European journal of pain : EJP
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Review Meta Analysis
Can we identify how programmes aimed at promoting self-management in musculoskeletal pain work and who benefits? A systematic review of sub-group analysis within RCTs.
There are now several systematic reviews of RCTs testing self-management for those with chronic musculoskeletal pain. Evidence for the effectiveness of self-management interventions in chronic musculoskeletal pain is equivocal and it is not clear for which sub-groups of patients SM is optimally effective. ⋯ The current evidence suggests four factors that relate to outcome as predictors/mediators, but there is no evidence for effect moderators. Future studies of mediation and moderation should be designed with 'a priori' hypotheses and adequate statistical power.
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The prevalence and burden of pain has long been reported as problematic. Comprehensive pain education in undergraduate programmes is essential for developing knowledgeable, skilled and effective healthcare professionals. This cross-sectional survey describes the nature, content and learning strategies for pain curricula in undergraduate healthcare programmes in major universities in the United Kingdom (UK). ⋯ Published curricula for pain education have been available for over 20 years but are rarely employed and pain is not a core part of regulatory and quality assurance standards for health professions. The hours of pain education is woefully inadequate given the prevalence and burden of pain. Recommendations include the introduction of pain-related educational standards across all professions, greater integration of pain content in undergraduate programmes and interprofessional approaches to the topic.
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Painful diabetic polyneuropathy is a common complication of diabetes mellitus. Drug therapies are ineffective in many patients. Therefore other treatment modalities should be considered, including spinal cord stimulation. We performed a systematic review to evaluate treatment efficacy and safety of spinal cord stimulation in painful diabetic polyneuropathy. SEARCH STRATEGY AND SELECTION CRITERIA: A systematic search with reference tracing was conducted in Pubmed and Embase from January 1980 to March 2010 to determine possible eligible articles. Reports were identified using the following keywords: (1) "diabetic neuropathies" AND "electric stimulation"; (2) "diabetic neuropathies" AND "spinal cord" and (3) "pain" AND "electric stimulation" AND "spinal cord". Subsequently, data were recruited on the efficacy and safety of spinal cord stimulation in this disorder. ⋯ Available literature shows promising results for the pain-relieving effect of spinal cord stimulation in painful diabetic polyneuropathy. The outcome of a randomized clinical trial is needed before spinal cord stimulation can be considered to be integrated in the standardized treatment algorithm.