scholarly journals To what extent are we confident that tapentadol induces less constipation and other side effects than the other opioids in chronic pain patients? a confidence evaluation in network meta-analysis

2020 ◽  
pp. 204946372094528
Author(s):  
Patrice Forget ◽  
Mathieu Vermeersch
Keyword(s):  
Chronic Pain ◽  
Side Effects ◽  
Meta Analysis ◽  
Random Effect ◽  
Chronic Pain Patients ◽  
High Level ◽  
Meta Analyses ◽  
Pain Patients ◽  
Random Effect Models ◽  
Indirect Comparisons

Background: A confidence evaluation helps to make informed decisions about the results of meta-analyses. The goal of this work is to perform a confidence evaluation of results of a network meta-analysis (NMA) on the digestive side effects of tapentadol in patients with chronic pain. Methods: An updated search in PubMed/Medline and Web of Science search until March 2020 was done to perform pairwise meta-analyses with NMA using random-effect models and confidence in network meta-analysis (CiNeMA) for the confidence analysis. Results: Twenty-five studies were included in the final analyses. Pairwise and indirect comparisons showed a reduced risk of constipation with tapentadol compared to oxycodone. The confidence evaluation did not raise any concerns in terms of confidence for the oxycodone versus tapentadol comparisons. The oxycodone-naloxone versus tapentadol comparisons showed some concerns, particularly in terms of imprecision and incoherence. Regarding the overall risk of any side effects, the confidence evaluation showed a major concern regarding imprecision, but not for the comparison between tapentadol and oxycodone. However, this comparison showed a major heterogeneity. Discussion and conclusions: A confidence evaluation in meta-analysis on the effect of tapentadol compared to other opioids in chronic pain showed possible imprecision, heterogeneity and/or incoherence. However, with a high level of confidence, tapentadol was associated with a lower incidence of constipation than oxycodone. Confidence analyses can help to get more information from meta-analyses.

679 Prevalence of Sleep Disturbances in Patients with Chronic Non-cancer Pain: A Systematic Review and Meta-Analysis

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A265-A266
Author(s):  
Yishi Sun ◽  
Isabelle Laksono ◽  
Janannii Selvanathan ◽  
Aparna Saripella ◽  
Mahesh Nagappa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Sleep Quality ◽  
Cancer Pain ◽  
Sleep Disturbances ◽  
Meta Analysis ◽  
Pain Group ◽  
Pooled Prevalence ◽  
Chronic Pain Patients ◽  
Pain Patients

Abstract Introduction In individuals with chronic pain, sleep disturbances have been suggested to increase suffering, perception of pain, and to negatively affect long-term prognosis. This systematic review and meta-analysis aims to determine the pooled prevalence of sleep disturbances in chronic non-cancer pain patients with no other sleep disorders, using the patient-rated questionnaires Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Methods Multiple databases were searched for studies reporting the prevalence of sleep disturbances in chronic pain patients. Chronic pain was defined as pain >3 months. Comorbid sleep disorders such as sleep disordered breathing and restless leg syndrome were excluded. Sleep disturbances were defined using the PSQI cutoff of > 5 (poor sleep quality) and ISI ≥ 8 (subthreshold to clinical insomnia). The meta-analysis was conducted to examine the pooled prevalence of PSQI and ISI data using the inverse-variance random-effects model and to examine mean differences in PSQI scores. Results The systematic search resulted in 25,486 articles and 20 were included for analysis. In 12 studies using PSQI, the pooled prevalence of sleep disturbance was 75.3% among 3,597 chronic pain patients (mean age 53 ± 12 years; 74% female). In eight studies using ISI, the pooled prevalence was 72.9% among 2,578 chronic pain patients (mean age 63 ± 12 years; 57% female). The meta-analysis showed a significant mean difference of 2.75 (p < 0.001) in the global PSQI score between the chronic pain group versus the non-chronic pain group. The meta-analysis also showed a significant mean difference in the scores of four of seven PSQI components: sleep latency, sleep efficiency, sleep duration, and sleep disturbances (p < 0.05). Conclusion In chronic pain patients, the pooled prevalence of sleep disturbances as measured by PSQI (75.3%) and ISI (72.9%) studies was much higher than those reported for the general population. The relatively high prevalence of sleep disturbances in chronic pain patients emphasizes the importance of further characterizing the relationship between sleep and chronic pain. Support (if any):

