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      Exercise for Neuropathic Pain: A Systematic Review and Expert Consensus

      systematic-review

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          Abstract

          Background: Neuropathic pain (NP), a severe and disruptive symptom following many diseases, normally restricts patients' physical functions and leads to anxiety and depression. As an economical and effective therapy, exercise may be helpful in NP management. However, few guidelines and reviews focused on exercise therapy for NP associated with specific diseases. The study aimed to summarize the effectiveness and efficacy of exercise for various diseases with NP supported by evidence, describe expert recommendations for NP from different causes, and inform policymakers of the guidelines.

          Design: A systematic review and expert consensus.

          Methods: A systematic search was conducted in PubMed. We included systematic review and meta-analysis, randomized controlled trials (RCTs), which assessed patients with NP. Studies involved exercise intervention and outcome included pain intensity at least. Physiotherapy Evidence Database and the Assessment of Multiple Systematic reviews tool were used to grade the quality assessment of the included RCTs and systematic reviews, respectively. The final grades of recommendation were based on strength of evidence and a consensus discussion of results of Delphi rounds by the Delphi consensus panel including 21 experts from the Chinese Association of Rehabilitation Medicine.

          Results: Eight systematic reviews and 21 RCTs fulfilled all of the inclusion criteria and were included, which were used to create the 10 evidence-based consensus statements. The 10 expert recommendations regarding exercise for NP symptoms were relevant to the following 10 different diseases: spinal cord injury, stroke, multiple sclerosis, Parkinson's disease, cervical radiculopathy, sciatica, diabetic neuropathy, chemotherapy-induced peripheral neuropathy, HIV/AIDS, and surgery, respectively. The exercise recommended in the expert consensus involved but was not limited to muscle stretching, strengthening/resistance exercise, aerobic exercise, motor control/stabilization training and mind-body exercise (Tai Chi and yoga).

          Conclusions: Based on the available evidence, exercise is helpful to alleviate NP intensity. Therefore, these expert consensuses recommend that proper exercise programs can be considered as an effective alternative treatment or complementary therapy for most patients with NP. The expert consensus provided medical staff and policymakers with applicable recommendations for the formulation of exercise prescription for NP. This consensus statement will require regular updates after five–ten years.

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          Most cited references64

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          GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.

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            GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables.

            This article is the first of a series providing guidance for use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of rating quality of evidence and grading strength of recommendations in systematic reviews, health technology assessments (HTAs), and clinical practice guidelines addressing alternative management options. The GRADE process begins with asking an explicit question, including specification of all important outcomes. After the evidence is collected and summarized, GRADE provides explicit criteria for rating the quality of evidence that include study design, risk of bias, imprecision, inconsistency, indirectness, and magnitude of effect. Recommendations are characterized as strong or weak (alternative terms conditional or discretionary) according to the quality of the supporting evidence and the balance between desirable and undesirable consequences of the alternative management options. GRADE suggests summarizing evidence in succinct, transparent, and informative summary of findings tables that show the quality of evidence and the magnitude of relative and absolute effects for each important outcome and/or as evidence profiles that provide, in addition, detailed information about the reason for the quality of evidence rating. Subsequent articles in this series will address GRADE's approach to formulating questions, assessing quality of evidence, and developing recommendations. Copyright © 2011 Elsevier Inc. All rights reserved.
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              Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis.

              New drug treatments, clinical trials, and standards of quality for assessment of evidence justify an update of evidence-based recommendations for the pharmacological treatment of neuropathic pain. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), we revised the Special Interest Group on Neuropathic Pain (NeuPSIG) recommendations for the pharmacotherapy of neuropathic pain based on the results of a systematic review and meta-analysis.
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                Author and article information

                Contributors
                Journal
                Front Med (Lausanne)
                Front Med (Lausanne)
                Front. Med.
                Frontiers in Medicine
                Frontiers Media S.A.
                2296-858X
                24 November 2021
                2021
                : 8
                : 756940
                Affiliations
                [1] 1Department of Sport Rehabilitation, Shanghai University of Sport , Shanghai, China
                [2] 2Department of Rehabilitation Medicine, Shanghai Shangti Orthopedic Hospital , Shanghai, China
                [3] 3Department of Pain Therapy, First Affiliated Hospital of Naval Medical University , Shanghai, China
                [4] 4The First Rehabilitation Hospital of Shanghai, Brain and Spinal Cord Innovation Research Center, School of Medicine, Advanced Institute of Translational Medicine, Tongji University , Shanghai, China
                [5] 5Institute of Psychology, Chinese Academy of Sciences , Beijing, China
                [6] 6Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University , Guangzhou, China
                [7] 7The Second School of Clinical Medicine, Xuzhou Medical University , Xuzhou, China
                [8] 8Rehabilitation Medicine Centre, Chinese PLA General Hospital , Beijing, China
                [9] 9Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University , Qingdao, China
                [10] 10School of Rehabilitation, Kunming Medical University , Kunming, China
                [11] 11Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University , Guangzhou, China
                [12] 12Department of Rehabilitation Medicine, Huashan Hospital, Fudan University , Shanghai, China
                [13] 13School of Rehabilitation Science, Shanghai University of T.C.M. , Shanghai, China
                [14] 14Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou, China
                [15] 15Department of Rehabilitation, Yixing JORU Rehabilitation Hospital , Wuxi, China
                [16] 16Department of Pain and Musculoskeletal Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University , Zhengzhou, China
                [17] 17Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province , Luoyang, China
                [18] 18Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine , