Journal ArticleDOI
Algorithm for neuropathic pain treatment:: an evidence based proposal.
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TLDR
NNT and NNH are currently the best way to assess relative efficacy and safety, but the need for dichotomous data, which may have to be estimated retrospectively for old trials, and the methodological complexity of pooling data from small cross‐over and large parallel group trials, remain as limitations.Abstract:
New studies of the treatment of neuropathic pain have increased the need for an updated review of randomized, double-blind, placebo-controlled trials to support an evidence based algorithm to treat neuropathic pain conditions. Available studies were identified using a MEDLINE and EMBASE search. One hundred and five studies were included. Numbers needed to treat (NNT) and numbers needed to harm (NNH) were used to compare efficacy and safety of the treatments in different neuropathic pain syndromes. The quality of each trial was assessed. Tricyclic antidepressants and the anticonvulsants gabapentin and pregabalin were the most frequently studied drug classes. In peripheral neuropathic pain, the lowest NNT was for tricyclic antidepressants, followed by opioids and the anticonvulsants gabapentin and pregabalin. For central neuropathic pain there is limited data. NNT and NNH are currently the best way to assess relative efficacy and safety, but the need for dichotomous data, which may have to be estimated retrospectively for old trials, and the methodological complexity of pooling data from small cross-over and large parallel group trials, remain as limitations.read more
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Journal ArticleDOI
Interpreting the Clinical Importance of Treatment Outcomes in Chronic Pain Clinical Trials: IMMPACT Recommendations
Robert H. Dworkin,Dennis C. Turk,Kathleen W. Wyrwich,Dorcas E. Beaton,Charles S. Cleeland,John T. Farrar,Jennifer A. Haythornthwaite,Mark P. Jensen,Robert D. Kerns,Deborah N. Ader,Nancy A. Brandenburg,Laurie B. Burke,David Cella,Julie Chandler,Penny Cowan,Rozalina Dimitrova,Raymond A. Dionne,Sharon Hertz,Alejandro R. Jadad,Nathaniel P. Katz,Henrik Kehlet,Lynn D. Kramer,Donald C. Manning,Cynthia McCormick,Michael P. McDermott,Henry J McQuay,Sanjay Patel,Linda Porter,Steve Quessy,Bob A. Rappaport,Christine Rauschkolb,Dennis A. Revicki,Margaret Rothman,Kenneth E. Schmader,Brett R. Stacey,Joseph W. Stauffer,Thorsten von Stein,Richard E. White,James Witter,Stojan Zavisic +39 more
TL;DR: A consensus meeting was convened by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to provide recommendations for interpreting clinical importance of treatment outcomes in clinical trials of the efficacy and effectiveness of chronic pain treatments as discussed by the authors.
Journal ArticleDOI
Pharmacologic management of neuropathic pain: evidence-based recommendations.
Robert H. Dworkin,Alec B. O'Connor,Miroslav Backonja,John T. Farrar,Nanna B. Finnerup,Troels S. Jensen,Eija Kalso,John D. Loeser,Christine Miaskowski,Turo Nurmikko,Russell K. Portenoy,Andrew S.C. Rice,Brett R. Stacey,Rolf-Detlef Treede,Dennis C. Turk,Mark S. Wallace +15 more
TL;DR: Patients with neuropathic pain are challenging to manage and evidence‐based clinical recommendations for pharmacologic management are needed, and medications should be individualized, considering side effects, potential beneficial or deleterious effects on comorbidities, and whether prompt onset of pain relief is necessary.
Journal ArticleDOI
painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain
TL;DR: Simple, patient-based, easy-to-use screening questionnaires can determine the prevalence of neuropathic pain components both in individual LBP patients and in heterogeneous cohorts of such patients.
Journal ArticleDOI
Neuropathic Pain: A Maladaptive Response of the Nervous System to Damage
TL;DR: Treatment needs to move from merely suppressing symptoms to a disease-modifying strategy aimed at both preventing maladaptive plasticity and reducing intrinsic risk.
Journal ArticleDOI
EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision
Nadine Attal,Giorgio Cruccu,Ralf Baron,Maija Haanpää,Per Hansson,Troels S. Jensen,Turo Nurmikko +6 more
TL;DR: The second European Federation of Neurological Societies Task Force as discussed by the authors aimed at updating the existing evidence about the pharmacological treatment of neuropathic pain since 2005, and identified studies using the Cochrane Database and Medline.
References
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Journal ArticleDOI
Assessing the quality of reports of randomized clinical trials : is blinding necessary?
Alejandro R. Jadad,R. A. Moore,Dawn Carroll,C. Jenkinson,David Reynolds,David J. Gavaghan,Henry J McQuay +6 more
TL;DR: An instrument to assess the quality of reports of randomized clinical trials (RCTs) in pain research is described and its use to determine the effect of rater blinding on the assessments of quality is described.
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The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials
TL;DR: The revised CONSORT statement is intended to improve the reporting of an RCT, enabling readers to understand a trial's conduct and to assess the validity of its results.
Journal ArticleDOI
Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement
TL;DR: This report hopes this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.
Journal ArticleDOI
The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials.
TL;DR: The revised CONSORT statement as discussed by the authors is intended to improve the reporting of an RCT, enabling readers to understand a trial's conduct and to assess the validity of its results, which can be achieved only through complete transparency from authors.
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