Nature clinical practice. Rheumatology
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Properly conducted meta-analyses that are based on systematic reviews of the literature allow the conclusive synthesis of accumulating scientific evidence. Systematic reviews, with or without meta-analyses, offer a more objective appraisal of the available evidence compared with traditional narrative reviews. ⋯ The validity of meta-analyses depends on the methodological quality of the included studies, the eligibility criteria used for the meta-analysis, and the various reporting biases. In this Review we examine the analytical strengths of, and the main problems encountered by, both systematic reviews and meta-analyses, focusing on how to best assess the validity of each for the practicing clinician.
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Nat Clin Pract Rheumatol · Feb 2008
ReviewChronic nonmalignant pain: a challenge for patients and clinicians.
Chronic pain is widely regarded as a condition that is triggered by various factors, including physical, socio-cultural and psychological deficiencies (that is, maladaptive beliefs). These factors are important in the development and maintenance of this unpleasant experience, which consequently requires a biopsychosocial treatment approach. Pain is a multifaceted sense, the perception of which is personal. ⋯ High-quality randomized controlled trials indicate that multidisciplinary pain programs represent the best therapeutic option for the management of patients with complaints associated with complex chronic pain. The prevalence and the costs--both direct and indirect--that are attributed to chronic pain are increasing; however, not enough is being done to sufficiently and effectively treat chronic pain. There is, therefore, a need for well-designed, interdisciplinary, internationally comparable, and widely distributed pain programs, both in outpatient and inpatient settings, to contribute to the prevention of some future pain diseases.
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Pain is a multidimensional experience that is a prominent feature of many musculoskeletal disorders. Despite its subjective nature, pain is a highly relevant complaint; hence, nothing should deter physicians from attempting to formally assess it. This Review summarizes the main aspects of pain measurement from a practical standpoint, with a specific focus on low back pain. ⋯ For assessing change, prospective measurements are preferable to retrospective reports. Pain is not synonymous with function or quality of life, and other tools covering these important outcome dimensions should complement the assessment of pain, especially in patients with chronic symptoms. Clinicians should be aware of the psychometric properties of the tool to be used, including its level of imprecision (random measurement error) and its minimum clinically important difference (score difference indicating meaningful change in clinical status).