia during labour, but the short duration limits the clinical feasibility. Different drugs have been added to prolong the analgesic duration. The additional effect of intra-thecal morphine has been studied during labour pain as well as after surgery. We assessed whether adding morphine to intra-thecal bupivacaine + fentanyl or sufentanil prolongs pain relief during labour.MethodsMeta-analysis of placebo-controlled randomized clinical trials of analgesia prolongation after single-shot intrathecal morphine ≤250µg during labour when given in combination with bupivacaine + fentanyl or sufentanil. After identifying 461 references, 24 eligible studies were evaluated after excluding duplicate publications, case reports, studies of analgesia after caesarean delivery, and epidural labour analgesia. Mean duration in minutes was the primary outcome measure and was included in the calculation of the standardized mean difference. Duration was defined as the time between a single shot spinal until patient request of rescue analgesia. All reported side effects were registered. Results of individual trials were combined using a random effect model. Cochrane tool was used to assess risk of bias.ResultsFive randomized placebo-controlled clinical trials (286 patients) were included in the metaanalysis. A dose of 50–250µg intrathecal morphine prolonged labour analgesia by a mean of 60.6 min (range 3–155 min). Adding morphine demonstrated a medium beneficial effect as we found a pooled effect of standardized mean difference = 0.57 (95% CI: –0.10 to 1.24) with high heterogeneity (I2 =88.1%). However, the beneficial effect was statistically non-significant (z =1.66, p = 0.096). The lower-bias trials showed a small statistically non-significant beneficial effect with lower heterogeneity. In influential analysis, that excluded one study at a time from the meta-analysis, the effect size appears unstable and the results indicate no robustness of effect. Omitting the study with highest effects size reduces the pooled effect markedly and that study suffers from inadequate concealment of treatment allocation and blinding. Trial quality was generally low, and there were too few trials to explore sources of heterogeneity in meta-regression and stratified analyses. In general, performing meta-analyses on a small number of trials are possible and may be helpful if one is aware of the limitations. As few as one more placebo-controlled trial would increase the reliability greatly.ConclusionsEvidence from this systematic review suggests a possible beneficial prolonging effect of adding morphine to spinal analgesia with bupivacaine + fentanyl or +sufentanil during labour. The study quality was low and heterogeneity high. No severe side effects were reported. More adequately-powered randomized trials with low bias are needed to determine the benefits and harms of adding morphine to spinal local anaesthetic analgesia during labour.ImplicationsEpidural analgesia is documented as the most effective method for providing pain relief during labour, but from a global perspective most women in labour have no access to epidural analgesia. Adding morphine to single shot spinal injection of low dose bupivacaine, fentanyl or sufentanil may be efficacious but needs to be investigated.

scholarly journals Comparing Verum and Sham Acupuncture in Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-13 ◽  
Author(s):  
Jiwon Kim ◽  
Su-Ryun Kim ◽  
Hyangsook Lee ◽  
Dong-Hyun Nam
Keyword(s):  
Pain Relief ◽  
Sleep Quality ◽  
Fibromyalgia Syndrome ◽  
Meta Analysis ◽  
Data Retrieval ◽  
Sham Acupuncture ◽  
Risk Of Bias ◽  
Pubmed Central ◽  
General Status ◽  
Standardized Mean Difference

Objectives. Acupuncture is often used for relieving symptoms of fibromyalgia syndrome (FMS). Our aim is to ascertain whether verum acupuncture is more effective than sham acupuncture in FMS. Methods. We collected RCTs to investigate the effects of verum acupuncture and sham acupuncture on pain, sleep quality, fatigue, and general status in FMS patients. The databases used for data retrieval were PubMed, Central Cochrane, EMBASE, PsycINFO, CNKI, VIP, OASIS, KoreaMed, and RISS. Selection/exclusion from the retrieved records was performed according to prespecified criteria, and the final selected records were assessed according to the Cochrane risk of bias tool. The results of the included trials were synthesized on the basis of outcomes, and subgroup analysis depended on the type of add-on sham acupuncture that was performed. Results. Ten RCTs (690 participants) were eligible, and eight RCTs were eventually included in the meta-analysis. The synthesis showed a sizable effect of verum acupuncture compared with sham acupuncture on pain relief (standardized mean difference (SMD) −0.49, Z = 3.26, P=0.001; I2 = 59%), improving sleep quality (SMD −0.46, Z = 3.24, P=0.001; I2 = 0%), and reforming general status (SMD −0.69, Z = 6.27, P<0.00001; I2 = 4%). However, efficacy on fatigue was insignificant (SMD −0.10, Z = 0.51, P=0.61; I2 = 46%). When compared with a combination of simulation and improper location of needling, the effect of verum acupuncture for pain relief was the most obvious. Conclusions. Verum acupuncture is more effective than sham acupuncture for pain relief, improving sleep quality, and reforming general status in FMS posttreatment. However, evidence that it reduces fatigue was not found.

