Using discrete choice experiments to inform randomised controlled trials: an application to chronic low back pain management in primary care. Autologous Fat Graft in Postmastectomy Pain Syndrome Following Breast Conservative Surgery and Radiotherapy Effect of levetiracetam on the postmastectomy pain syndrome. Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. [Method of pharmacological myocardial preconditioning with halogen-containing anesthetics in cardiosurgical patients]. Efficacy of Radiofrequency Procedures for the Treatment of Spinal Pain: A Systematic Review of Randomized Clinical Trials Fatigue in a simple repetitive motor task: a combined electrophysiological and neuropsychological study Effect of early administration of the N-methyl-d-aspartate receptor antagonist amantadine on the development of postmastectomy pain syndrome: a prospective pilot study. Use of Condition-Specific Patient-Reported Outcome Measures in Clinical Trials among Patients with Wrist Osteoarthritis: A Systematic Review Cytoreduction and HIPEC in The Netherlands: Nationwide Long-term Outcome Following the Dutch Protocol The Effect of a Pain Management Program on Patients With Cancer Pain [Preventive analgesic effect of intraoperative administration of ibuprofen-arginine on postmastectomy pain syndrome]. Diagnostic utility of facet (zygapophysial) joint injections in chronic spinal pain: a systematic review of evidence.
Pain Management Programmes ( PMPs ) are a multi-disciplinary approach to the management of chronic low back pain ( CLBP ) . Notwithst and ing evidence of effectiveness , successful take-up of programmes requires acceptability to patients . We used a discrete choice experiment to investigate patient preferences for alternative PMPs for managing CLBP in primary care . Specifically , we estimated the probability of uptake of alternative configurations of PMPs . Potential attributes and associated levels influencing take-up were identified through a systematic literature review , survey of current PMPs , expert consultation , and focus groups . Five attributes were included : content ; provider ; schedule ; group size ; and travel time to clinic . Four hundred and fourteen question naires were mailed to patients attending clinics and 124 question naires were returned suitable for analysis . Method of delivery influenced probability of take-up , with small group sizes and low intensity programmes over a prolonged period increasing the probabilities . Travel time was also important . However , providers and contents of PMPs were not main drivers of preferences , though those with more severe pain did prefer PMPs provided by more specialists . Probability of take-up increases when PMPs better reflect patient preferences . Given preferences , re source constraints , and evidence on clinical outcomes of alternative configurations it is suggested more re source -intensive PMPs be reserved for those with the most severe and disabling pain and less intensive programmes delivered over a longer time period in smaller groups for those with less severe pain . These findings can inform future r and omised trials to evaluate acceptable PMPs in primary care Background Breast cancer is the most common cancer in women worldwide , affecting one in eight women . Breast-conserving surgery ( BCS ) has become a well-established alternative to mastectomy in the treatment of breast cancer , providing a less invasive treatment . Just as life expectancy after breast cancer has improved , so has morbidity increased . One of the most relevant and debilitating consequences of oncological breast surgery is postmastectomy pain syndrome ( PMPS ) . Our results published in 2011 on the treatment of PMPS in patients who had undergone mastectomy and radiotherapy  and our experience in scar treatment with fat grafts were the theoretical bases for this prospect i ve study . Methods From April 2011 to April 2012 a total of 96 patients , who had undergone lumpectomy and radiation therapy , with the diagnosis of PMPS were considered for fat grafts .  We performed autologous fat grafting in  59 patients ( study group ) , whereas  37 patients did not receive any further surgical procedure  ( control group ) . Pain assessment was performed using the visual analog scale ( VAS ) before and after treatment in the treated group and in the control group at the first visit and the control visit , with a mean follow-up of 10 months . Results were analyzed using the Wilcoxon rank sum test . Results Four patients were lost to follow-up ( two patients in the control group and two patients in the treated group ) . A significant VAS pain decrease was detected in patients treated with autologous fat grafting ( 3.1 point reduction , p ≤ 0.005 ) . Conclusion Because of the safety , efficacy , and optimal tolerability of the procedure , we believe that fat grafting can be considered useful in treating PMPS in patients who have undergone BCS and radiotherapy . Level of Evidence IIIFor a full description of these Evidence -Based Medicine ratings , please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 BACKGROUND AND PURPOSE The aim of this r and omized , double-blind , placebo-controlled , cross-over study was to test whether levetiracetam relieves the postmastectomy pain syndrome ( PMPS ) . METHODS Postmastectomy pain syndrome was defined as pain of neuropathic character located in the area of the surgery and /or the ipsilateral arm . The inclusion criteria were : age more than 18 years , characteristic symptoms corresponding to PMPS more than 6 months after surgery for breast cancer , pain duration more than 3 months , peripheral nerve lesions confirmed by abnormal neurological and quantitative sensory tests , intensity of pain more than 4 on a numeric rating scale from 0 to 10 and pain present at least 4 days a week . RESULTS Forty-nine patients were screened for participation and 27 patients were included in the study . Twenty-five patients completed two treatment phases of 4 weeks duration with levetiracetam ( 3000 mg/day ) and placebo . There was no difference in the rating of pain relief between treatment with levetiracetam ( P = 0.83 ) and placebo nor when adjusted for possible period effect ( P = 0.60 ) . Analysis defining response as pain relief more than 4 on an eleven-point numeric rating scale showed no significant difference between treatment with levetiracetam and placebo ( P = 1.00 ) . CONCLUSIONS Levetiracetam apparently does not relieve peripheral neuropathic pain in PMPS BACKGROUND The Cochrane Collaboration is strongly encouraging the use of a newly developed tool , the Cochrane Collaboration Risk of Bias Tool ( CCRBT ) , for all review groups . However , the psychometric properties of this tool to date have yet to be described . Thus , the objective of this study was to add information about psychometric properties of the CCRBT including inter-rater reliability and concurrent validity , in comparison with the Effective Public Health Practice Project Quality Assessment Tool ( EPHPP ) . METHODS Both tools were used to assess the method ological quality of 20 r and omized controlled trials included in our systematic review of the effectiveness of knowledge translation interventions  to improve the management of cancer pain . Each study assessment was completed independently by two review ers using each tool . We analysed the inter-rater reliability of each tool 's individual domains , as well as final grade assigned to each study . RESULTS The EPHPP had fair inter-rater agreement for individual domains and excellent agreement for the final grade . In contrast , the CCRBT had slight inter-rater agreement for individual domains and fair inter-rater agreement for final grade . Of interest , no agreement between the two tools was evident in their final grade assigned to each study . Although both tools were developed to assess ' quality of the evidence ' , they appear to measure different constructs . CONCLUSIONS Both tools performed quite differently when evaluating the risk of bias or method ological quality of studies in knowledge translation interventions for cancer pain . The newly introduced CCRBT assigned these studies a higher risk of bias . Its psychometric properties need to be more thoroughly vali date d , in a range of research fields , to underst and fully how to interpret results from its application The purpose of the investigation was to study whether isoflurane and sevoflurane might be used for pharmacological myocardial preconditioning ( PMP ) in patients with coronary heart disease during myocardial revascularization on the working ( Part I ) and arrested ( Part II ) heart and to develop a possible procedure for PMP . Part I deals with the study of the effect of PMP with halogen-containing anesthetics during myocardial revascularization on the working heart . The study included 66 patients who were divided into 4 groups ; 1 )  sevoflurane feeding was started just after anesthesia induction and it lasted until some coronary arteries were ligated ; 2 ) sevoflurane was fed for 15 min ; 3 ) isoflurane was used ; 4 ) controls . The markers of myocardial lesion ( troponin T , I ) were measured and the incidence of perioperative myocardial ischemia and needs for inotropic support were also analyzed . Part II was dedicated to the study of the effect of PMP during myocardial revascularization under extracorporeal circulation ( EC ) . The study covered 65 patients who were divided into 4 groups ; 1 ) sevoflurane was administered throughout the anesthesia until the aorta was ligated ; 2 ) it was used for 15 min before aortic ligation ; 3 ) sevoflurane was employed only to induce anesthesia ; 4 ) controls . The variables similar to those in Part I of the investigation were chosen to assess the results of this study . The use of sevoflurane and isoflurane reduces a risk for myocardial ischemic lesion during myocardial revascularization both under EC and on the working heart . Short-term ( 15-min ) use of an agent before myocardial ischemia suffices for PMP to develop its effect . The effect of PMP has its duration that is 76 min , as shown by our findings Background and Objectives The use of radiofrequency ( RF ) procedures in the peripheral nervous system to treat  chronic spinal pain  has been the subject of controversy . Publications