Commentary: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Neuroablative Procedures for Patients With Cancer Pain

BackgroundPain is one of the most common and problematic symptoms encountered by patients with cancer. Due to the multifactorial aetiology, pain management of these patients frequently requires multidisciplinary interventions including conventional support and specialty palliative care. Acupuncture has been identified as a possible adjunctive therapy for symptom management in cancer pain, and there is currently no systematic review focused solely on the evidence of acupuncture on cancer pain in palliative care.ObjectiveTo critically analyse currently available publications regarding the use of acupuncture for pain management among patients with cancer in palliative care settings.MethodsMultiple academic databases were searched from inception to 29 October 2020. Randomised controlled trials involving acupuncture in palliative care for treatment of cancer-related pain were synthesised. Data were extracted by two independent reviewers, and methodological quality of each included study was assessed using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 Levels of Evidence.ResultsFive studies (n=189) were included in this systematic review. Results indicated a favourable effect of acupuncture on pain relief in palliative care for patients with cancer. According to OCEBM 2011 Levels of Evidence, they were level 2 in one case (20%), level 3 in two cases (40%) and level 4 in the remaining (40%). Low-level evidence adversely affects the reliability of findings.ConclusionsAcupuncture may be an effective and safe treatment associated with pain reduction in the palliative care of patients with cancer. Further high-quality, adequately powered studies are needed in the future.

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Use of opioids in patients with cancer with hepatic impairment—a systematic review

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-003065 ◽

2021 ◽

pp. bmjspcare-2021-003065

Author(s):

Lewis Thomas Hughes ◽

David Raftery ◽

Paul Coulter ◽

Barry Laird ◽

Marie Fallon

Keyword(s):

Systematic Review ◽

Cancer Pain ◽

Hepatic Impairment ◽

Evaluation System ◽

Meta Analysis ◽

Hepatic Function ◽

Cochrane Central Register ◽

Assessment Development ◽

Patients With Cancer ◽

Central Register

PurposeOpioids are recommended for moderate-to-severe cancer pain; however, in patients with cancer, impaired hepatic function can affect opioid metabolism. The aim of this systematic review was to evaluate the evidence for the use of opioids in patients with cancer with hepatic impairment.MethodsA systematic review was conducted and the following databases searched: AMED (−2021), MEDLINE (−2021), EMBASECLASSIC + EMBASE (−2021) and Cochrane Central Register of Controlled Trials (−2021). Eligible studies met the following criteria: patients with cancer-related pain, taking an opioid (as defined by the WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents); >18 years of age; patients with hepatic impairment defined using recognised or study-defined definitions; clinical outcome hepatic impairment related; and primary studies. All eligible studies were appraised using the Grading of Recommendations Assessment, Development and Evaluation system.ResultsThree studies (n=95) were eligible but heterogeneity meant meta-analysis was not possible. Each individual study focused on only one each of oxycodone±hydrocotarnine, oxycodone/naloxone and morphine. No recommendations could be formulated on the preferred opioid in patients with hepatic impairment.ConclusionsMorphine is the preferred opioid in hepatic impairment owing to clinical experience and pharmacokinetics. This review, however, found little clinical evidence to support this. Dose adjustments of morphine and the oxycodone formulations reviewed remain necessary in the absence of quality evidence. Overall, the quality of existing evidence on opioid treatments in cancer pain and hepatic impairment is low and there remains a need for high-quality clinical studies examining this.

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A systematic review and evidence-based guideline for diagnosis and treatment of Menkes disease

Molecular Genetics and Metabolism ◽

10.1016/j.ymgme.2018.12.005 ◽

2019 ◽

Vol 126 (1) ◽

pp. 6-13 ◽

Cited By ~ 5

Author(s):

Filippo Pinto e Vairo ◽

Bruna Cristine Chwal ◽

Silvana Perini ◽

Maria Angélica Pires Ferreira ◽

Ana Carolina de Freitas Lopes ◽

...

Keyword(s):

Systematic Review ◽

Menkes Disease ◽

Diagnosis And Treatment ◽

Evidence Based ◽

Evidence Based Guideline

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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Primary Management of Patients With Nonfunctioning Pituitary Adenomas

Neurosurgery ◽

10.1227/neu.0000000000001389 ◽

2016 ◽

Vol 79 (4) ◽

pp. E533-E535 ◽

Cited By ~ 21

Author(s):

Joshua William Lucas ◽

Mary E. Bodach ◽

Luis M. Tumialan ◽

Nelson M. Oyesiku ◽

Chirag G. Patil ◽

...

Keyword(s):

Systematic Review ◽

Pituitary Adenomas ◽

Evidence Based ◽

Nonfunctioning Pituitary Adenomas ◽

Evidence Based Guideline ◽

Primary Management

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Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice

Palliative Medicine ◽

10.1177/0269216316655746 ◽

2016 ◽

Vol 31 (1) ◽

pp. 26-34 ◽

Cited By ~ 28

Author(s):

Jan Gaertner ◽

Ulrike M Stamer ◽

Constanze Remi ◽

Raymond Voltz ◽

Claudia Bausewein ◽

...

