&lt;p&gt;Characteristics of physicians who prescribe opioids for chronic pain: a meta-narrative systematic review&lt;/p&gt;

Hooten, W. Michael; Dvorkin, Jodie; Warner, Nafisseh S.; Pearson, Amy C.S.; Murad, M. Hassan; Warner, David O.

doi:10.2147/jpr.s202376

Cited by 17 publications

(13 citation statements)

References 52 publications

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“…This approach is useful when key clinical factors vary between studies. Narrative methods for evidence synthesis have been used to study various populations of patients with pain [ 17 – 22 ].…”

Section: Methodsmentioning

confidence: 99%

Lidocaine for postoperative pain after cardiac surgery: a systematic review

Boswell

Moman

Burtoft

et al. 2021

J Cardiothorac Surg

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Objective Lidocaine is one of the most widely used local anesthetics with well-known pharmacological properties. The purpose of this systematic review is to investigate the effects of lidocaine on postoperative pain scores and recovery after cardiac surgery. Methods A comprehensive database search was conducted by a reference librarian for randomized clinical trials (RCT) from January 1, 1980 to September 1, 2019. Eligible study designs included randomized controlled trials of lidocaine for postoperative pain management in adults undergoing cardiac surgery. After removal of duplicates, 947 records were screened for eligibility and 3 RCTs met inclusion criteria. Results Sources of bias were identified in 2 of 3 RCTs. Lidocaine was administered intravenously, topically, and intrapleurally. Key findings included [1] 2% lidocaine placed topically on chest tube prior to intraoperative insertion was associated with significantly lower pain scores and lower cumulative doses of fentanyl; and [2] 2% lidocaine administered intrapleurally was associated with significantly lower pain scores and significant improvements in pulmonary mechanics. Lidocaine infusions were not associated with significant changes in pain scores or measures of recovery. No significant associations were observed between lidocaine and overall mortality, hospital length of stay or ICU length of stay. No data were reported for postoperative nausea and vomiting or arrhythmias. Conclusions Due to the favorable risk profile of topical lidocaine and the need for further advancements in the postoperative care of adults after cardiac surgery, topically administered lidocaine could be considered for incorporation into established postoperative recovery protocols.

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Section: Methodsmentioning

confidence: 99%

Lidocaine for postoperative pain after cardiac surgery: a systematic review

Boswell

Moman

Burtoft

et al. 2021

J Cardiothorac Surg

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“…Interestingly, the more recent pain literature identifies fear of regulatory scrutiny as a significant clinician fear, particularly for opioids for non-cancer chronic pain. 45 Although pain is a licensed indication, current widespread attention to the 'opioid crisis' regarding abuse in chronic non-cancer pain, may heighten both clinician and patient fears, and adversely affect appropriate use of opioids for cancer-related pain. 46 Clinicians' fears were often based on historical teaching about respiratory risks, particularly in lung and heart disease, and hearsay.…”

Section: Main Findingsmentioning

confidence: 99%

Professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness: A systematic review using the framework method and pillar process

et al. 2021

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Background: In combination with non-pharmacological interventions, opioids may safely reduce chronic breathlessness in patients with severe illness. However, implementation in clinical practice varies. Aim: To synthesise the published literature regarding health professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness, identifying issues which influence implementation in clinical practice. Design: Systematic review and synthesis using the five-stage framework synthesis method. Data sources: Three electronic databases (MEDLINE, Embase via OVID, ASSIA via Proquest) were searched (March 2020) using a predefined search strategy. Studies were also citation chained from key papers. Papers were screened against a priori eligibility criteria. Data were extracted from included studies using the framework synthesis method. Qualitative and quantitative data were synthesised using the pillar process. Included studies were critically appraised using the Mixed-Methods Appraisal Tool. Results: After de-duplication, 843 papers were identified. Following screening, 22 studies were included. Five themes were developed: (i) clinician/patient characteristics, (ii) education/knowledge/experience, (iii) relationship between clinician/family, (iv) clinician/patient fear of opioids and (v) regulatory issues. Conclusions: There are significant barriers and enablers to the use of opioids for the symptomatic reduction of chronic breathlessness based on the knowledge, views and attitudes of clinicians, patients and families. Clinicians’ interactions with patients and their families strongly influences adherence with opioid treatment regimens for chronic breathlessness. Clinicians’, patients’ and families’ knowledge about the delicate balance between benefits and risks is generally poor. Education for all, but particularly clinicians, is likely to be a necessary (but insufficient) factor for improving implementation in practice.

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“…Narrative methods for evidence synthesis have been used to study various populations of patients with pain. [11][12][13][14][15][16]…”

Section: Data Extractionmentioning

confidence: 99%

Electromyography and Therapeutic Response to Lumbosacral Epidural Steroid Injections: A Systematic Review

Meiling¹,

Moman

Pagan-Rosado³

et al. 2021

JPR

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The association between electromyography (EMG)-confirmed lumbosacral (LS) radiculopathy and pain outcomes following epidural steroid injection (ESI) has not been systematically summarized. The primary objective of this systematic review was to summarize the effects of EMG-confirmed LS radiculopathy on pain intensity following ESI. A secondary objective was to summarize the effects of EMG-confirmed LS radiculopathy on physical functioning following ESI. An a priori protocol was registered and a database search conducted by a reference librarian from January 2000 through December 2020. The search was date-limited to ensure the results of the systematic review represented contemporary clinical practice. Study-inclusion criteria included randomized trials, prospective and retrospective studies, cross-sectional studies, case series, and case reports, age ≥18 years, and use of EMG as a prognostic tool prior to an ESI. Two independent reviewers screened all titles, abstracts, and full texts. Data were extracted using a templated electronic database. The risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions tool and certainty in evidence assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Due to clinical heterogeneity in study characteristics, a meta-analysis was not performed. A total of 454 studies were screened, and eight nonrandomized studies met the inclusion criteria. Five studies had a moderate risk of bias, two serious risks, and one a critical risk. The key findings included four of eight nonrandomized studies reporting a significant association between EMG-confirmed radiculopathy and ESI response and four of eight nonrandomized studies reporting no significant association. Important sources of bias limited interpretation of individual study findings, and multiple sources of clinical heterogeneity limited between-study comparisons. The findings of this systematic review demonstrate that associations existed between EMG-confirmed LS radiculopathy and pain outcomes after ESI in some, but not all studies. These results should be carefully interpreted with full understanding of the risk of bias and very low certainty in evidence that characterize the nonrandomized studies comprising this systematic review.

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<p>Characteristics of physicians who prescribe opioids for chronic pain: a meta-narrative systematic review</p>

Cited by 17 publications

References 52 publications

Lidocaine for postoperative pain after cardiac surgery: a systematic review

Lidocaine for postoperative pain after cardiac surgery: a systematic review

Professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness: A systematic review using the framework method and pillar process

Electromyography and Therapeutic Response to Lumbosacral Epidural Steroid Injections: A Systematic Review

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