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Systematic review of management of chronic pain after surgery.

作者信息

Wylde V, Dennis J, Beswick A D, Bruce J, Eccleston C, Howells N, Peters T J, Gooberman-Hill R

机构信息

Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.

Warwick Clinical Trials Unit, University of Warwick, Warwick, UK.

出版信息

Br J Surg. 2017 Sep;104(10):1293-1306. doi: 10.1002/bjs.10601. Epub 2017 Jul 6.


DOI:10.1002/bjs.10601
PMID:28681962
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5599964/
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.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b6f9/5599964/72c075ae729f/BJS-104-1293-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b6f9/5599964/72c075ae729f/BJS-104-1293-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b6f9/5599964/72c075ae729f/BJS-104-1293-g001.jpg

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本文引用的文献

[1]
The Use of Systematic Reviews When Designing and Reporting Surgical Trials.

Ann Surg. 2017-4

[2]
Pharmacologic interventions for treating phantom limb pain.

Cochrane Database Syst Rev. 2016-10-14

[3]
Subcutaneous Stimulation as ADD-ON Therapy to Spinal Cord Stimulation Is Effective in Treating Low Back Pain in Patients With Failed Back Surgery Syndrome: A Multicenter Randomized Controlled Trial.

Neuromodulation. 2016-2

[4]
Failed back surgery syndrome - definition, epidemiology and demographics.

Br J Pain. 2013-2

[5]
Oral nonsteroidal anti-inflammatory drugs for neuropathic pain.

Cochrane Database Syst Rev. 2015-10-5

[6]
Buprenorphine for neuropathic pain in adults.

Cochrane Database Syst Rev. 2015-9-30

[7]
Venlafaxine for neuropathic pain in adults.

Cochrane Database Syst Rev. 2015-8-23

[8]
Chronic postsurgical pain in Europe: An observational study.

Eur J Anaesthesiol. 2015-10

[9]
Amitriptyline for neuropathic pain in adults.

Cochrane Database Syst Rev. 2015-7-6

[10]
Long-term effect of pulsed high-intensity laser therapy in the treatment of post-mastectomy pain syndrome: a double blind, placebo-control, randomized study.

Lasers Med Sci. 2015-8

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