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      “Evidence‐Based Interventional Pain Medicine According to Clinical Diagnoses”: Update 2018

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          Abstract

          Introduction

          Between 2009 and 2011 a series of 26 articles on evidence‐based medicine for interventional pain medicine according to clinical diagnoses were published. The high number of publications since the last literature search justified an update.

          Methods

          For the update an independent 3rd party, specialized in systematic reviews was asked in 2015 to perform the literature search and summarize relevant evidence using Cochrane and GRADE methodology to compile guidelines on interventional pain management. The guideline committee reviewed the information and made a last update on March 1st 2018. The information from new studies published after the research performed by the 3th party and additional observational studies was used to incorporate other factors such as side effects and complications, invasiveness, costs and ethical factors, which influence the ultimate recommendations.

          Results

          For the different indications a total of 113 interventions were evaluated. Twenty‐seven (24%) interventions were new compared to the previous guidelines and the recommendation changed for only 3 (2.6%) of the interventions.

          Discussion

          This article summarizes the evolution of the quality of evidence and the strength of recommendations for the interventional pain treatment options for 28 clinical pain diagnoses.

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          Most cited references30

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          Grading strength of recommendations and quality of evidence in clinical guidelines: report from an american college of chest physicians task force.

          While grading the strength of recommendations and the quality of underlying evidence enhances the usefulness of clinical guidelines, the profusion of guideline grading systems undermines the value of the grading exercise. An American College of Chest Physicians (ACCP) task force formulated the criteria for a grading system to be utilized in all ACCP guidelines that included simplicity and transparency, explicitness of methodology, and consistency with current methodological approaches to the grading process. The working group examined currently available systems, and ultimately modified an approach formulated by the international GRADE group. The grading scheme classifies recommendations as strong (grade 1) or weak (grade 2), according to the balance among benefits, risks, burdens, and possibly cost, and the degree of confidence in estimates of benefits, risks, and burdens. The system classifies quality of evidence as high (grade A), moderate (grade B), or low (grade C) according to factors that include the study design, the consistency of the results, and the directness of the evidence. For all future ACCP guidelines, The College has adopted a simple, transparent approach to grading recommendations that is consistent with current developments in the field. The trend toward uniformity of approaches to grading will enhance the usefulness of practice guidelines for clinicians.
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            Developing optimal search strategies for detecting clinically sound treatment studies in EMBASE.

            The ability to accurately identify articles about therapy in large bibliographic databases such as EMBASE is important for researchers and clinicians. Our study aimed to develop optimal search strategies for detecting sound treatment studies in EMBASE in the year 2000. Hand searches of journals were compared with retrievals from EMBASE for candidate search strategies. Six trained research assistants reviewed fifty-five journals indexed in EMBASE and rated articles using purpose and quality indicators. Candidate search strategies were developed for identifying treatment articles and then tested, and the retrievals were compared with the hand-search data. The operating characteristics of the strategies were calculated. Three thousand eight hundred fifty articles were original studies on treatment, of which 1,256 (32.6%) were methodologically sound. Combining search terms revealed a top performing strategy (random:.tw. OR clinical trial:.mp. OR exp health care quality) with sensitivity of 98.9% and specificity of 72.0%. Maximizing specificity, a top performing strategy (double-blind:.mp. OR placebo:.tw. OR blind: .tw.) achieved a value over 96.0%, but with compromised sensitivity at 51.7%. A 3-term strategy achieved the best optimization of sensitivity and specificity (random:.tw. OR placebo:.mp. OR double-blind:.tw.), with both these values over 92.0%. Search strategies can achieve high performance for retrieving sound treatment studies in EMBASE.
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              11. Lumbosacral radicular pain.

              Lumbosacral radicular pain is characterized by a radiating pain in one or more lumbar or sacral dermatomes; it may or may not be accompanied by other radicular irritation symptoms and/or symptoms of decreased function. The annual prevalence in the general population, described as low back pain with leg pain traveling below the knee, varied from 9.9% to 25%, which means that it is presumably the most commonly occurring form of neuropathic pain. The patient's history may give a suggestion of lumbosacral radicular pain. The best known clinical investigation is the straight-leg raising test. Final diagnosis is made based on a combination of clinical examination and potentially additional tests. Medical imaging studies are indicated to exclude possible serious pathologies and to confirm the affected level in patients suffering lumbosacral radicular pain for longer than 3 months. Magnetic resonance imaging is preferred. Selective diagnostic blocks help confirming the affected level. There is controversy concerning the effectiveness of conservative management (physical therapy, exercise) and pharmacological treatment. When conservative treatment fails, in subacute lumbosacral radicular pain under the level L3 as the result of a contained herniation, transforaminal corticosteroid administration is recommended (2 B+). In chronic lumbosacral radicular pain, (pulsed) radiofrequency treatment adjacent to the spinal ganglion (DRG) can be considered (2 C+). For refractory lumbosacral radicular pain, adhesiolysis and epiduroscopy can be considered (2 B+/-), preferentially study-related. In patients with a therapy-resistant radicular pain in the context of a Failed Back Surgery Syndrome, spinal cord stimulation is recommended (2 A+). This treatment should be performed in specialized centers.
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                Author and article information

                Contributors
                Jan.Vanzundert@zol.be
                Journal
                Pain Pract
                Pain Pract
                10.1111/(ISSN)1533-2500
                PAPR
                Pain Practice
                John Wiley and Sons Inc. (Hoboken )
                1530-7085
                1533-2500
                02 May 2019
                July 2019
                : 19
                : 6 ( doiID: 10.1111/papr.2019.19.issue-6 )
                : 664-675
                Affiliations
                [ 1 ] Department of Anesthesiology Erasmus University Medical Center Rotterdam The Netherlands
                [ 2 ] Department of Anesthesiology Rijnstate Hospital Velp The Netherlands
                [ 3 ] Department of Epidemiology and Biostatistics Vrije Universiteit Medical Centre Amsterdam Amsterdam The Netherlands
                [ 4 ] Department of Anesthesiology Critical Care and Multidisciplinary Pain Center Ziekenhuis Oost‐Limburg Belgium
                [ 5 ] Department of Pain and Palliative Pain Medicine Radboud University Medical Center Nijmegen Nijmegen The Netherlands
                [ 6 ] Department of Anesthesiology and Pain Medicine Maastricht University Medical Center Maastricht The Netherlands
                Author notes
                [*] [* ]Address correspondence and reprint requests to: Jan Van Zundert, MD, PhD, FIPP, Department of Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost‐Limburg, Bessemersstraat, 478, 3620 Lanaken, Belgium. E‐mail: Jan.Vanzundert@ 123456zol.be
                Article
                PAPR12786
                10.1111/papr.12786
                6850128
                30957944
                aa32d61e-5a73-4a5d-86f2-04f005e08043
                © 2019 The Authors. Pain Practice published by Wiley Periodicals, Inc. on behalf of World Institute of Pain

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 20 December 2018
                : 28 March 2019
                : 31 March 2019
                Page count
                Figures: 0, Tables: 3, Pages: 12, Words: 7129
                Categories
                Review Article
                Review Article
                Custom metadata
                2.0
                July 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.1 mode:remove_FC converted:12.11.2019

                interventional pain management,evidence‐based medicine,systematic review,grade,recommendations

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