Opioid induced hyperalgesia: A focus on opioid use in chronic pain

2013 ◽  
Vol 2 (12) ◽  
pp. 395-397
Author(s):  
Julie L. Cunningham
Keyword(s):  
Chronic Pain ◽  
Side Effects ◽  
Treatment Option ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Chronic Pain Patients ◽  
Opioid Induced Hyperalgesia ◽  
Pain Patients ◽  
Established Treatment

Opioids are a well-established treatment option for chronic pain. However, opioid therapy is associated with many side effects, including opioid induced hyperalgesia (OIH). This article reviews studies which have evaluated OIH in chronic pain patients on opioids.

Monitoring outcomes during long-term opioid therapy for noncancer pain: Results with the Pain Assessment and Documentation Tool

2005 ◽  
Vol 1 (5) ◽  
pp. 257 ◽  
Author(s):  
Steven D. Passik, PhD ◽  
Kenneth L. Kirsh, PhD ◽  
Laurie Whitcomb, MA ◽  
Jeffrey R. Schein, PhD, MPH ◽  
Mitchell A. Kaplan, PhD ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Side Effects ◽  
Pain Assessment ◽  
The United States ◽  
Opioid Therapy ◽  
Chronic Pain Patients ◽  
Noncancer Pain ◽  
Documentation Tool ◽  
Pain Patients

The increasingly common practice of long-term opioid therapy for chronic noncancer pain must be guided by ongoing assessment of four types of outcomes: pain relief, function, side effects, and drug-related behaviors. Our objective was to gather initial pilot data on the clinical application of a specialized chart note, the Pain Assessment and Documentation Tool (PADT), which was developed and tested with 27 physicians. This pilot test provided the means to collect cross-sectional outcome data on a large sample of opioid-treated chronic pain patients. Each of the physician volunteers (located in a variety of settings across the United States) completed the PADT for a convenience sample of personally treated chronic pain patients who had received at least three months of opioid therapy. Completion of the PADT required a clinical interview, review of the medical chart, and direct clinical observation. Data from the PADTs were collated and analyzed. The results suggested that the majority of patients with chronic pain achieve relatively positive outcomes in the eyes of their prescribing physicians in all four relevant domains with opioid therapy. Analgesia was modest but meaningful, functionality was generally stabilized or improved, and side effects were tolerable. Potentially aberrant behaviors were common but viewed as an indicator of a problem (i.e., addiction or diversion) in only approximately 10 percent of cases. Using the PADT, physician ratings can be developed in four domains. In this sample, outcomes suggested that opioid therapy provided meaningful analgesia.

scholarly journals Mortality rate and predictors of Stroke: A Meta-Analysis and Systematic Review

2019 ◽  
Author(s):  
Amanual Getnet Mersha ◽  
Tadesse Melaku Abegaz ◽  
Mohammed Assen Seid ◽  
Eyob Alemayehu Gebreyohannes ◽  
Akshaya Srikanth Bhagavath ◽  
...  
Keyword(s):  
Systematic Review ◽  
Risk Factor ◽  
Observational Studies ◽  
Meta Analysis ◽  
Random Effect ◽  
Stroke Mortality ◽  
Stroke Event ◽  
Meta Analyses ◽  
Random Effect Models ◽  
Overall Mortality