concerned only uncontrolled studies , and irreversible nervous tissue damage was believed to be responsible for the effect , if any . In recent years , r and omized , controlled studies have appeared , which have attested to an increasing use of these techniques . This is a systematic review of r and omized controlled trials on RF procedures for spinal pain . Methods We performed a st and ardized literature search for r and omized , controlled trials . Three adjudicators independently registered trial methodology and outcome using vali date d and subject-related instruments . Interadjudicator disagreement was resolved by discussion . It was found necessary to devise additional parameters of study assessment . Results Six trials met the inclusion criteria . This small number , along with clinical and technical heterogeneity precluded statistical analysis . All studies , whether high or low quality , reported positive outcomes . Conclusions We conclude that there is moderate evidence that RF lumbar facet denervation is more effective for chronic low back pain  than placebo . Limited evidence exists for efficacy of RF neurotomy in chronic cervical zygapophyseal joint pain after flexion-extension injury . There is limited evidence that RF heating of the dorsal root ganglion is more effective than placebo in chronic cervicobrachialgia .  We recommend the systematic application of our additional parameter assessment s for future evaluations of RF studies . These additional parameters should also be used in the preparation of future trial protocol s of RF procedures for the treatment of chronic pain Fatigue is one of the most common psychophysiological symptoms that interact with the control mechanisms regulating task behaviour . The cortical processes involved in preparation and feedback control of voluntary movement are associated with EEG activity time-locked to movement onset : a pre-movement Movement-Related Cortical Potential ( MRCP ) is followed by a post-movement potential ( PMP ) . The aim of this study was to determine whether changes in subjective fatigue which arise in the course of a simple repetitive motor task affect cortical information processing as measured by MRCPs or PMPs . MRCPs/PMPs were recorded in 33 healthy subjects while they made 100 self-paced unilateral button presses with their left or right index finger , and then continued with the other index finger for another 100 movements . Before and after the motor tasks , subjective fatigue was assessed via question naire . ( 1 ) Subjects who reported a higher increase of fatigue when they had finished the motor tasks showed smaller ( more negative ) amplitudes of the PMP . ( 2 ) This increase of negativity was strongest during the initial part of the tasks . ( 3 ) Physical aspects of perceived fatigue had a stronger effect on PMP amplitude than cognitive aspects . Smaller amplitudes of the PMP in more fatigued subjects might be explained by reduced attention to somatosensory feedback . Adaptation of this effect may result from more automatic performance at later stages of the task when all subjects required a lower degree of attentional control . In conjunction with previous studies , effects of fatigue could be separated from habituation UNLABELLED Postmastectomy pain syndrome ( PMPS ) is a neuropathic pain syndrome that might develop after breast surgery . Like many other forms of neuropathic pain , it is relatively resistant to treatment and negatively affects the quality of life . A double-blind , r and omized , placebo-controlled pilot trial was conducted to study the analgesic efficacy of perioperative administration of the N-methyl-D-aspatrate ( NMDA ) receptor antagonist amantadine in preventing PMPS after mastectomy plus axillary lymph node dissection ( ALND ) . In the study group , a regimen of 200 mg/day of amantadine was started 1 day before surgery and continued for 14 days , whereas the control group received a placebo .  Patients were required to indicate the exact location of their pain and to record its level at 1 , 3 , and 6 months after surgery . Neurologic examination and Quantitative Thermal Testing ( QTT ) were performed 1 and 6 months after surgery . On both the neurologic examination and the QTT , all patients , regardless of the perioperative intervention ( amantadine or placebo ) , presented evidence for nerve injury , manifested primarily by painful hypoesthesia ( anesthesia dolorosa ) in the axilla or inner arm . PMPS persisted for the entire duration of the study in 82 % of the patients who were available for follow-up . The average intensity of the pain was moderate in both groups and tended not to decline over time . No differences between the 2 groups in any of the outcome parameters reached statistical significance . According to the results of the present pilot study , the NMDA antagonist amantadine does not prevent the development of PMPS in patients who undergo breast surgery with ALND . PERSPECTIVE Breast surgery that involves ALND seems to uniformly cause nerve injury , which can not be prevented by the perioperative administration of 200 mg of amantadine . It is most commonly presented by painful