Faculty of 1000 evaluation for Characteristics of acupuncture treatment associated with outcome: an individual patient meta-analysis of 17,922 patients with chronic pain in randomised controlled trials.

ObjectiveNearly 100 000 primary total knee replacements (TKR) are performed in the UK annually. The primary aim of TKR is pain relief, but 10%–34% of patients report chronic pain. The aim of this systematic review was to evaluate the effectiveness of presurgical interventions in preventing chronic pain after TKR.DesignMEDLINE, Embase, CINAHL,The Cochrane Libraryand PsycINFO were searched from inception to December 2018. Screening and data extraction were performed by two authors. Meta-analysis was conducted using a random effects model. Risk of bias was assessed using the Cochrane tool and quality of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation.Primary and secondary outcomesPain at 6 months or longer; adverse events.InterventionsPresurgical interventions aimed at improving TKR outcomes.ResultsEight randomised controlled trials (RCTs) with data from 960 participants were included. The studies involved nine eligible comparisons. We found moderate-quality evidence of no effect of exercise programmes on chronic pain after TKR, based on a meta-analysis of 6 interventions with 229 participants (standardised mean difference 0.20, 95% CI −0.06 to 0.47, I2=0%). Sensitivity analysis restricted to studies at overall low risk of bias confirmed findings. Another RCT of exercise with no data available for meta-analysis showed no benefit. Studies evaluating combined exercise and education intervention (n=1) and education alone (n=1) suggested similar findings. Adverse event data were reported by most studies, but events were too few to draw conclusions.ConclusionsWe found low to moderate-quality evidence to suggest that neither preoperative exercise, education nor a combination of both is effective in preventing chronic pain after TKR. This review also identified a lack of evaluations of other preoperative interventions, such as multimodal pain management, which may improve long-term pain outcomes after TKR.PROSPERO registration numberCRD42017041382.

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Systematic review of randomised controlled trials of psychological therapy for chronic pain in children and adolescents, with a subset meta-analysis of pain relief

Pain ◽

10.1016/s0304-3959(02)00072-6 ◽

2002 ◽

Vol 99 (1) ◽

pp. 157-165 ◽

Cited By ~ 199

Author(s):

Christopher Eccleston ◽

Stephen Morley ◽

Amanda Williams ◽

Louise Yorke ◽

Kiki Mastroyannopoulou

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Pain Relief ◽

Children And Adolescents ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Psychological Therapy ◽

Controlled Trials ◽

Randomised Controlled

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The clinical efficacy of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain: a protocol for a meta-analysis of randomised controlled trials (RCTs)

BMJ Open ◽

10.1136/bmjopen-2019-029999 ◽

2019 ◽

Vol 9 (10) ◽

pp. e029999

Author(s):

Mark I Johnson ◽

Gareth Jones ◽

Carole A Paley ◽

Priscilla G Wittkopf

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Transcutaneous Electrical Nerve Stimulation ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Continuous Data ◽

Controlled Trials ◽

Electrical Nerve Stimulation ◽

Dichotomous Data ◽

Randomised Controlled

IntroductionThe aim of this systematic review with meta-analysis is to evaluate the clinical efficacy of transcutaneous electrical nerve stimulation (TENS) for any type of acute and chronic pain in adults.Methods and analysisWe intend to search electronic databases (Cochrane Library, MEDLINE, Embase, CINAHL, PsycINFO, LILACS, PEDRO, Web of Science, AMED and SPORTDiscus) from inception to the present day to identify all randomised controlled trials (RCT) on the use of TENS in adults for any type of pain including acute pain, chronic pain and cancer-related pain. We will screen the RCTs against eligibility criteria for inclusion in our review. Two reviewers will independently undertake RCT selection, data extraction and risk of bias assessment. Primary outcomes will be: (i) participant-reported pain relief of ≥30% expressed as frequency (dichotomous) data; and (ii) participant-reported pain intensity expressed as mean (continuous) data. We will conduct meta-analyses to determine risk ratio for dichotomous data, and mean difference (MD) or standardised MD for continuous data for TENS versus placebo TENS, no treatment or waiting list control, standard of care, and other treatments. Subgroup analyses will include different pain conditions (eg, acute vs chronic), TENS intensity, during versus after TENS, TENS as a sole treatment versus TENS in combination with other treatments and TENS administered as a single dose versus repetitive dose.Ethics and disseminationThis systematic review will not use data from individual participants, and the results will be disseminated in a peer-reviewed publication and presented at a conference.PROSPERO registration numberCRD42019125054.

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