Paracetamol, NSAIDS and opioid analgesics for chronic low back pain: a network meta-analysis

Bagg, Matthew K; McLachlan, Andrew J.; Maher, Christopher G.; Kamper, Steven J; Williams, Christopher M; Wand, Benedict M; Moseley, G. Lorimer; Hübscher, Markus; O’Connell, Neil E; Tulder, Maurits W. van; Nikolakopoulou, Adriani; McAuley, James H.

doi:10.1002/14651858.cd013045

Cited by 20 publications

(30 citation statements)

References 100 publications

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“…Even though the better safety profile of drugs may be explained by a relative weak activity compared with other types of analgesics, their place in the therapeutic armamentarium can be particularly relevant when considering a multimodal approach combining, for instance, paracetamol and NSAID, a strategy expected to provide pain relief with a low risk of adverse effects, and then to avoid opioid use, abuse and dependency (Samuelsen et al, ; White, ). The respective rationale of paracetamol, NSAIDs, opioids or their combination is under assessment in chronic low back pain (Bagg et al, ).…”

Section: Resultsmentioning

confidence: 99%

Self‐medication in pain management: The state of the art of pharmacists’ role for optimal Over‐The‐Counter analgesic use

Perrot

Cittée²,

Louis

et al. 2019

European Journal of Pain

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Background and Objective Self‐medication is associated with an important utilization of Over‐The‐Counter (OTC) analgesics. The medical outcome resulting from therapeutic options bypassing the physician prescription is a major issue. In that context, pharmacists are expected to play a crucial role. The main objective of this review was to analyse the state‐of‐the art of pharmacists' role in pain management self‐medication. Databases and Data Treatment An expert multidisciplinary group dedicated to self‐medication in pain was established. Selection of publications was performed from PubMedand EMBASE databases which was based on the use of “pain” and/or “self‐medication” and/or “self‐care” and/or “analgesics” and/or “painkillers” keywords, restricted to the past 10 years. Results A total of 480 papers were identified, 49 of which papers were considered relevant and finally kept for final discussion, on OTC pain management and pharmacist's role. Literature analysis demonstrates that OTC analgesics are generally safe when appropriately used. Risks associated with misuse or inappropriateness depend on patients’ vulnerability (elderly, pregnancy) or behaviour. Social cognitive theory‐based intervention and multimedia applications improve self‐medication but do not replace health care professional advice Pharmacists’ interventions may improve the benefits and safety of OTC analgesic medication, with a better management of pain. Conclusions Considering the heterogeneity of patients’ knowledge and behaviour reported worldwide, inappropriate use of OTC pain medication should not be underestimated. Community pharmacists are ideally placed to guide self‐medication or recommend a medical advice when needed. Embedding pharmacists in primary care pain management is essential and pharmacist‐led medication coupled with an appropriate training of pharmacy staffs should be encouraged. Significance Analgesics are widely used without prescription, all over the world. They represent the largest market of OTC drugs, with an overall benefit/risk ratio favourable when appropriately used. Because of potential individual risks associated to the ailment or to the patient's behaviour, pharmacists’ interventions have proven to optimize analgesic self‐medication, provided that pharmacy staffs are both available and more specifically trained. In the future, in pain management, especially self‐medication, pharmacists should play an increasing role and should be included in educational programmes and pain management guidelines.

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Section: Resultsmentioning

confidence: 99%

Self‐medication in pain management: The state of the art of pharmacists’ role for optimal Over‐The‐Counter analgesic use

Perrot

Cittée²,

Louis

et al. 2019

European Journal of Pain

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“…We will extract results of the primary and secondary outcome measures at a time point close to or at the end of the interventions, or the changes in outcome measures from baseline for each intervention group. If a study used more than 1 outcome measure of pain intensity, we will select and extract only a single measure, prioritizing them in the following order: 100-mm/10-cm visual analog scale, 11-point numeric rating scale (0 = no pain, 10 = the worst pain imaginable), and then pain intensity rating from composite measures or other scales [ 28 ].…”

Section: Methodsmentioning

confidence: 99%

“…We will convert the primary and secondary outcome data to a 0- to 100-point scale (mean and standard deviation) [ 28 ]. In numerical or continuous scales, the score value is divided by the range of scale, and then multiplied by 100.…”

Section: Methodsmentioning

confidence: 99%

“…The relative treatment effects of the compared interventions (eg, EEG neurofeedback vs control) on the outcome measures will be estimated using weighted mean difference with 95% confidence intervals [ 28 ]. We will use a threshold of 10 points on the 0- to 100-point scale to clarify the minimal clinically important effect of EEG neurofeedback on pain intensity [ 34 ].…”

Section: Methodsmentioning

confidence: 99%

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The Analgesic Effect of Electroencephalographic Neurofeedback for People With Chronic Pain: Protocol for a Systematic Review and Meta-analysis

