Pain physician
-
Meta Analysis
Stellate Ganglion Block Therapy for Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis.
Sympathetic ganglion block (SGB) technique is becoming increasingly prevalent in the treatment of complex regional pain syndromes (CRPS). Given the varied reported effectiveness of these techniques and the heterogeneity of treatment regimens, there is an urgent need for consistent and high-quality evidence on the efficacy and safety of such procedures. ⋯ SGB therapy can reduce pain intensity in patients with CRPS with few adverse events. However, owing to the relatively high heterogeneity of the included RCTs, a larger sample of high-quality RCTs is needed to further confirm this conclusion.
-
Meta Analysis
Adverse Events After Cervical Spinal Manipulation - A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
Cervical manipulations are widely used by physiotherapists, chiropractors, osteopaths, and medical doctors for musculoskeletal dysfunctions like neck pain and cervicogenic headache. The use of cervical manipulation remains controversial, since it is often considered to pose a risk for not only benign adverse events (AEs), such as aggravation of pain or muscle soreness, but also severe AEs such as strokes in the vertebrobasilar or carotid artery following dissections. Studies finding an association between cervical manipulation and serious AEs such as artery dissections are mainly case control studies or case reports. These study designs are not appropriate for investigating incidences and therefore do not imply causal relationships. Randomized controlled trials (RCTs) are considered the gold standard study designs for assessing the unconfounded effects of benefits and harms, such as AEs, associated with therapies. ⋯ In summary, HVLA manipulation does not impose an increased risk of mild or moderate AEs compared to various control interventions. However, these results must be interpreted with caution, since RCTs are not appropriate for detecting the rare serious AEs. In addition, future RCTs should follow a standardized protocol for reporting AEs in clinical trials.
-
Numerous meta-analyses and systematic reviews have explored the differences between percutaneous vertebroplasty (PVP) and percutaneous balloon kyphoplasty (PKP) for treating osteoporotic vertebral compression fractures (OVCFs), however, their final conclusions have been inconsistent. The inconsistent conclusions drawn from these meta-analyses create uncertainty among clinicians about the best treatment approach for OVCFs. ⋯ Currently, the best evidence indicates that PVP and PKP are equally effective at alleviating pain and enhancing function in the treatment of OVCFs, but PKP had a lower incidence of polymethylmethacrylate leakage. However, there is still a need for high-quality randomized controlled trials to provide higher levels of evidence regarding other aspects of the differences between the 2 procedures.
-
Reducing postoperative pain is still a tremendous challenge for perioperative clinicians. Lidocaine is a local anesthetic that belongs to the amide class and has anti-inflammatory, anti-hyperalgesic, and analgesic effects. Extensive research has been conducted to determine the optimal route for its administration. ⋯ This meta-analysis suggests that post-abdominal surgery intraperitoneal lidocaine administration has a better analgesic effect than intravenous lidocaine, with a lower pain score. However, intravenous lidocaine is more beneficial for gastrointestinal recovery after abdominal surgery.
-
Meta Analysis Comparative Study
A Comparison of Minimally Invasive Surgical Techniques and Standard Open Discectomy for Lumbar Disc Herniation: A Network Meta-analysis.
Lumbar disc herniation is a common spinal disease that causes low back pain; surgery is required when conservative treatment is ineffective. There is a growing demand for minimally invasive surgery in younger patient populations due to their fear of significant damage and a long recovery period following standard open discectomy. The development history of minimally invasive surgery is relatively short, and no gold standard has been established. ⋯ Compared to standard open discectomy, minimally invasive surgical procedures not only achieve satisfactory efficacy, but also microendoscopic discectomy and percutaneous endoscopic lumbar discectomy can obtain a more satisfactory short-term VAS score and ODI score. Microendoscopic discectomy has significant advantages in blood loss and reoperation rate, and tubular discectomy has fewer postoperative complications.