Current pain and headache reports
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Curr Pain Headache Rep · Apr 2024
Review Meta AnalysisUtility of Repetitive Transcranial Magnetic Stimulation for Chronic Daily Headache Prophylaxis: A Systematic Review and Meta-Analysis.
Management of chronic daily headaches (CDH) remains challenging due to the limited efficacy of standard prophylactic pharmacological measures. Several studies have reported that repetitive transcranial magnetic stimulation (rTMS) can effectively treat chronic headaches. The objective was to determine the utility of rTMS for immediate post-treatment and sustained CDH prophylaxis. ⋯ Protocol preregistered in PROSPERO International Prospective Register of Systematic Reviews (CRD42021250100).
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Curr Pain Headache Rep · Apr 2024
Review Meta AnalysisEfficacy and Safety of Ketamine-Dexmedetomidine Versus Ketamine-Propofol Combination for Periprocedural Sedation: A Systematic Review and Meta-analysis.
The combination of ketamine with propofol and dexmedetomidine has gained popularity for sedation and general anesthesia in different populations. In our meta-nalysis, we helped the anesthesiologists to know the efficiency and the efficacy of both combinations in adult and pediatric patients. ⋯ Twenty-two trials were included with a total of 1429 patients. We found a significantly longer recovery time in the ketadex group of 7.59 min (95% CI, 4.92, 10.26; I2 = 94%) and a significantly less pain score of - 0.72 (95% CI, - 1.10, - 0.34; I2 = 0%). Adults had a significantly better physician satisfaction score with the ketofol group, odds ratio of 0.29 (95% CI, 0.12, 0.71; I2 = 0%). Recovery agitations were higher in the ketofol group with an odds ratio of 0.48 (95% CI, 0.24, 0.98; I2 = 36%). Furthermore, we found a significant difference between the combinations with a higher incidence in the ketadex group with pooled odds ratio of 1.75 (95% CI, 1.06, 2.88; I2 = 15%). Ketadex was associated with lower pain scores, hypoxic events and airway obstruction, and emergence agitation. At the same time, ketofol had much more clinician satisfaction which might be attributed to the shorter recovery time and lower incidence of nausea and vomiting. Therefore, we suppose that ketadex is the better combination in periprocedural sedation for both adult and pediatric patients who are not at greater risk for postoperative nausea and vomiting.
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Curr Pain Headache Rep · May 2020
Review Meta AnalysisIs Percutaneous Adhesiolysis Effective in Managing Chronic Low Back and Lower Extremity Pain in Post-surgery Syndrome: a Systematic Review and Meta-analysis.
The growing prevalence of spinal pain in the USA continues to produce substantial economic impact and strain on health-related quality of life. Percutaneous adhesiolysis is utilized for recalcitrant, resistant conditions involving spinal pain when epidural injections have failed to provide adequate improvement, especially low back and lower extremity pain, specifically in post-lumbar surgery syndrome. Despite multiple publications and systematic reviews, the debate continues in reference to effectiveness, safety, appropriate utilization, and medical necessity of percutaneous adhesiolysis in chronic pain. This systematic review, therefore, was undertaken to evaluate and to update effectiveness of percutaneous adhesiolysis to treat chronic refractory low back and lower extremity pain, post-surgical patients of the lumbar spine. ⋯ From 2009 to 2016, there was a decline of 53.2% utilization of percutaneous adhesiolysis with an annual decline of 10.3% per 100,000 fee-for-service (FFS) Medicare population. Multiple insurers, including Medicare, with Medicare area contractors of Noridian and Palmetto have issued noncoverage policies for percutaneous adhesiolysis resulting in these steep declines and continued noncoverage by Medicare Advantage plans, Managed Care plans of Medicaid, and other insurers. Since 2005, 4 systematic reviews of percutaneous adhesiolysis were published with 3 of them showing proper methodology and appropriate results with effectiveness of adhesiolysis, whereas one poorly performed systematic review showed negative results. In addition, there were only 4 randomized controlled trials (RCTs) to be included in the previous systematic reviews of post-surgery syndrome, whereas now, the RCTs and other studies have increased. This systematic review shows level I or strong evidence for the effectiveness of percutaneous adhesiolysis in managing chronic low back and lower extremity pain related to post-lumbar surgery syndrome.