hypoesthesia or anesthesia dolorosa in the axillary/inner arm area , which is moderate in intensity and likely to persist for at least 6 months Background . This paper aim ed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer- review ed evidence supporting their reliability , validity , and responsiveness to change . Methods . A systematic review of r and omised controlled trials among people with wrist osteoarthritis was undertaken . Studies reporting reliability , validity , or responsiveness were identified using a systematic reverse citation trail audit procedure . Psychometric properties of the instruments were examined against predefined criteria and summarised . Results . Thirteen clinical trials met inclusion criteria . The most common patient-reported outcome was the disabilities of the arm , shoulder , and h and question naire ( DASH ) . The DASH , the  Michigan H and Outcomes Question naire ( MHQ ) , the  Patient Evaluation Measure ( PEM ) , and the  Patient-Reported Wrist Evaluation ( PRWE ) had evidence supporting their reliability , validity , and responsiveness . A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis H and Index as another suitable instrument that had favourable reliability , validity , and responsiveness . Conclusions . The DASH , MHQ , and AUSCAN Osteoarthritis H and Index instruments were supported by the most favourable empirical evidence for validity , reliability , and responsiveness . The PEM and PRWE also had favourable empirical evidence reported for these elements . Further psychometric testing of these instruments among people with wrist osteoarthritis is warranted Purpose This nationwide study evaluated results of cytoreductive surgery ( CRS ) combined with hyperthermic intraperitoneal chemotherapy ( HIPEC ) for peritoneal metastasis of colorectal origin in the Netherl and s following a national protocol . Methods In a multi-institutional study prospect i ve data bases of patients with peritoneal carcinomatosis ( PC ) from colorectal cancer and pseudomyxoma peritonei ( PMP ) treated according to the Dutch HIPEC protocol , a uniform approach for the CRS and HIPEC treatment , were review ed . Primary end point was overall survival and secondary end points were surgical outcome and progression-free survival . Results Nine-hundred sixty patients were included ; 660 patients ( 69 % ) were affected by PC of colorectal carcinoma and the remaining suffered from PMP ( 31 % ) . In 767 procedures ( 80 % ) , macroscopic complete cytoreduction was achieved . Three-hundred and thirty one patients had grade III – V complications ( 34 % ) . Thirty-two patients died perioperatively ( 3 % ) . Median length of hospital stay was 16 days ( range 0–166 days ) . Median follow-up period was 41 months ( 95 % confidence interval ( CI ) , 36–46 months ) . Median progression-free survival was 15 months ( 95 % CI 13–17 months ) for CRC patients and 53 months ( 95 % CI 40–66 months ) for PMP patients . Overall median survival was 33 ( 95 % CI 28–38 months ) months for CRC patients and 130 months ( 95 % CI 98–162 months ) for PMP patients . Three- and five-year survival rates were 46 and 31 % respectively in case of CRC patients and 77 and 65 % respectively in case of PMP patients . Conclusions The results underline the safety and efficacy of cytoreduction and HIPEC for PC from CRC and PMP . It is assumed the uniform Dutch HIPEC protocol was beneficial Background : Pain is 1 of the most common symptoms that a cancer patient would experience . A significant barrier to positive pain management is patients ’ misconceptions regarding analgesics and inadequate use of nonpharmacological strategies as pain relief . Objective : The purpose of this study was to investigate the effectiveness of a pain management program ( PMP ) on pain intensity , use of PRN drugs  and  nonpharmacological strategies  as pain relief , and barriers to managing pain in cancer patients . Methods : The study was conducted in the palliative care and hospice ward of a public hospital in Hong Kong . Patients were r and omized to either an experimental group ( receiving the PMP ) or a control group ( routine care ) . There were 38 hospitalized patients , with 20 ( 13 males and 7 females ) in the experimental group and 18 ( 11 males and 7 females ) in the control group ; mean age was 61.95 years ( experimental group ) to 63.94 years ( control group ) . Results : Upon the completion of PMP , pain scores were significantly reduced in both groups , yet patients in the experimental group showed a significant increase in the use of PRN analgesics and nonpharmacological strategies to relieve pain ( P < .05 ) and significantly reduce barriers to managing their cancer pain ( P < .05 ) compared with the control group . Conclusion : Cancer patients should be empowered with pain management education to gain knowledge and correct misconceptions in managing their cancer pain . Implication s for Practice : Integration of the PMP into routine clinical work may help to improve the st and ard of care for cancer patients . It is recommended to provide pain management education to all cancer patients The efficacy of preemptive analgesia