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

Abstract

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 Published and unpublished trials will be sought through the search of all relevant databases and trial registries.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

Interventions to facilitate return to work in adults with chronic non-malignant pain: a protocol for a systematic review and network meta-analysis

“…In this study, we decided not to focus on measures of pain because a protocol of NMA is already designed and published. 29 In addition, pain relief is out of scope of this NMA. We will extract secondary outcome data from baseline to the last available follow-up.…”

“…Moreover, all the available evidence is based either on pairwise meta-analyses or on systematic reviews without quantifiable synthesis of data, leading to a lack of an established hierarchy for the best intervention option. [27][28][29] In addition, head-to-head comparisons are limited in the available studies. 17 18 29 Consequently, a broad evaluation of the effectiveness of RTW interventions integrating direct and indirect comparisons from RCTs 28 that can provide a clinical ranking is imperative for the treatment of patients with CNMP.…”

Management of Musculoskeletal Pain: An Update with Emphasis on Chronic Musculoskeletal Pain

“…This affects between 13.5 and 47% of the general population [7]. The prevalence of certain types of musculoskeletal pain showed wide variations; for example, low back pain (LBP) is extremely common, affecting 30-40% of adults, while other rheumatologic problems with musculoskeletal pain components like fibromyalgia and rheumatoid arthritis are fairly low, affecting only 2% [9]. The prevalence of neck and shoulder pain ranges from 15 to 20%, and 10 to 15% for knee pain [10].…”

“…The Pain Task Force of the (IASP), defines Chronic Primary Musculoskeletal Pain (CPMP) as ''chronic pain in the muscles, bones, joints, or tendons that is characterized by significant emotional distress (i.e., anxiety, anger, frustration, and depressed mood) or functional disability'' [17,18].…”

Emotional distress: Specifying a neglected part of chronic pain

“…Thus, both psychological and physical factors may contribute to the presenting problems. However, when we screened more than 50,000 titles and abstracts for inclusion in a comprehensive network meta‐analysis (Koechlin, Whalley, Welton, & Locher, ), we were surprised to find that despite existing guidelines only a small proportion of the RCTs included any measure of psychological functioning or distress, although most studies report pain intensity and functional disability. Including such standard measures for distress and interference would give a fuller picture of the patient samples, take the new CPP diagnosis into account, and allow controlling for interaction effects between intensity, disability and distress.…”