Serotonin norepinephrine reuptake inhibitors in managing neuropathic pain following spinal and non-spinal surgery: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: While serotonin norepinephrine reuptake inhibitors (SNRIs) offer promise in managing Post-surgical neuropathic pain (PSNP), uncertainties remain. This study aims to evaluate the effectiveness and adverse events of SNRIs in managing PSNP. METHODS: Systematic searches of PubMed, Embase, and Cochrane databases up to January 1st 2023 identified randomized controlled trials (RCTs) comparing SNRIs to placebo for PSNP. The primary outcome measures were pain at rest and adverse events post-surgery. Subgroup analyses were conducted based on surgical type and specific SNRIs. RESULTS: A total of 19 RCTs, encompassing 1440 participants (719 in the SNRI group vs 721 in the placebo group), met the inclusion criteria and were included. The pooled results demonstrated that pain scores were significantly lower in patients treated with SNRIs at 2 hours (MD:-0.26; 95%CI: -0.47 to -0.04; p=0.02), 6 hours (MD:-0.68; 95%CI: -1.01 to -0.34; p<0.0001), 24 hours (MD:-0.54; 95%CI: -0.99 to -0.09; p=0.02), and 48 hours (MD:-0.66; 95%CI: -1.23 to -0.10; p=0.02) post-surgery. In terms of adverse events, dizziness (OR:2.53; 95%CI: 1.34-4.78; p=0.004) and dry mouth (OR:2.21; 95%CI: 1.25-3.92; p=0.007) were significantly higher in the SNRIs group. Subgroup analysis showed that SNRI was found to significantly lower the 24-hour pain score after spinal surgery (MD:-0.45; 95%CI: -0.84 to -0.05; p=0.03). Duloxetine (MD:-0.63; 95%CI: -1.15 to -0.11; p=0.02) had a significant effect in lowering the 24-hour pain score at rest compared to placebo, whereas venlafaxine did not. CONCLUSIONS: SNRIs yielded considerable pain score reductions across multiple post-surgical intervals, although accompanied by an increased incidence of dizziness and dry mouth.

Associations of Sociodemographic and Psychosocial Factors with Headache Symptom Among Indonesian Adolescents Based on the 5th Wave of the Indonesian Family Life Survey (IFLS-5).

BACKGROUND: Headaches are common among children and adolescents, with more than half of adolescents reporting headache symptom worldwide. The number of migraine sufferers among adolescents has increased dramatically in the past decade. Headache has negatively influenced children and has been linked with emotional and behavioral problems. STUDY DESIGN: A cross-sectional study. METHODS: This study was conducted using secondary data from the Indonesian Family Life Survey (IFLS) to evaluate the relationship between sociodemographic and psychosocial factors in Indonesian adolescents and headaches. We used data from the fifth wave of IFLS, which was conducted between September 2014 and April 2015. The figures represent roughly 83% of the Indonesian population. We investigated the possible relationship between sociodemographic and psychosocial factors in adolescents with headaches. RESULTS: A total of 3605 participants (1875 females and 1730 males) aged 15 to 19 years with headache symptom were included in the study. Headache was associated with sleep disturbances (OR 1.99; 95% CI: 1.72, 2.30), depression (OR 1.94; 95% CI: 1.65, 2.28), and female gender (OR 1.72; 95% CI: 1.50, 1.98). Other factors contributing to headaches include poor/moderate sleep quality (OR 1.25; 95% CI: 1.08, 1.45) and low income (OR 1.22; 95% CI: 1.01, 1.48). CONCLUSION: In Indonesian adolescents aged 15 to 19 with headaches, sleep disturbances were the dominant factor associated with headache occurrence. Other factors such as depression, female gender, low socioeconomic status (SES), and poor/moderate sleep quality showed a positive association with headaches but further large population-based studies with more refined variables are needed to elucidate this association.