on postoperative pain is discussed . From experimental neurophysiological data , the present policy of preventive analgesia aims at precluding modifications of the nervous system secondary to a nervous lesion and the appearance of chronic pain , particularly of the neurogenic kind . The post-mastectomy pain syndrome ( PMPS ) falls within the realm of neurogenic pain and is still poorly understood and underestimated . This study evaluated the preemptive effect of a perioperative administration of an oral non steroid anti-inflammatory , the ibuprofen-arginine , on PMPS . Thirty patients scheduled for partial or total mastectomy with axillary dissection were prospect ively and r and omly assigned to 2 groups . The ibuprofen-arginine group ( group I ) ( n = 15 ) , received an oral administration of 400 mg of ibuprofen-arginine , 90 min before surgery , 2 h after surgery and then every 8 h in the first 32 postoperative hours . The control group ( group C ) received in doubled blind a placebo at the same time . At 6 months , we looked after pain or dysesthesia . We confirmed the diagnosis of PMPS in presence of association of diagnosis criteria s. Fourteen patients in each group have been included . Eighty-six percent of the patients ( 13 patients in group I and 11 patients in group C ) presented at 6 months dysesthesia of the upper member ipsilateral to the mastectomy and /or the operated breast , appearing either immediately or after a laps of time . Nine patients ( group I ) and 6 patients ( group C ) had PMPS . Postoperative radiotherapy and lymphoedema were statistically associated with PMPS ( p = 0.019 and p = 0.011 ) . The perioperative preventive administration of a non-steroid anti-inflammatory drug reduces neither the incidence of pain in the first post-operative months , nor the appearance of PMPS at 6 months . These results suggest that others factors than the nervous lesion may play a role in the occurrence of PMPS , as radiotherapy , lymphoedema , but also psychosocials factors BACKGROUND Chronic refractory spinal pain poses a peculiar diagnostic challenge because of multiple putative pain sources , overlapping clinical features , and nonspecific radiologic findings . Diagnostic injection techniques are employed to isolate the source ( s ) of pain . Facet or zygapophysial joint pain is an example of spinal pain diagnosed by local anesthetic injections of the facet joint or its nerve supply . Diagnostic facet joint injections are expected to meet the cardinal features of a diagnostic test ( i.e. , accuracy , safety and reproducibility ) . Accuracy must be compared with a " gold " or criterion st and ard that can confirm presence or absence of a disease . There is , however , no available gold st and ard , such as biopsy , to measure presence or absence of pain . Hence , there is a degree of uncertainty concerning the accuracy of diagnostic facet joint injections . OBJECTIVES To evaluate accuracy , safety and reproducibility of facet or zygapophysial joint injections in diagnosing chronic spinal pain of facet joint origin . STUDY DESIGN A systematic review of the literature for clinical studies on efficacy and utility of facet joint/nerve injections in diagnosing spinal pain from facet joints . METHODS Relevant literature on diagnostic facet injections was identified through data base search es . Excluded were abstract s , review s , book chapters , case reports and studies based on single blocks or blocks without radiologic control . Prospect i ve studies with placebo control , or controlled comparative local anesthetic blocks , were given priority over retrospective studies . Each study was grade d using AHRQ and QUADAS criteria . The level of evidence was classified as conclusive , strong , moderate , limited , or inconclusive . RESULTS Available literature pointed to strong evidence for controlled comparative local anesthetic facet joint medial branch blocks in the diagnosis of neck and low back pain . There was moderate evidence in the diagnosis of pain arising from thoracic facet joints . CONCLUSION The evidence obtained from literature review suggests that controlled comparative local anesthetic blocks of facet joint nerves ( medial branch or dorsal ramus ) are reproducible , reasonably accurate , and safe . The sensitivity , specificity , false-positive rates , and predictive values of these diagnostic tests for neck and low back pain have been vali date d and reproduced in multiple studies
The level of evidence for PMPs varied across different test procedures in different types of PJP .
H and -held pressure algometry is the only test procedure that showed moderate positive evidence of intrarater reliability , agreement , and responsiveness , simultaneously , when it was investigated in patients with chronic knee osteoarthritis .
BACKGROUND Test procedures that were developed to assess somatosensory abnormalities should possess optimal psychometric properties ( PMPs ) to be used in clinical practice .
The aim of this systematic review was to evaluate the literature to assess the level of evidence for PMPs of test procedures investigated in individuals with peripheral joint pain ( PJP ) .