A systematic review of pharmacologic treatments of pain after spinal cord injury.

OBJECTIVE: To conduct a systematic review of published research on the pharmacologic treatment of pain after spinal cord injury (SCI). DATA SOURCES: MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for articles published 1980 to June 2009 addressing the treatment of pain post SCI. Randomized controlled trials (RCTs) were assessed for methodologic quality using the Physiotherapy Evidence Database (PEDro) assessment scale, whereas non-RCTs were assessed by using the Downs and Black (D&B) evaluation tool. A level of evidence was assigned to each intervention by using a modified Sackett scale. STUDY SELECTION: The review included RCTs and non-RCTs, which included prospective controlled trials, cohort, case series, case-control, pre-post studies, and post studies. Case studies were included only when there were no other studies found. DATA EXTRACTION: Data extracted included the PEDro or D&B score, the type of study, a brief summary of intervention outcomes, the type of pain, the type of pain scale, and the study findings. DATA SYNTHESIS: Articles selected for this particular review evaluated different interventions in the pharmacologic management of pain after SCI. Twenty-eight studies met inclusion criteria; there were 21 randomized controlled trials; of these, 19 had level 1 evidence. Treatments were divided into 5 categories: anticonvulsants, antidepressants, analgesics, cannabinoids, and antispasticity medications. CONCLUSIONS: Most studies did not specify participants' types of pain, making it difficult to identify the type of pain being targeted by the treatment. Anticonvulsant and analgesic drugs had the highest levels of evidence and were the drugs most often studied. Gabapentin and pregabalin had strong evidence (5 level 1 RCTs) for effectiveness in treating post-SCI neuropathic pain as did intravenous analgesics (lidocaine, ketamine, and morphine), but the latter only had short-term benefits. Tricyclic antidepressants only showed benefit for neuropathic pain in depressed persons. Intrathecal baclofen reduced musculoskeletal pain associated with spasticity; however, there was conflicting evidence for the reduction in neuropathic pain. Studies assessing the effectiveness of opioids were limited and revealed only small benefits. Cannabinoids showed conflicting evidence in improving spasticity-related pain. Clonidine and morphine when given together had a significant synergistic neuropathic pain-relieving effect.

A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury.

OBJECTIVE: To systematically review evidence on the prevention and treatment of pressure ulcers in those with a spinal cord injury (SCI). DATA SOURCES: For this evidence-based review, the following data sources were used: MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO. STUDY SELECTION: To be selected for inclusion in the current review, there had to have been an intervention, studies had to have 3 or more subjects, and 50% or more of the participating group had to have an SCI. DATA EXTRACTION: Data extracted included study design, subject demographics, inclusion and exclusion criteria, study type, sample size, outcome measures used, and study results. DATA SYNTHESIS: Articles selected for this review were organized into 1 of 2 categories: prevention or treatment. Within each broad category, several smaller ones were created, and articles were grouped according to the prevention (direct or indirect) or treatment intervention discussed. CONCLUSIONS: Of the 26 articles selected for inclusion in the systematic review, 7 were randomized controlled trials (RCTs) that dealt with treatment for pressure ulcers, and there was 1 RCT on prevention. Despite the cost-effectiveness of prevention, little research exists on preventative interventions, and what does exist is mostly level 4 evidence. More research is needed for both prevention and treatment, but especially the former.

Venous thromboembolism after spinal cord injury.

OBJECTIVE: To review systematically the published literature on the treatment of deep venous thromboembolism after spinal cord injury (SCI). DATA SOURCES: MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing the treatment of deep venous thromboembolism post-SCI. Randomized controlled trials (RCTs) were assessed for methodologic quality using the Physiotherapy Evidence Database Scale, while non-RCTs were assessed using the Downs and Black evaluation tool. STUDY SELECTION: Studies included RCTs, non-RCTS, cohort, case-control, case series, pre-post, and postinterventional studies. Case studies were included only when no other studies were available. DATA EXTRACTION: Data extracted included demographics, the nature of the study intervention, and study results. DATA SYNTHESIS: Levels of evidence were assigned to the interventions using a modified Sackett scale. CONCLUSIONS: Twenty-three studies met inclusion criteria. Thirteen studies examined various pharmacologic interventions for the treatment or prevention of deep venous thrombosis in patients with SCI. There was strong evidence to support the use of low-molecular-weight heparin in reducing venous thrombosis events, and a higher adjusted dose of unfractionated heparin was found to be more effective than 5000 units administered every 12 hours, although bleeding complications were more common. Nonpharmacologic treatments were also reviewed, but again limited evidence was found to support these treatments.

The potential effectiveness of warning labels on cigarette packages: the perceptions of young adult Canadians.

BACKGROUND: Since 1989 when health warning labels appeared on Canadian cigarette packages, the labels have changed from text only covering less than one quarter of the package to text and graphics covering over half the package. This study examines how Canadians in their 20s feel about the current graphic warning labels and their potential to prevent smoking and encourage quitting. METHODS: Participants between 20 and 24 years of age were part of a 10-year cohort study begun when the group was in Grade 6, with the purpose of examining factors that may affect smoking. Five questions about warning labels were added to the 2002 questionnaire requesting information on perceptions of the labels and their potential impact on smoking behaviours of young adults. One item had been included in previous questionnaires. RESULTS: 32.8% (n = 1267) of the respondents were smokers, with males (35.6%) being more likely to smoke than females (30.4%). Current smokers were less likely than experimental/ex-smokers to believe that warning labels with stronger messages would make people their age less likely to smoke. Female current smokers were more likely to think about quitting. CONCLUSION: Despite the efforts taken in developing the labels, some young adults are skeptical about their effects. Warning labels may have to be modified to target issues that are relevant to young adults; gender differences are important in this modification. Warning labels can offer an additional component to a comprehensive tobacco control program, in that they provide health information.

