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      State of clinical pain research in Nepal: a systematic scoping review

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          Abstract

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          Abstract

          Before determining the pain research priorities for a country, a comprehensive literature review of existing research is warranted. We aimed to (1) identify and describe the extent and nature of pain research performed in Nepal, (2) identify existing knowledge and significant knowledge gaps, and (3) provide recommendations for future studies. We conducted a systematic scoping review of the literature, in accordance with recommended guidelines. We searched local and international databases to identify research conducted in Nepal on individuals with a diagnosis of clinical pain conditions. A pair of independent reviewers screened the studies for inclusion. We identified 1396 records and included 116 studies. Most studies were published in Nepalese journals (75%) and were conducted in clinical settings (73%). Postsurgical pain was the most commonly studied pain condition (33%), followed by musculoskeletal pain (16%), headache (14%), and low back pain (13%). The most common research topics, in order of frequency, were (1) medical management (40%), (2) pain prevalence/incidence (21%), (3) diagnostic procedures (15%), (4) surgical management (8%), and (5) patient-reported outcome measurement (8%). Research gaps and potential areas of research waste were identified. Although a large number of research articles about pain in Nepal have been published, the majority of these have focused on the biomedical diagnosis and management of pain. Other topic areas (eg, psychological and social aspects of pain) are under-represented. The findings may inform future research directions for maximizing the knowledge that could be gained.

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          Guidance for conducting systematic scoping reviews.

          Reviews of primary research are becoming more common as evidence-based practice gains recognition as the benchmark for care, and the number of, and access to, primary research sources has grown. One of the newer review types is the 'scoping review'. In general, scoping reviews are commonly used for 'reconnaissance' - to clarify working definitions and conceptual boundaries of a topic or field. Scoping reviews are therefore particularly useful when a body of literature has not yet been comprehensively reviewed, or exhibits a complex or heterogeneous nature not amenable to a more precise systematic review of the evidence. While scoping reviews may be conducted to determine the value and probable scope of a full systematic review, they may also be undertaken as exercises in and of themselves to summarize and disseminate research findings, to identify research gaps, and to make recommendations for the future research. This article briefly introduces the reader to scoping reviews, how they are different to systematic reviews, and why they might be conducted. The methodology and guidance for the conduct of systematic scoping reviews outlined below was developed by members of the Joanna Briggs Institute and members of five Joanna Briggs Collaborating Centres.
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            Core outcome measurement instruments for clinical trials in nonspecific low back pain

            Supplemental Digital Content is Available in the Text. Consensus-based recommendations are provided on outcome measurement instruments for physical functioning, pain intensity, and health-related quality of life in patients with nonspecific low back pain.
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              A two years open-label prospective study of OnabotulinumtoxinA 195 U in medication overuse headache: a real-world experience

              Background The efficacy and safety of OnabotulinumtoxinA (BOTOX®) in adults with chronic migraine (CM) were demonstrated in the PREEMPT program. However, the dosage used in this study was flexible from 155 U to 195 U at the physician’s discretion. Therefore, the objective of this prospective study was to compare the efficacy and safety of OnabotulinumtoxinA 195 U vs. 155 U for the treatment of CM and medication overuse headache (MOH) during a 2-year period. Methods We prospectively evaluated the mean reduction in headache days, migraine days, acute pain medication intake days and Headache Impact Test (HIT)-6 score in 172 patients injected with OnabotulinumtoxinA 195 U. Successively, we compared the efficacy measures with data of 155 patients injected with OnabotulinumtoxinA 155 U and followed up for 2 years. All patients were affected by CM and MOH, and failed one or more previous detoxification and preventative therapies. Results Both OnabotulinumtoxinA 195 U and 155 U reduced significantly the number of headache and migraine days, acute pain medication intake days and HIT-6 score, when compared with the baseline measures. Nevertheless, OnabotulinumtoxinA 195 U proved to be superior of 155 U in all efficacy measures since the first injection and for all the 2 years of treatment, with the exception of the reduction in pain medication intake days that resulted significantly larger with 195 U only after the 4th injection. The safety and tolerability of the two doses were similar and treatment related adverse events were transient and mild-moderate. Conclusions This study represents the largest and longest post-marketing studies of doses comparison with OnabotulinumtoxinA in a real-life clinical setting. Here, we demonstrate the superior efficacy of OnabotulinumtoxinA 195 U compared to 155 U in CM patients with MOH during a 2-year treatment period with similar safety and tolerability profile. Electronic supplementary material The online version of this article (doi:10.1186/s10194-016-0591-3) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Pain Rep
                Pain Rep
                PAIREP
                Painreports
                Pain Reports
                Wolters Kluwer (Philadelphia, PA )
                2471-2531
                Nov-Dec 2019
                06 December 2019
                : 4
                : 6
                : e788
                Affiliations
                [a ]Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
                [b ]Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
                [c ]Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
                [d ]Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
                [e ]Institute for Musculoskeletal Health, Sydney, Australia
                [f ]Department of Physiotherapy, Annapurna Neurological Institute and Allied Sciences, Kathmandu, Nepal
                Author notes
                [* ]Corresponding author. Address: Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel Hospital Kathmandu University Hospital, Box 11008, Dhulikhel, 45210, Nepal. Tel.: +977-9841634043; fax: +977-1-490707. E-mail address: saurabsharma1@ 123456gmail.com (S. Sharma).
                Article
                PAINREPORTS-D-19-0078 00004
                10.1097/PR9.0000000000000788
                6903326
                31984293
                a2c27220-4755-4b31-ae0c-a1b0e45dcdfc
                Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.

                This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0 (CC BY-ND) which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.

                History
                : 02 May 2019
                : 22 July 2019
                : 10 August 2019
                Categories
                25
                Pain in the Developing World
                Review
                Custom metadata
                TRUE
                T

                pain,pain management,chronic pain,headache,back pain,musculoskeletal pain,postoperative pain,developing countries,nepal

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