Sohail M Mulla1, Li Wang2, Rabia Khokhar2, Zain Izhar2, Arnav Agarwal2, Rachel Couban2, D Norman Buckley2, Dwight E Moulin2, Akbar Panju2, Sun Makosso-Kallyth2, Alparslan Turan2, Victor M Montori2, Daniel I Sessler2, Lehana Thabane2, Gordon H Guyatt2, Jason W Busse2. 1. From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.). mullasm@mcmaster.ca. 2. From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
Abstract
BACKGROUND AND PURPOSE: Central poststroke pain is a chronic neuropathic disorder that follows a stroke. Current research on its management is limited, and no review has evaluated all therapies for central poststroke pain. METHODS: We conducted a systematic review of randomized controlled trials to evaluate therapies for central poststroke pain. We identified eligible trials, in any language, by systematic searches of AMED, CENTRAL, CINAHL, DARE, EMBASE, HealthSTAR, MEDLINE, and PsychINFO. Eligible trials (1) enrolled ≥10 patients with central poststroke pain; (2) randomly assigned them to an active therapy or a control arm; and (3) collected outcome data≥14 days after treatment. Pairs of reviewers, independently and in duplicate, screened titles and abstracts of identified citations, reviewed full texts of potentially eligible trials, and extracted information from eligible studies. We used a modified Cochrane tool to evaluate risk of bias of eligible studies, and collected patient-important outcomes according to recommendations by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials. We conducted, when possible, random effects meta-analyses, and evaluated our certainty in treatment effects using the Grading of Recommendations Assessment, Development, and Evaluation System. RESULTS: Eight eligible English language randomized controlled trials (459 patients) tested anticonvulsants, an antidepressant, an opioid antagonist, repetitive transcranial magnetic stimulation, and acupuncture. Results suggested that all therapies had little to no effect on pain and other patient-important outcomes. Our certainty in the treatment estimates ranged from very low to low. CONCLUSIONS: Our findings are inconsistent with major clinical practice guidelines; the available evidence suggests no beneficial effects of any therapies that researchers have evaluated in randomized controlled trials.
BACKGROUND AND PURPOSE:Central poststroke pain is a chronic neuropathic disorder that follows a stroke. Current research on its management is limited, and no review has evaluated all therapies for central poststroke pain. METHODS: We conducted a systematic review of randomized controlled trials to evaluate therapies for central poststroke pain. We identified eligible trials, in any language, by systematic searches of AMED, CENTRAL, CINAHL, DARE, EMBASE, HealthSTAR, MEDLINE, and PsychINFO. Eligible trials (1) enrolled ≥10 patients with central poststroke pain; (2) randomly assigned them to an active therapy or a control arm; and (3) collected outcome data≥14 days after treatment. Pairs of reviewers, independently and in duplicate, screened titles and abstracts of identified citations, reviewed full texts of potentially eligible trials, and extracted information from eligible studies. We used a modified Cochrane tool to evaluate risk of bias of eligible studies, and collected patient-important outcomes according to recommendations by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials. We conducted, when possible, random effects meta-analyses, and evaluated our certainty in treatment effects using the Grading of Recommendations Assessment, Development, and Evaluation System. RESULTS: Eight eligible English language randomized controlled trials (459 patients) tested anticonvulsants, an antidepressant, an opioid antagonist, repetitive transcranial magnetic stimulation, and acupuncture. Results suggested that all therapies had little to no effect on pain and other patient-important outcomes. Our certainty in the treatment estimates ranged from very low to low. CONCLUSIONS: Our findings are inconsistent with major clinical practice guidelines; the available evidence suggests no beneficial effects of any therapies that researchers have evaluated in randomized controlled trials.
Authors: Alyson R Plecash; Amokrane Chebini; Alvin Ip; Joshua J Lai; Andrew A Mattar; Jason Randhawa; Thalia S Field Journal: Curr Neurol Neurosci Rep Date: 2019-11-13 Impact factor: 5.081