Hesam‐Shariati¹,

Chang²,

McAuley³

et al. 2020

JMIR Res Protoc

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Background Chronic pain is a global health problem, affecting around 1 in 5 individuals in the general population. The understanding of the key role of functional brain alterations in the generation of chronic pain has led researchers to focus on pain treatments that target brain activity. Electroencephalographic neurofeedback attempts to modulate the power of maladaptive electroencephalography frequency powers to decrease chronic pain. Although several studies have provided promising evidence, the effect of electroencephalographic neurofeedback on chronic pain is uncertain. Objective This systematic review aims to synthesize the evidence from randomized controlled trials to evaluate the analgesic effect of electroencephalographic neurofeedback. In addition, we will synthesize the findings of nonrandomized studies in a narrative review. Methods We will apply the search strategy in 5 electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycInfo, and CINAHL) for published studies and in clinical trial registries for completed unpublished studies. We will include studies that used electroencephalographic neurofeedback as an intervention for people with chronic pain. Risk-of-bias tools will be used to assess methodological quality of the included studies. We will include randomized controlled trials if they have compared electroencephalographic neurofeedback with any other intervention or placebo control. The data from randomized controlled trials will be aggregated to perform a meta-analysis for quantitative synthesis. The primary outcome measure is pain intensity assessed by self-report scales. Secondary outcome measures include depressive symptoms, anxiety symptoms, and sleep quality measured by self-reported questionnaires. We will investigate the studies for additional outcomes addressing adverse effects and resting-state electroencephalography analysis. Additionally, all types of nonrandomized studies will be included for a narrative synthesis. The intended and unintended effects of nonrandomized studies will be extracted and summarized in a descriptive table. Results Ethics approval is not required for a systematic review, as there will be no patient involvement. The search for this systematic review commenced in July 2020, and we expect to publish the findings in early 2021. Conclusions This systematic review will provide recommendations for researchers and health professionals, as well as people with chronic pain, about the evidence for the analgesic effect of electroencephalographic neurofeedback. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42020177608; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=177608 International Registered Report Identifier (IRRID) PRR1-10.2196/22821

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“…For example, Gabapentinoids showed minimal improvement of pain when compared to placebo [16], and opioids showed better pain reduction for chronic low back pain than placebo, with standardized mean differences (SMDs) ranging from − 0.55 for tramadol to − 2.47 for transdermal buprenorphine, and strong opioids showed an SMD of − 0.43 [17]. A network meta-analysis looking at paracetamol, NSAIDs, and opioid analgesics is underway [18]. Additionally, vitamin D supplementation recently showed no effect on pain (SMD = 0.004) [19].…”

Section: Introductionmentioning

confidence: 99%

The best treatment option(s) for adult and elderly patients with chronic primary musculoskeletal pain: a protocol for a systematic review and network meta-analysis

et al. 2019

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BackgroundChronic primary musculoskeletal pain (CPMP) is one subcategory of the new classification of chronic primary pain for the upcoming ICD-11, defined as chronic pain in the muscles, bones, joints, or tendons that persists or recurs for more than 3 months and is associated with significant emotional distress or functional disability. An array of pharmacological, psychological, physical, complementary, and rehabilitative interventions is available for CPMP, for which previous research has demonstrated varying effect sizes with regard to effectiveness in pain reduction and other main outcomes. This highlights the need for the synthesis of all available evidence. The proposed network meta-analysis will compare all available interventions for CPMP to determine the best treatment option(s) with a focus on efficacy and safety of interventions.MethodsWe are interested in comparing interventions of the following types: psychological, pharmacological, physical, complementary, and rehabilitative interventions. We will include all randomized controlled trials that compare one intervention with another, or with a control group, in the treatment of CPMP. Primary efficacy outcomes will be pain intensity, emotional distress, and functional disability. Safety outcomes extracted will include proportion of patients with treatment-emergent adverse events, unwanted events, or drop-out rates due to side effects. Published and unpublished trials will be sought through the search of all relevant databases and trial registries. At least two independent reviewers of the team will select the references and extract data independently. We will assess the risk of bias of each individual study using the Cochrane risk of bias assessment tool. We will conduct a network meta-analysis to synthesize all evidence for each outcome. We will fit our model primarily within a Bayesian framework.DiscussionCPMP is a disabling condition for which several interventions exist. To our knowledge, this is the first network meta-analysis to systematically compare all available evidence. This is required by national health institutions to inform their decisions about the best available treatment option(s) with regard to efficacy and safety outcomes.Systematic review registrationPROSPERO CRD42018096114

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Paracetamol, NSAIDS and opioid analgesics for chronic low back pain: a network meta-analysis

Cited by 20 publications

References 100 publications

Self‐medication in pain management: The state of the art of pharmacists’ role for optimal Over‐The‐Counter analgesic use

Self‐medication in pain management: The state of the art of pharmacists’ role for optimal Over‐The‐Counter analgesic use

The Analgesic Effect of Electroencephalographic Neurofeedback for People With Chronic Pain: Protocol for a Systematic Review and Meta-analysis

The best treatment option(s) for adult and elderly patients with chronic primary musculoskeletal pain: a protocol for a systematic review and network meta-analysis

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