术后临床试验和荟萃分析中运动诱发疼痛与静息痛对比：一项随访系统评价方案

Movement-Evoked Pain Versus Pain at Rest in Postsurgical Clinical Trials and Meta-Analyses: Protocol for a Follow-Up Systematic Review.

作者信息

Camiré Daenis, Erb Jason, Kehlet Henrik, Brennan Timothy, Gilron Ian

机构信息

Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada.

Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.

出版信息

JMIR Res Protoc. 2020 Jan 22;9(1):e15309. doi: 10.2196/15309.

DOI:10.2196/15309

PMID:32012101

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7003115/

Abstract

BACKGROUND

Postoperative pain is one of the most prevalent and disabling complications of surgery that is associated with personal suffering, delayed functional recovery, prolonged hospital stay, perioperative complications, and chronic postsurgical pain. Accumulating evidence has pointed to the important distinction between pain at rest (PAR) and movement-evoked pain (MEP) after surgery. In most studies including both measures, MEP has been shown to be substantially more severe than PAR. Furthermore, as MEP is commonly experienced during normal activities (eg, breathing, coughing, and walking), it has a greater adverse functional impact than PAR. In a previous systematic review conducted in 2011, only 39% of reviewed trials included MEP as a trial outcome and 52% failed to identify the pain outcome as either PAR or MEP. Given the recent observations of postsurgical pain trials that continue to neglect the distinction between PAR and MEP, this updated review seeks to evaluate the degree of progress in this area.

OBJECTIVE

This updated review will include postsurgical clinical trials and meta-analyses in which the primary outcome was early postoperative pain intensity. The primary outcome for this review is the reporting of MEP (vs PAR) as an outcome measure for each trial and meta-analysis. Secondary outcomes include whether trials and meta-analyses distinguished between PAR and MEP.

METHODS

To be consistent with the 2011 review that we are updating, this review will again focus on randomized controlled trials and meta-analyses, from Medical Literature Analysis and Retrieval System Online and EMBASE databases, focusing on pain treatment after thoracotomy, knee arthroplasty, and hysterectomy in humans. Trials and meta-analyses will be characterized as to whether or not they assessed PAR and MEP; whether their pain outcome acknowledged the distinction between PAR and MEP; and, for trials assessing MEP, which pain-evoking maneuver(s) were used.

RESULTS

Scoping review and pilot data extraction are under way, and the results are expected by March 2020.

CONCLUSIONS

It is our belief that every postsurgical analgesic trial should include MEP as an outcome measure. The previous 2011 review was expected to have an impact on more widespread assessment of MEP in subsequent postoperative pain treatment trials. Thus, the purpose of this follow-up review is to reevaluate the frequency of use of MEP as a trial outcome, compared with PAR, in more recently published postoperative pain trials.

TRIAL REGISTRATION

PROSPERO CRD42019125855; https://tinyurl.com/qw9dty8.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15309.

摘要

背景

术后疼痛是手术中最常见且致残的并发症之一，与个人痛苦、功能恢复延迟、住院时间延长、围手术期并发症及慢性术后疼痛相关。越来越多的证据表明，术后静息痛（PAR）与运动诱发痛（MEP）之间存在重要区别。在大多数同时包含这两种测量方法的研究中，MEP已被证明比PAR严重得多。此外，由于MEP在正常活动（如呼吸、咳嗽和行走）中很常见，它对功能的不良影响比PAR更大。在2011年进行的一项系统评价中，仅39%的纳入试验将MEP作为试验结局，52%的试验未明确疼痛结局是PAR还是MEP。鉴于近期术后疼痛试验仍忽视PAR和MEP之间区别的情况，本次更新的综述旨在评估该领域的进展程度。

目的

本次更新的综述将纳入以术后早期疼痛强度为主要结局的术后临床试验和荟萃分析。本综述的主要结局是报告每个试验和荟萃分析中作为结局指标的MEP（相对于PAR）。次要结局包括试验和荟萃分析是否区分了PAR和MEP。

方法

为与我们正在更新的2011年综述保持一致，本次综述将再次聚焦于来自医学文献分析和检索系统在线数据库及EMBASE数据库的随机对照试验和荟萃分析，重点关注人类开胸手术、膝关节置换术和子宫切除术后的疼痛治疗。试验和荟萃分析将根据以下方面进行特征描述：是否评估了PAR和MEP；其疼痛结局是否承认PAR和MEP之间的区别；对于评估MEP的试验，使用了哪种诱发疼痛的操作。