Abstract Background Global data on stroke mortality remained to be sparse. In light of this, we aimed to conduct a Meta-analysis and systematic review of observational studies to estimate the mortality of stroke and to identify risk factors that predispose patients for stroke-related death.Methods This study was conducted based on the Meta-Analyses of Observational Studies in Epidemiology (MOOSE) guidelines. Overall mortality, in-hospital and 30- day mortality due to stroke were the primary outcome measures of the study. The meta-analysis was performed using Stata (Version 14, Stata Corp, College Station, Texas). Random-effect models were used for estimating pooled effects.Findings Overall, thirty two studies assessed overall mortality due to stroke. A total number of 2,885, 126 patients were recruited for the study. Pooled estimate indicated that the overall mortality of stroke was reported to be 20% (19%-22%). Whereas, the 30-day and In-hospital mortality were found to be 18% (16%-20%) and 16% (16%-19%), respectively. A subgroup analysis revealed that Africa registered the highest stroke-related death 29% (23%-36%). Hypertension was found to be an important risk factor for mortality secondary to stroke 61.9% (52.8%-71.1%).Conclusion Overall mortality of stroke was estimated to be twenty percent. The burden of stroke mortality was prominent in Africa region. Hypertension remained to be an independent risk factor for stroke mortality. Mortality of stroke can be minimized by establishing stroke centers that promptly deliver emergency management of stroke event.

scholarly journals Action identification and meaning in life in chronic pain

2015 ◽  
Vol 9 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Helen Richardson ◽  
Stephen Morley
Keyword(s):  
Chronic Pain ◽  
Meaning In Life ◽  
Pain Interference ◽  
Action Identification ◽  
Life Meaning ◽  
Behavioural Activity ◽  
Chronic Pain Patients ◽  
High Level ◽  
The Relationship ◽  
Pain Patients

AbstractBackground and aimsWe explore the relationship between behaviour and cognition in chronic pain by applying Action Identification Theory (AIT). AIT holds that every action may be construed in several ways. High level construals confer greater meaning than lower level construals. When an action is interrupted a lower level, more concrete identity with reduced meaning is elicited. We hypothesized that interference of activity by chronic pain affects the meaning ascribed to activity and thus a person’s overall sense of meaning in life.MethodsIn Study 1, a measure of Action Identification in Pain (AIP) is developed. In Study 2, the AIP was administered to 47 chronic pain patients who also completed the Meaningful Life Measure and measures of pain interference, depression, acceptance and optimism.ResultsHigh levels of action identification were positively correlated with meaning in life and high levels of interference were negatively correlated with meaning in life. Contrary to expectation interference and action identification were not associated. Further analyses showed that inclusion of depression, acceptance and optimism eliminated the effect of pain interference but only optimism abolished the effect of action identification.ConclusionChronic pain patients holding higher levels of action identification report a greater sense of meaning in life. Meaning in life is also associated with the amount of interference of behavioural activity. The anticipated relationship between action identification and interference was not observed. The present evidence suggests that interference and action identification contribute independently to a person’s sense of meaning in life.

The genetics of venous thromboembolism

2009 ◽  
Vol 102 (08) ◽  
pp. 360-370 ◽  
Author(s):  
Reya Gohil ◽  
George Peck ◽  
Pankaj Sharma
Keyword(s):  
Venous Thromboembolism ◽  
Meta Analysis ◽  
Random Effect ◽  
Case Control ◽  
Disease Association ◽  
Factor V ◽  
Case Control Studies ◽  
Factor V G1691a ◽  
Meta Analyses ◽  
Random Effect Models

SummaryWe conducted a systematic and comprehensive meta-analysis on all candidate genes to assess their genetic contribution to the aetiology of venous thromboembolism (VTE) (pulmonary embolism and deep venous thrombosis) in all ethnic groups. Electronic databases were searched until and including January 2008 for any candidate gene investigated in VTE. Odds ratios (OR) and 95% confidence intervals (CI) were determined for each gene disease association using fixed and random effect models. Our meta-analyses included ∼126,525 cases and 184,068 controls derived from 173 case-control studies, which included 21 genes (28 polymorphisms). Statistically significant associations with VTE were identified for factor V G1691A (OR 9.45; 95% CI 6.72–13.30, p<0.0001), factor V A4070G (OR 1.24; 95% CI

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