Expert review of neurotherapeutics
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Expert Rev Neurother · Apr 2020
Meta AnalysisNoninvasive brain stimulation combined with exercise in chronic pain: a systematic review and meta-analysis.
Background: The use of noninvasive brain stimulation (NIBS) combined with exercise could produce synergistic effects on chronic pain conditions. This study aims to evaluate the efficacy and safety of NIBS combined with exercise to treat chronic pain as well as to describe the parameters used to date in this combination. Methods: The search was carried out in Medline, Central, Scopus, Embase, and Pedro until November 2019. ⋯ Regarding NIBS techniques, the pooled effect sizes were significant for both tDCS (ES: -0.59, 95% CI: -0.89 to -0.29, I2 = 0.0%) and rTMS (ES: -0.76, 95% CI: -1.41 to -0.11, I2 = 0.0%). Conclusions: This meta-analysis suggests a significant moderate to large effects of the NIBS and exercise combination in chronic pain. The authors discuss the potential theoretical framework for this synergistic effect.
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Expert Rev Neurother · May 2015
Meta AnalysisPrognostic value of copeptin in patients with acute stroke.
There is a need to improve stroke care through the prompt identification of stroke patients at increased risk of an adverse outcome. ⋯ Copeptin is an independent predictor of poor outcome and mortality for patients with acute stroke.
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Expert Rev Neurother · Nov 2008
Review Meta AnalysisExtended-release epidural morphine (DepoDur): review and safety analysis.
Extended-release epidural morphine (EREM) provides effective postoperative analgesia for 48 h following injection. It is administered as a single bolus into the lumbar epidural space, and is indicated for lower abdominal and lower extremity surgery associated with moderate-to-severe pain. While its efficacy has been well documented in randomized controlled trials, the safety and clinically appropriate dosing are less well defined. ⋯ Vomiting was also increased with EREM 15 mg or greater compared with placebo (odds ratio: 0.40; 95% CI: 0.18-0.89; p = 0.02; NNT = 5). A multimodal analgesic regime is recommended to permit the use of lower EREM doses, thus reducing the risk for adverse effects including respiratory depression. Prophylactic time-contingent antiemetics are also recommended when EREM is used.
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Medication-overuse headache (MOH) has developed into the third most common type of headache after tension-type headache and migraine. The prevalence reaches approximately 1% of the world's population and shows an increasing trend. ⋯ Several large population-based longitudinal studies clearly demonstrated that overuse of any kind of acute headache medication is the main risk factor leading to the development of chronic headache. Management of MOH remains difficult; the only effective treatment concept is consequent withdrawal therapy.