Pain physician
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Several countries developed guidelines in order to provide a systematic approach for treatment of (chronic) lower back pain. The risk of suffering from (chronic) lower back pain differs significantly within the general population. A serious lack of research exists concerning the risk factor "dysfunctional behavior of the subjects in terms of acute lower back pain." ⋯ The study revealed a lack of awareness of common available guidelines and an uneven distribution of existing knowledge throughout the population. Passive coping strategies like taking pain medication or ointment therapy were favored over active coping strategies like gymnastics, physical activities, and relaxation exercises. Respondents with a higher level of education suffered significantly less often from lower back pain and tended toward active treatment strategies. Respondents with lower levels of education more often demanded passive treatment strategies. The general population, especially those with lower education, is not sufficiently aware of behavioral strategies for managing lower back pain as proposed in available guidelines.
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About 1% of patients suffering from chronic migraine do not respond to medications and require more invasive treatments. Occipital nerve stimulation (ONS) is one of these new therapeutic options. The aim of this data review is to evaluate the clinical impact of ONS and whether the neuropsychological aspects of anxiety and depression can be considered as predictors of therapeutic effects. ⋯ ONS seems to be an effective and safe treatment for chronic migraine. The effects of ONS can be optimized by a multidisciplinary diagnostic and therapeutic approach, especially for the importance of the psychological factors in pain perception and their correlation with a good therapeutic outcome. Our experience highlighted that a multidisciplinary team which includes psychological support and psychosocial rehabilitation is essential for the success of this therapy.
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A major component of a systematic review is an assessment of the methodological quality and bias of randomized trials. The most commonly utilized methodological quality assessment and bias assessment for randomized trials is by the Cochrane Review Group. While this is not a "gold standard," it is an indication of the current state-of-the-art review methodology. There is, however, no specific instrument to assess the methodological quality of manuscripts published for interventional techniques. ⋯ We have developed a new comprehensive instrument to assess the methodological quality of randomized trials of interventional techniques. This instrument is superior to Cochrane review methodology criteria in that it provides more extensive and specific information for interventional techniques that will be useful in assessing the methodologic quality and bias of interventional techniques.
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The major component of a systematic review is assessment of the methodologic quality and bias of randomized and nonrandomized trials. While there are multiple instruments available to assess the methodologic quality and bias for randomized controlled trials (RCTs), there is a lack of extensively utilized instruments for observational studies, specifically for interventional pain management (IPM) techniques. Even Cochrane review criteria for randomized trials is considered not to be a "gold standard," but merely an indication of the current state of the art review methodology. Recently a specific instrument to assess the methodologic quality of randomized trials has been developed for interventional techniques. ⋯ We have developed a new comprehensive instrument to assess the methodological quality of nonrandomized studies of interventional techniques. This instrument provides extensive information specific to interventional techniques is useful in assessing the methodological quality and bias of observational studies of interventional techniques.