Nonsteroidal Anti‐Inflammatory Drugs, Gastroprotection, and Benefit–Risk

Moore, R Andrew; Derry, Sheena; Simon, Lee S.; Emery, Paul

doi:10.1111/papr.12100

Cited by 56 publications

(47 citation statements)

References 126 publications

(193 reference statements)

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“…The high prevalence of inappropriate or absence of gastroprotection among NSAID users had also been reported by Moore et al22 in their systematic review. However, as highlighted by Rostom et al,21 direct comparisons of the magnitudes of prevalence should be avoided as all studies had different patient populations, GI risk factors consideration or guidelines used.…”

Section: Discussionsupporting

confidence: 67%

Utilization of gastroprotective strategies for nonsteroidal anti-inflammatory drug-induced gastrointestinal events in a major teaching hospital

Lee¹,

Chua²,

Mahadeva³

2016

TCRM

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Background and purposeClinical guidelines recommend the prescribing of gastroprotective strategies in nonsteroidal anti-inflammatory drug (NSAID) users with risk factors for gastrointestinal (GI) ulcer or ulcer complications. However, these guidelines are not often translated into clinical practice. Therefore, the aim of this study was to investigate the utilization of gastroprotective strategies for NSAID-induced upper GI events in at-risk users in a major teaching hospital.Patients and methodsA cross-sectional, observational, pharmacy-based study was conducted in a major Asian institution with both primary and secondary health care services. This study involved the screening of prescriptions for regular NSAIDs, and patients who met the inclusion criteria were recruited and interviewed using a questionnaire.ResultsOf the 409 participants recruited, 83.1% had at least one GI risk factor, of whom 70.3% did not receive appropriate gastroprotection. The most common GI risk factor was the use of high-dose NSAIDs (69.2%), followed by participants aged 65 years and older (22%) and concomitant use of low-dose aspirin (11.7%). Appropriate gastroprotective strategies utilized consisted of the use of a cyclooxygenase (COX)-2 inhibitor alone or a nonselective NSAID plus a proton pump inhibitor (PPI) in the moderate-risk group and a COX-2 inhibitor plus a PPI in the high-risk group. Gastroprotective strategies were underutilized in 67.1% of at-risk participants and overutilized in 59.4% of those without risk factors. Co-prescription of a histamine-2 receptor antagonist at lower-than-recommended doses constituted 59% of the inappropriate gastroprotective agents used. Logistic regression analysis revealed patients aged 65 years and older (odds ratio, 1.89; 95% CI =1.15–3.09) as a predictor for the prescribing of gastroprotection by the clinicians.ConclusionApproximately 70% of at-risk NSAID users, mainly on high-dose NSAIDs, were not prescribed appropriate gastroprotective strategies. Further measures are warranted to improve the safe prescribing of regular NSAIDs.

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Section: Discussionsupporting

confidence: 67%

Utilization of gastroprotective strategies for nonsteroidal anti-inflammatory drug-induced gastrointestinal events in a major teaching hospital

Lee¹,

Chua²,

Mahadeva³

2016

TCRM

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“…This responder analyses approach differed from other primary outcome measures in the included reviews in this overview. There may be merit in promoting responder analyses reporting within this field, particularly if TENS trials demonstrate bimodal outcome distributions similar to that reported by Moore 2013a, Moore 2014b and Moore 2014c. However, at present there is no clear evidence this is the case within the body of TENS evidence.…”

Section: Discussionmentioning

confidence: 95%

“…There is little consensus or evidence regarding what the threshold should be for a clinically important difference in pain intensity based on the between‐group difference post‐intervention. For some pharmacological interventions the distribution of participant outcomes is bimodally distributed (Moore 2013a; Moore 2014b; Moore 2014c). That is, some patients experience a substantial reduction in symptoms, some minimal to no improvement, and very few experience intermediate (moderate) improvements.…”

Section: Methodsmentioning

confidence: 99%

Transcutaneous electrical nerve stimulation (TENS) for chronic pain - an overview of Cochrane Reviews