Keyword(s):

Systematic Review ◽

Cancer Pain ◽

Pain Intensity ◽

Oral Morphine ◽

Cochrane Library ◽

Evidence Based ◽

Low Doses ◽

Inflammatory Drugs ◽

Anti Inflammatory

Background: Dipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain. Aim: Because evidence-based recommendations are not yet available, a systematic review was conducted for the German Guideline Program in Oncology to provide recommendations for the use of dipyrone in cancer pain. Design: First, a systematic review for clinical trials assessing dipyrone in adult patients with cancer pain was conducted. Endpoints were pain intensity, opioid-sparing effects, safety, and quality of life. Data sources: The search was performed in MedLine, Embase (via Ovid), and the Cochrane Library (1948–2013) and additional hand search was conducted. Finally, recommendations were developed and agreed in a formal structured consensus process by 53 representatives of scientific medical societies and 49 experts. Results: Of 177 retrieved studies, 4 could be included (3 randomized controlled trials and 1 cohort study, n = 252 patients): dipyrone significantly decreased pain intensity compared to placebo, even if low doses (1.5–2 g/day) were used. Higher doses (3 × 2 g/day) were more effective than low doses (3 × 1 g/day), but equally effective as 60 mg oral morphine/day. Pain reduction of dipyrone and non-steroidal anti-inflammatory drugs did not differ significantly. Compared to placebo, non-steroidal anti-inflammatory drugs, and morphine, the incidence of adverse effects was not increased. Conclusion: Dipyrone can be recommended for the treatment of cancer pain as an alternative to other non-opioids either alone or in combination with opioids. It can be preferred over non-steroidal anti-inflammatory drugs due to the presumably favorable side effect profile in long-term use, but comparative studies are not available for long-term use.

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Time to update evidence-based guideline recommendations about concurrent tamoxifen and antidepressant use? A systematic review

Clinical Breast Cancer ◽

10.1016/j.clbc.2021.10.003 ◽

2021 ◽

Author(s):

Michelle Bradbury ◽

Brian Hutton ◽

Ana-Alicia Beltran-Bless ◽

Mashari AlZahrani ◽

Thomas Lariviere ◽

...

Keyword(s):

Systematic Review ◽

Evidence Based ◽

Antidepressant Use ◽

Evidence Based Guideline

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Quality of Cancer Pain Management: An Update of a Systematic Review of Undertreatment of Patients With Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2014.56.0383 ◽

2014 ◽

Vol 32 (36) ◽

pp. 4149-4154 ◽

Cited By ~ 213

Author(s):

Maria Teresa Greco ◽

Anna Roberto ◽

Oscar Corli ◽

Silvia Deandrea ◽

Elena Bandieri ◽

...

Keyword(s):

Systematic Review ◽

Pain Management ◽

Cancer Pain ◽

Experimental Studies ◽

Sensitivity Analyses ◽

Substantial Impact ◽

Patients With Cancer ◽

Pain Management Index ◽

Before And After

Purpose Pain is a frequent symptom in patients with cancer, with substantial impact. Despite the availability of opioids and updated guidelines from reliable leading societies, undertreatment is still frequent. Methods We updated a systematic review published in 2008, which showed that according to the Pain Management Index (PMI), 43.4% of patients with cancer were undertreated. This review included observational and experimental studies reporting negative PMI scores for adults with cancer and pain published from 2007 to 2013 and retrieved through MEDLINE, Embase, and Google Scholar. To detect any temporal trend and identify potential determinants of undertreatment, we compared articles published before and after 2007 with univariable, multivariable, and sensitivity analyses. Results In the new set of 20 articles published from 2007 to 2013, there was a decrease in undertreatment of approximately 25% (from 43.4 to 31.8%). In the whole sample, the proportion of undertreated patients fell from 2007 to 2013, and an association was confirmed between negative PMI score, economic level, and nonspecific setting for cancer pain. Sensitivity analysis confirmed the robustness of results. Conclusion Analysis of 46 articles published from 1994 to 2013 using the PMI to assess the adequacy of analgesic therapy suggests the quality of pharmacologic pain management has improved. However, approximately one third of patients still do not receive pain medication proportional to their pain intensity.

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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Diagnosis of Patients with Positional Plagiocephaly

Neurosurgery ◽

10.1227/neu.0000000000001427 ◽

2016 ◽

Vol 79 (5) ◽

pp. E625-E626 ◽

Cited By ~ 6

Author(s):

Catherine Mazzola ◽

Lissa C. Baird ◽

David F. Bauer ◽

Alexandra Beier ◽

Susan Durham ◽

...

Keyword(s):

Computed Tomography ◽

Systematic Review ◽

Clinical Examination ◽

Full Text ◽

Evidence Based ◽

X Rays ◽

Class Iii ◽

Positional Plagiocephaly ◽

Evidence Based Guideline

Abstract BACKGROUND: No evidence-based guidelines exist for the imaging of patients with positional plagiocephaly. OBJECTIVE: The objective of this systematic review and evidence-based guideline is to answer the question, Is imaging necessary for infants with positional plagiocephaly to make a diagnosis. METHODS: The National Library of Medicine Medline database and the Cochrane Library were queried with the use of MeSH headings and key words relevant to imaging as a means to diagnose plagiocephaly. Abstracts were reviewed, and an evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). RESULTS: A total of 42 full-text articles were selected for review. Of these, 10 were eliminated; thus, 32 full-text were manuscripts selected. There was no Class I evidence, but 2 Class II and 30 Class III studies were included. Three-dimensional cranial topographical imaging, ultrasound, skull x-rays, computed tomography, and magnetic resonance imaging were investigated. CONCLUSION: Clinical examination is most often sufficient to diagnose plagiocephaly (quality, Class III; strength, Level III). Within the limits of this systematic review, the evidence suggests that imaging is rarely necessary and should be reserved for cases in which the clinical examination is equivocal. Many of the imaging studies were not designed to address the diagnostic utility of the imaging modality, and authors were actually assessing the utility of the imaging in longitudinal follow-up, not initial diagnosis. For this reason, some of the studies reviewed were downgraded in Level of Evidence. When needed, 3-dimensional cranial topographical photo, skull x-rays, or ultrasound imaging is almost always sufficient for definitive diagnosis. Computed tomography scanning should not be used to diagnose plagiocephaly, but it may be necessary to rule out craniosynostosis. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_2.

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