Interventions for Neuropathic Pain: An Overview of Systematic Reviews.

Numerous interventions for neuropathic pain (NeuP) are available, but its treatment remains unsatisfactory. We systematically summarized evidence from systematic reviews (SRs) of randomized controlled trials on interventions for NeuP. Five electronic databases were searched up to March 2015. Study quality was analyzed using A Measurement Tool to Assess Systematic Reviews. The most common interventions in 97 included SRs were pharmacologic (59%) and surgical (15%). The majority of analyzed SRs were of medium quality. More than 50% of conclusions from abstracts on efficacy and approximately 80% on safety were inconclusive. Effective interventions were described for painful diabetic neuropathy (pregabalin, gabapentin, certain tricyclic antidepressants [TCAs], opioids, antidepressants, and anticonvulsants), postherpetic neuralgia (gabapentin, pregabalin, certain TCAs, antidepressants and anticonvulsants, opioids, sodium valproate, topical capsaicin, and lidocaine), lumbar radicular pain (epidural corticosteroids, repetitive transcranial magnetic stimulation [rTMS], and discectomy), cervical radicular pain (rTMS), carpal tunnel syndrome (carpal tunnel release), cubital tunnel syndrome (simple decompression and ulnar nerve transposition), trigeminal neuralgia (carbamazepine, lamotrigine, and pimozide for refractory cases, rTMS), HIV-related neuropathy (topical capsaicin), and central NeuP (certain TCAs, pregabalin, cannabinoids, and rTMS). Evidence about interventions for NeuP is frequently inconclusive or completely lacking. New randomized controlled trials about interventions for NeuP are necessary; they should address safety and use clear diagnostic criteria.

Comparison of information sources used in Cochrane and non-Cochrane systematic reviews: A case study in the field of anesthesiology and pain.

BACKGROUND: It has been reported that information sources searched in systematic reviews (SRs) are insufficiently comprehensive. We analyzed information sources used in SRs, as well as how up-to-date were the searches. METHODS: We searched PubMed and the Cochrane Database of Systematic Reviews (CDSR) through Wiley from 2012 to 2016 to find SRs of randomized controlled trials (RCTs) in the field of anesthesiology and pain. We analyzed information sources used and search dates. RESULTS: We analyzed 674 SRs, including 374 non-Cochrane SRs (NCSRs) and 300 Cochrane reviews. The most commonly searched electronic databases reported in all included SRs were Embase (88.6%), MEDLINE (78.3%), CENTRAL (76.1%), CINAHL (29.1%), and PubMed (30.9%). In 303 (45%) SRs, authors reported that they searched clinical trial registries; 57 (8.5%) reported that they searched for unpublished data, 184 (27.3%) searched grey literature, 51 (7.6%) searched citations, and 546 (81%) searched references of included studies. A substantial amount of Cochrane reviews searched clinical trial registries (75.7%), compared with NCSRs (20.3%). Search date was reported in 647 SRs (96.1%). The median time between the last search date and publication for the SRs that reported search date was 10 months. For the NCSRs, median time between the last search and publication date was significantly higher compared with Cochrane reviews. Nonreporting of search date was more prevalent in NCSRs. CONCLUSION: SRs in the field of anesthesiology and pain often neglect to search all possible information sources, particularly in NCSRs. Cochrane reviews had more comprehensive searching and shorter search to publication time.

Anesthesia and perioperative pain management during cardiac electronic device implantation.

BACKGROUND: The degree of pain caused by the implantation of cardiac electronic devices (CEDs) and the type of anesthesia or perioperative pain management used with the procedure have been insufficiently studied. The aim of this study was to analyze perioperative pain management, as well as intensity and location of pain among patients undergoing implantation of CED, and to compare the practice with published guidelines. PATIENTS AND METHODS: This was a combined retrospective and prospective study conducted at the tertiary hospital, University Hospital Split, Croatia. The sample included 372 patients who underwent CED implantation. Perioperative pain management was analyzed retrospectively in 321 patients who underwent CED implantation during 2014. In a prospective study, intensity and location of pain before, during, and after the procedure were measured by using a numerical rating scale (NRS) ranging from 0 to 10 in 51 patients at the same institution from November 2014 to August 2015. RESULTS: A quarter of patients received analgesia or sedation before surgery. All the patients received local lidocaine anesthesia. After surgery, 31% of patients received pain medication or sedation. The highest pain intensity was observed during CED implantation with the highest NRS pain score being 8. Some patients reported severe pain (NRS >5) also at 1, 3, 6, 8, and 24 hours after surgery. The most common pain locations were surgical site, shoulder, and chest. Adherence to guidelines for acute perioperative pain management was insufficient. CONCLUSION: Patients may experience severe pain during and after CED implantation. Perioperative pain management was suboptimal, and higher doses of sedation and intensive analgesia are required. Guidelines for acute perioperative pain management and anesthesia during CED implantation should be developed.