Gibson

Wand

Meads

et al. 2019

Cochrane Database of Systematic Reviews

123

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BackgroundChronic pain, considered to be pain lasting more than three months, is a common and often difficult to treat condition that can significantly impact upon function and quality of life. Treatment typically includes pharmacological and non‐pharmacological approaches. Transcutaneous electrical nerve stimulation (TENS) is an adjunct non‐pharmacological treatment commonly recommended by clinicians and often used by people with pain.ObjectivesTo provide an overview of evidence from Cochrane Reviews of the effectiveness of TENS to reduce pain in adults with chronic pain (excluding headache or migraine).To provide an overview of evidence from Cochrane Reviews of the safety of TENS when used to reduce pain in adults with chronic pain (excluding headache or migraine).To identify possible sources of inconsistency in the approaches taken to evaluating the evidence related to TENS for chronic pain (excluding headache or migraine) in the Cochrane Library with a view to recommending strategies to improve consistency in methodology and reporting.To highlight areas of remaining uncertainty regarding the effectiveness of TENS for chronic pain (excluding headache or migraine) with a view to recommending strategies to reduce any uncertainty.MethodsSearch methodsWe searched the Cochrane Database of Systematic Reviews (CDSR), in the Cochrane Library, across all years up to Issue 11 of 12, 2018.Selection of reviewsTwo authors independently screened the results of the electronic search by title and abstract against inclusion/exclusion criteria. We included all Cochrane Reviews of randomised controlled trials (RCTs) assessing the effectiveness of TENS in people with chronic pain. We included reviews if they investigated the following: TENS versus sham; TENS versus usual care or no treatment/waiting list control; TENS plus active intervention versus active intervention alone; comparisons between different types of TENS; or TENS delivered using different stimulation parameters.Data extraction and analysisTwo authors independently extracted relevant data, assessed review quality using the AMSTAR checklist and applied GRADE judgements where required to individual reviews. Our primary outcomes included pain intensity and nature/incidence of adverse effects; our secondary outcomes included disability, health‐related quality of life, analgesic medication use and participant global impression of change.Main resultsWe included nine reviews investigating TENS use in people with defined chronic pain or in people with chronic conditions associated with ongoing pain. One review investigating TENS for phantom or stump‐associated pain in people following amputation did not have any included studies. We therefore extracted data from eight reviews which represented 51 TENS‐related RCTs representing 2895 TENS‐comparison participants entered into the studies.The included reviews followed consistent methods and achieved overall high scores on the AMSTAR checklist. The evidence reported within each review was consistently rated as very low quality. U...

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“…Cost effectiveness of interventional techniques has been demonstrated for spinal cord stimulation (531), percutaneous adhesiolysis (532), and caudal epidural injections (533) in chronic recalcitrant pain presenting to interventional pain management settings after failure of conservative modalities and often surgical interventions. Cost effectiveness of drug therapy modalities also has been demonstrated for various nonopioid drug treatments, often with clinically insignificant outcomes and higher costs than interventional therapies (518,(534)(535)(536)(537)(538)(539)(540)(541)(542)(543). A cost utility analysis showed caudal epidural injections to be effective at $2,172 for one year of qualityadjusted life year (QALY) (533), $2,650 for percutaneous adhesiolysis for one year of QALY (532), and (£) 6,392 for spinal cord stimulation for one year of QALY (531).…”

Section: Effectiveness Of Nonopioid Pharmacological and Nonpharmacolomentioning

confidence: 99%

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Kaye²,

et al. 2017

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Background: Opioid use, abuse, and adverse consequences, including death, have escalated at an alarming rate since the 1990s. In an attempt to control opioid abuse, numerous regulations and guidelines for responsible opioid prescribing have been developed by various organizations. However, the US opioid epidemic is continuing and drug dose deaths tripled during 1999 to 2015. Recent data show a continuing increase in deaths due to natural and semisynthetic opioids, a decline in methadone deaths, and an explosive increase in the rates of deaths involving other opioids, specifically heroin and illicit synthetic fentanyl. Contrary to scientific evidence of efficacy and negative recommendations, a significant proportion of physicians and patients (92%) believe that opioids reduce pain and a smaller proportion (57%) report better quality of life. In preparation of the current guidelines, we have focused on the means to reduce the abuse and diversion of opioids without jeopardizing access for those patients suffering from non-cancer pain who have an appropriate medical indication for opioid use. Objectives: To provide guidance for the prescription of opioids for the management of chronic non-cancer pain, to develop a consistent philosophy among the many diverse groups with an interest in opioid use as to how appropriately prescribe opioids, to improve the treatment of chronic non-cancer pain and to reduce the likelihood of drug abuse and diversion. These guidelines are intended to provide a systematic and standardized approach to this complex and difficult arena of practice, while recognizing that every clinical situation is unique. Methods: The methodology utilized included the development of objectives and key questions. The methodology also utilized trustworthy standards, appropriate disclosures of conflicts of interest, as well as a panel of experts from various specialties and groups. The literature pertaining to opioid use, abuse, effectiveness, and adverse consequences was reviewed, with a best evidence synthesis of the available literature, and utilized grading for recommendation as described by the Agency for Healthcare Research and Quality (AHRQ).

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Nonsteroidal Anti‐Inflammatory Drugs, Gastroprotection, and Benefit–Risk

Cited by 56 publications

References 126 publications

Utilization of gastroprotective strategies for nonsteroidal anti-inflammatory drug-induced gastrointestinal events in a major teaching hospital

Utilization of gastroprotective strategies for nonsteroidal anti-inflammatory drug-induced gastrointestinal events in a major teaching hospital

Transcutaneous electrical nerve stimulation (TENS) for chronic pain - an overview of Cochrane Reviews

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

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