Efficacy, tolerability and safety of cannabis-based medicines for chronic pain management - An overview of systematic reviews

BACKGROUND Patients with chronic, non-cancer pain are frequently prescribed opioids, often due to favourable results from systematic reviews. However, even studies with high-quality evidence can suffer from spin, which includes misleading reporting, interpretation, and extrapolation of study results. OBJECTIVE This study evaluated spin in systematic review abstracts concerning analgesic opioids for non-cancer, chronic pain management and the relationship between its presence and study characteristics. METHODS We searched MEDLINE and Embase for systematic reviews pertaining to analgesic opioids for non-cancer, chronic pain management. Screening and data extraction were done in a masked, duplicate fashion. Abstracts were evaluated for the presence of the nine most-severe types of spin. RESULTS Our search returned 1,109 articles; of which, 53 systematic reviews met our eligibility criteria. We found at least one type of spin in 30.2% of the included systematic review abstracts. Spin type 5 was the most common type of spin in our sample and occurred in 17% of abstracts. Spin types 1, 2, 4, 6, and 8 were not detected. Abstracts of systematic reviews published in journals that recommend PRISMA adherence were 9.33 times more likely to contain spin compared to those published in journals without specific PRISMA guidelines. The remaining study characteristics were not significantly associated with spin. CONCLUSIONS Our results showed that nearly one-third of the 53 included systematic reviews contained at least one type of spin in their abstract. Based on our results, systematic reviews about managing chronic, non-cancer pain with opioids require improvements in their abstract reporting.

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Supporting Chronic Pain Management across Provincial and Territorial Health Systems in Canada: Findings from Two Stakeholder Dialogues

Pain Research and Management ◽

10.1155/2015/918976 ◽

2015 ◽

Vol 20 (5) ◽

pp. 269-279 ◽

Cited By ~ 7

Author(s):

Michael G Wilson ◽

John N Lavis ◽

Moriah E Ellen

Keyword(s):

Health Care ◽

Chronic Pain ◽

Pain Management ◽

Health System ◽

Systematic Reviews ◽

Research Evidence ◽

Chronic Pain Management ◽

Stakeholder Dialogue ◽

Patient Registries ◽

National Network

BACKGROUND: Chronic pain is a serious health problem given its prevalence, associated disability, impact on quality of life and the costs associated with the extensive use of health care services by individuals living with it.OBJECTIVE: To summarize the research evidence and elicit health system policymakers’, stakeholders’ and researchers’ tacit knowledge and views about improving chronic pain management in Canada and engaging provincial and territorial health system decision makers in supporting comprehensive chronic pain management in Canada.METHODS: For these two topics, the global and local research evidence regarding each of the two problems were synthesized in evidence briefs. Three options were generated for addressing each problem, and implementation considerations were assessed. A stakeholder dialogue regarding each topic was convened (with 29 participants in total) and the deliberations were synthesized.RESULTS: To inform the first stakeholder dialogue, the authors found that systematic reviews supported the use of evidence-based tools for strengthening chronic pain management, including patient education, self-management supports, interventions to implement guidelines and multidisciplinary approaches to pain management. While research evidence about patient registries/treatment-monitoring systems is limited, many dialogue participants argued that a registry/system is needed. Many saw a registry as a precondition for moving forward with other options, including creating a national network of chronic pain centres with a coordinating ‘hub’ to provide chronic pain-related decision support and a cross-payer, cross-discipline model of patient-centred primary health care-based chronic pain management. For the second dialogue, systematic reviews indicated that traditional media can be used to positively influence individual health-related behaviours, and that multistakeholder partnerships can contribute to increasing attention devoted to issues on policy agendas. Dialogue participants emphasized the need to mobilize behind an effort to build a national network that would bring together existing organizations and committed individuals.CONCLUSIONS: Developing a national network and, thereafter, a national pain strategy are important initiatives that garnered broad-based support during the dialogues. Efforts toward achieving this goal have been made since convening the dialogues.

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