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Curr Pain Headache Rep · Apr 2020
Review Meta Analysis Comparative StudyDoes Epidural Bupivacaine with or Without Steroids Provide Long-Term Relief? A Systematic Review and Meta-analysis.
Low back and lower extremity pain have been treated since 1901 with local anesthetics alone and since 1952 in combination with steroids. Over the years, multiple randomized controlled trials, systematic reviews with or without meta-analysis have been reaching discordant conclusions regarding the effectiveness of sodium chloride solution, local anesthetics, and steroids in managing spinal pain. Further, related to lack of understanding, multiple reviewers have considered local anesthetics including lidocaine and bupivacaine as equivalent to placebo based on theory that steroid is the only drug effective in the epidural space. In this review, we assessed effectiveness of epidurally administered bupivacaine with or without steroids to rule out misconceptions of placebo and to show the comparative effectiveness of epidural bupivacaine alone compared to epidural bupivacaine with steroids. ⋯ Multiple systematic reviews performed in assessing the effectiveness of epidural injections have converted epidurally administered lidocaine and bupivacaine to placebo. This led to inappropriate conclusions of lack of effectiveness of epidural local anesthetics with or without steroids as showing equal effectiveness when analyzed with conventional dual-arm meta-analysis. Thus, true placebo control trials with injection of an inactive substance into unrelated structures have been almost non-existent. Epidurally administered bupivacaine alone or with steroids are effective in managing low back and lower extremity pain. The findings of this review provide appropriate information of epidurally administered bupivacaine as an active agent (not a placebo) with level 1 evidence and almost equally effective as bupivacaine with steroids with level II evidence.
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Curr Pain Headache Rep · Aug 2019
Meta AnalysisManual Therapy and Quality of Life in People with Headache: Systematic Review and Meta-analysis of Randomized Controlled Trials.
People with headache usually experienced significantly lower health-related quality of life (HRQoL) than the healthy subjects. The goal of this systematic review was to evaluate the effectiveness of manual therapy on HRQoL in patients with tension-type headache (TTH), migraine (MH) or cervicogenic headache (CGH). ⋯ We searched randomized controlled trials (RCTs) on MEDLINE, COCHRANE and PEDro databases. Treatment was manual therapy compared to usual care or placebo. The outcome was the HRQoL that could be measured by Headache Impact Test (HIT-6), Headache Disability Inventory (HDI), Migraine Disability Assessment Questionnaire (MIDAS) and Short Form Health Survey 12/36 (SF-12/36). For the RCT internal validity, we used the Cochrane risk of bias (RoB) tool. For the level of evidence, we used the Grading of Recommendations, Assessment, Development and Evaluation approach (GRADE). We identified a total of 10 RCTs, 7 of which were included into the meta-analysis. For HIT-6 scale, meta-analysis showed statistically significant differences in favour to manual therapy both after treatment (mean difference (MD) - 3.67; 95% CI from - 5.71 to - 1.63) and at follow-up (MD - 2.47; 95% CI from - 3.27 to - 1.68). For HDI scale, meta-analysis showed statistically significant differences in favour to manual therapy both after treatment (MD - 4.01; 95% CI from - 5.82 to - 2.20) and at follow-up (MD - 5.62; 95% CI from - 10.69 to - 0.54). Other scales provided inconclusive results. Manual therapy should be considered as an effective approach in improving the quality of life in patients with TTH and MH, while in patients with CGH, the results were inconsistent. Those positive results should be considered with caution due to the very low level of evidence. Researchers should in future design primary studies using valid and reliable disease-specific outcome measures.