![]() ![]() ![]() Others report that people suffering from chronic neuropathic pain generate medical costs that are three times greater than those not living with pain. Tarride et al 12 estimated that managing a Canadian patient with chronic neuropathic pain over a 3-month period costs an average of $2567, of which 52% are direct costs, for example, cost of physicians, diagnostic tests and surgical procedures. 8–11Ĭhronic neuropathic pain is associated with substantial economic burden. 7 It is associated with depression, anxiety and sleep disturbances, and patients with chronic neuropathic pain experience lower health-related quality of life than the general population. 4, 6Ĭhronic neuropathic pain is common worldwide, affecting 7% to 10% of the general population. The latter may manifest as increased sensitivity to pain (hyperalgesia) or as a painful response to a stimulus that would not normally be painful (allodynia). 3–5 The pain may be spontaneous or evoked in response to physical stimuli. 2 Among the causes of chronic neuropathic pain are metabolic disease (eg, diabetes), infection (eg, shingles), trauma (eg, spinal cord injury) and autoimmune disease (eg, multiple sclerosis). We will define a priori hypotheses to explain heterogeneity between studies, and conduct meta-regression and subgroup analyses consistent with the current best practices.Ĭhronic neuropathic pain is defined as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.” 1 It may be classified as central or peripheral, depending on the site of the lesion. When possible, we will conduct: (1) in direct comparisons, a random-effects meta-analysis to establish the effect of reported therapies on patient-important outcomes and (2) a multiple treatment comparison meta-analysis within a Bayesian framework to assess the relative effects of treatments. We will use a modified Cochrane instrument to evaluate risk of bias of eligible studies, recommendations from the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to inform the outcomes we will collect, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to evaluate our confidence in treatment effects. Pairs of reviewers will, independently and in duplicate, screen titles and abstracts of identified citations, review the full texts of potentially eligible trials and extract information from eligible trials. Eligible trials will be: (1) enrol patients presenting with chronic neuropathic pain, and (2) randomise patients to alternative interventions (pharmacological or non-pharmacological) or an intervention and a control arm. We will identify eligible trials, in any language, by a systematic search of CINAHL, EMBASE, MEDLINE, AMED, HealthSTAR, DARE, PsychINFO and the Cochrane Central Registry of Controlled Trials. Methods and analysis We will conduct a systematic review of all randomised controlled trials evaluating therapies for chronic neuropathic pain. Correspondence to Sohail M Mulla mullasmmcmaster.ca. ![]() 9 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.8 Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care & Policy Research, Mayo Clinic, Rochester, Minnesota, USA.7 Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA.6 Department of Medicine, McMaster University, Hamilton, Ontario, Canada.5 Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada.DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada 3 Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.2 Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA.1 Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.
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