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Systematic review of management of chronic pain after surgery

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Wylde, V., Dennis, J., Beswick, A. D., Bruce, J. (Julie), Eccleston, C., Howells, N., Peters, T. J. and Gooberman-Hill, R. (2017) Systematic review of management of chronic pain after surgery. British Journal of Surgery, 104 (10). pp. 1293-1306. doi:10.1002/bjs.10601

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Official URL: https://doi.org/10.1002/bjs.10601

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Abstract

Background:

Pain present for at least 3 months after a surgical procedure is considered chronic postsurgical pain (CPSP) and affects 10–50 per cent of patients. Interventions for CPSP may focus on the underlying condition that indicated surgery, the aetiology of new-onset pain or be multifactorial in recognition of the diverse causes of this pain. The aim of this systematic review was to identify RCTs of interventions for the management of CPSP, and synthesize data across treatment type to estimate their effectiveness and safety.

Methods:

MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Library were searched from inception to March 2016. Trials of pain interventions received by patients at 3 months or more after surgery were included. Risk of bias was assessed using the Cochrane risk-of-bias tool.

Results:

Some 66 trials with data from 3149 participants were included. Most trials included patients with chronic pain after spinal surgery (25 trials) or phantom limb pain (21 trials). Interventions were predominantly pharmacological, including antiepileptics, capsaicin, epidural steroid injections, local anaesthetic, neurotoxins, N-methyl-d-aspartate receptor antagonists and opioids. Other interventions included acupuncture, exercise, postamputation limb liner, spinal cord stimulation, further surgery, laser therapy, magnetic stimulation, mindfulness-based stress reduction, mirror therapy and sensory discrimination training. Opportunities for meta-analysis were limited by heterogeneity. For all interventions, there was insufficient evidence to draw conclusions on effectiveness.

Conclusion:

There is a need for more evidence about interventions for CPSP. High-quality trials of multimodal interventions matched to pain characteristics are needed to provide robust evidence to guide management of CPSP.

Item Type: Journal Article
Subjects: R Medicine > RD Surgery
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit
Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
SWORD Depositor: Library Publications Router
Library of Congress Subject Headings (LCSH): Postoperative pain, Systematic reviews (Medical research)
Journal or Publication Title: British Journal of Surgery
Publisher: Wiley-Blackwell
ISSN: 0007-1323
Official Date: September 2017
Dates:
DateEvent
September 2017Published
6 July 2017Available
21 April 2017Accepted
Volume: 104
Number: 10
Page Range: pp. 1293-1306
DOI: 10.1002/bjs.10601
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
RP-PG-0613-20001National Institute for Health Research (Great Britain). Applied Research Programme (ARP NIHR)UNSPECIFIED

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