Systematic review of management of chronic pain after surgery.
Study Goal
The researchers aimed to evaluate the effectiveness and safety of various interventions, including mindfulness-based stress reduction, for managing chronic postsurgical pain (CPSP).
Results Summary
The study found insufficient evidence to draw conclusions on the effectiveness of mindfulness-based stress reduction or other interventions for CPSP due to limited opportunities for meta-analysis and heterogeneity among trials.
Population
Patients with chronic pain after spinal surgery or phantom limb pain.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
antiepileptics | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #1 |
capsaicin | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #2 |
epidural steroid injections | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #3 |
local anaesthetic | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #4 |
neurotoxins | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #5 |
N-methyl-d-aspartate receptor antagonists | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #6 |
opioids | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #7 |
acupuncture | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #8 |
exercise | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #9 |
postamputation limb liner | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #10 |
spinal cord stimulation | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #11 |
further surgery | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #12 |
laser therapy | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #13 |
magnetic stimulation | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #14 |
mindfulness-based stress reduction | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #15 |
mirror therapy | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #16 |
sensory discrimination training | no change | chronic postsurgical pain (CPSP) | patients with chronic pain after spinal surgery or phantom limb pain | insufficient evidence | insufficient evidence to draw conclusions on effectiveness | #17 |
BACKGROUND: Pain present for at least 3 months after a surgical procedure is considered chronic postsurgical pain (CPSP) and affects 10-50 per cent of patients. Interventions for CPSP may focus on the underlying condition that indicated surgery, the aetiology of new-onset pain or be multifactorial in recognition of the diverse causes of this pain. The aim of this systematic review was to identify RCTs of interventions for the management of CPSP, and synthesize data across treatment type to estimate their effectiveness and safety. METHODS: MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Library were searched from inception to March 2016. Trials of pain interventions received by patients at 3 months or more after surgery were included. Risk of bias was assessed using the Cochrane risk-of-bias tool. RESULTS: Some 66 trials with data from 3149 participants were included. Most trials included patients with chronic pain after spinal surgery (25 trials) or phantom limb pain (21 trials). Interventions were predominantly pharmacological, including antiepileptics, capsaicin, epidural steroid injections, local anaesthetic, neurotoxins, N-methyl-d-aspartate receptor antagonists and opioids. Other interventions included acupuncture, exercise, postamputation limb liner, spinal cord stimulation, further surgery, laser therapy, magnetic stimulation, mindfulness-based stress reduction, mirror therapy and sensory discrimination training. Opportunities for meta-analysis were limited by heterogeneity. For all interventions, there was insufficient evidence to draw conclusions on effectiveness. CONCLUSION: There is a need for more evidence about interventions for CPSP. High-quality trials of multimodal interventions matched to pain characteristics are needed to provide robust evidence to guide management of CPSP.