scholarly journals Efficacy of ibuprofen in musculoskeletal post-traumatic pain in children: A systematic review

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243314
Author(s):  
Niccolò Parri ◽  
Simone Lazzeri
Keyword(s):  
Systematic Review ◽  
Pain Relief ◽  
Meta Analysis ◽  
Drug Of Choice ◽  
Pain Scores ◽  
Wide Range ◽  
Significant Difference ◽  
Meta Analyses ◽  
Study Designs ◽  
Initial Drug

Musculoskeletal (MSK) injuries are one of the most frequent reason for pain-related evaluation in the emergency department (ED) in children. There is still no consensus as to what constitutes the best analgesic for MSK pain in children. However, ibuprofen is reported to be the most commonly prescribed analgesic and is considered the standard first-line treatment for MSK injury pain in children, even if it is argued that it provides inadequate relief for many patients. The purpose of this study was to review the most recent literature to assess the efficacy of ibuprofen for pain relief in MSK injuries in children evaluated in the ED. We performed a systematic review of randomized controlled trials on pharmacological interventions in children and adolescents under 19 years of age with MSK injuries according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome was the risk ratio for successful reduction in pain scores. Six studies met the inclusion criteria and provided data on 1028 children. A meta-analysis was not performed since studies were not comparable due to the different analgesic treatment used. No significant difference in term of main pain score reduction between all the analgesics used in the included studies was noted. Patients who received oral opioids had side effects more frequently when compared to children who received ibuprofen. The combination of effect on pain relief and tolerability would suggest ibuprofen as the initial drug of choice in providing relief from mild-to-moderate MSK pain in children in the ED. The results obtained in this review and current research suggest that there’s no straightforward statistically significant evidence of the optimal analgesic agent to be used. However, ibuprofen may be preferable as the initial drug of choice in providing relief from MSK pain due to the favorable combination of effectiveness and safety profile. In fact, despite the non-significant pain reduction as compared to children who received opioids, there are less side effect associated to ibuprofen within studies. The wide range of primary outcomes measured in respect of pain scores and timing of recorded measures warrants a future standardization of study designs.

scholarly journals Pain Relief and Safety Outcomes with Cervical 10 kHz Spinal Cord Stimulation: Systematic Literature Review and Meta-analysis

2021 ◽  
Author(s):  
Ganesan Baranidharan ◽  
Beatrice Bretherton ◽  
Craig Montgomery ◽  
John Titterington ◽  
Tracey Crowther ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Spinal Cord Stimulation ◽  
Meta Analysis ◽  
Safety Outcomes

Paravertebral Block versus Thoracic Epidural Analgesia for Postthoracotomy Pain Relief: A Meta-Analysis of Randomized Trials

2021 ◽  
Author(s):  
Mu Xu ◽  
Jiajia Hu ◽  
Jianqin Yan ◽  
Hong Yan ◽  
Chengliang Zhang
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Meta Analysis ◽  
Thoracic Epidural Analgesia ◽  
Paravertebral Block ◽  
Cochrane Library ◽  
Thoracic Epidural ◽  
Analgesic Consumption ◽  
Postthoracotomy Pain

Abstract Objective Paravertebral block (PVB) and thoracic epidural analgesia (TEA) are commonly used for postthoracotomy pain management. The purpose of this research is to evaluate the effects of TEA versus PVB for postthoracotomy pain relief. Methods A systematic literature search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library (last performed on August 2020) to identify randomized controlled trials comparing PVB and TEA for thoracotomy. The rest and dynamic visual analog scale (VAS) scores, rescue analgesic consumption, the incidences of side effects were pooled. Results Sixteen trials involving 1,000 patients were included in this meta-analysis. The pooled results showed that the rest and dynamic VAS at 12, 24, and rest VAS at 48 hours were similar between PVB and TEA groups. The rescue analgesic consumption (weighted mean differences: 3.81; 95% confidence interval [CI]: 0.982–6.638, p < 0.01) and the incidence of rescue analgesia (relative risk [RR]: 1.963; 95% CI: 1.336–2.884, p < 0.01) were less in TEA group. However, the incidence of hypotension (RR: 0.228; 95% CI: 0.137–0.380, p < 0.001), urinary retention (RR: 0.392; 95% CI: 0.198–0.776, p < 0.01), and vomiting (RR: 0.665; 95% CI: 0.451–0.981, p < 0.05) was less in PVB group. Conclusion For thoracotomy, PVB may provide no superior analgesia compared with TEA but PVB can reduce side effects. Thus, individualized treatment is recommended. Further study is still necessary to determine which concentration of local anesthetics can be used for PVB and can provide equal analgesic efficiency to TEA.

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