A comparison of the PEDro and Downs and Black quality assessment tools using the acquired brain injury intervention literature.

OBJECTIVE: The objective of this study was to examine the correlation between the Physiotherapy Evidence Database (PEDro) and the Downs and Black (D&B) quality assessment scale and the PEDro and a modified D&B assessment scores in a research synthesis of the ABI literature. METHODS AND MAIN OUTCOMES: A systematic review of the literature from 1980-2007 was conducted looking at treatment interventions following an ABI published in peer-reviewed English language journals. Of the articles chosen for inclusion in the study, 165 were identified as randomised controlled trials (RCT). All RCTs were scored using two quality assessment tools: the PEDro and D&B quality assessment scales. Items from these two scales were compared to identify which questions addressed similar information. RESULTS: The association between the overall PEDro and D&B scores was moderately high (r = 0.71, p < 0.01) indicating a significant relationship between these two quality assessment tools. When considering the modified D&B scores, which contained a subset of questions deemed most comparable to the PEDro scale, the correlation between the two was also moderately high (r = 0.68, p < 0.01). CONCLUSIONS: Further analysis is required to investigate the strength of the relationship between these two scales in the assessment of RCTs.

A comparison of heterotopic ossification treatment within the traumatic brain and spinal cord injured population: An evidence based systematic review.

BACKGROUND: To compare the treatment of heterotopic ossification (HO) within the traumatic brain and spinal cord injured populations. METHODS: MEDLINE/Pubmed, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing treatment of HO post-injury. Articles were constrained to: English language and human subjects. Studies were included if: n ≥ 50% of the subjects had a spinal cord injury (SCI) or a traumatic brain injury (TBI), n ≥ 3 SCI or TBI subjects, and study subjects participated in a treatment or intervention. Study quality, for randomized control trials (RCTs), were assessed using the PEDro assessment scale, while non-RCTs was assessed using the Downs and Black evaluation tool. A modified Sackett scale was used to apply levels of evidence for each intervention. RESULTS: In total 26 studies (NTBI = 12; NSCI = 14) met inclusion criteria. The majority of studies (10/12) conducted in the TBI population were surgical interventions. Studies conducted with the SCI population investigated diverse pharmacological treatments including: bisphosphonates, non-steroidal anti-inflammatory drugs (NSAIDs) and Warfarin. Non-pharmacological studies investigated the benefits of pulse low-intensity electromagnetic field therapy, surgical excision, and radiotherapy in the treatment of HO. CONCLUSIONS: Within the SCI literature, NSAIDs showed the greatest efficacy in the prevention of HO when administered early after a SCI, and biphosphonates were found to be the most effective treatment strategy. In the TBI population, surgical excision was the most effective treatment.

An evidence-based review of the effectiveness of cognitive behavioral therapy for psychosocial issues post-spinal cord injury.

STUDY DESIGN: Systematic review. OBJECTIVE: To examine the evidence supporting the effectiveness of cognitive behavioral therapy (CBT) for improving psychosocial outcomes in individuals with spinal cord injury (SCI). METHOD: Electronic databases (MEDLINE, CINAHL, EMBASE, and PsycINFO) were searched for studies published between 1990 and October 2010. Randomized control trials (RCTs) and nonrandomized control trials (non-RCTs) utilizing a CBT intervention to improve psychosocial outcomes (depressive symptomatology, anxiety, coping, and adjustment to disability) in outpatient persons with SCI were included for review. Levels of evidence were assigned to each study using a modified Sackett scale. Effect size calculations for the interventions were provided where possible. RESULTS: Nine studies met the inclusion criteria. The studies reviewed included two RCTs, six prospective controlled trials (PCTs) and one cohort study. All studies examined at least two groups. There is Level 1 and Level 2 evidence supporting the use of specialized CBT protocols in persons with SCI for improving outcomes related to depression, anxiety, adjustment, and coping. CONCLUSIONS: CBT holds promise as an effective approach for persons with SCI experiencing depression, anxiety, adjustment, and coping problems. As CBT may involve many different components, it is important in the future to determine which of these elements alone or in combination is most effective in treating the emotional consequences of SCI.

Does a relationship exist between body weight, concerns about weight, and smoking among adolescents? An integration of the literature with an emphasis on gender.

It has been speculated that body weight and concern about body weight are important factors in initiation of tobacco use among adolescents, particularly females. An examination of studies that have explored these relationships can provide important information on possible underlying mechanisms that could be used for prevention interventions. This review summarizes recent studies examining weight concerns and youth smoking, with a focus on gender differences. These studies were integrated with the few studies that have examined the relationship between actual body weight and smoking among adolescents. A total of 55 primary research articles met inclusion criteria for the review. Of these, 19 studies assessed the relationship between body weight and smoking, and 50 studies addressed weight concerns and smoking. Some evidence indicated a positive relationship between smoking and body weight among adolescents, although not all studies found a positive association. In terms of the relationship between weight concerns and adolescent smoking, the amount of evidence supporting a positive association differed depending on the dimension of weight concern considered, with the strongest evidence for dieting behaviors. For dieting behaviors, disordered eating symptoms, and some aspects of general weight concerns, the positive relationship with smoking was more consistent among female adolescents than among male adolescents. Possible explanations for these findings are discussed, and priorities for future research are identified.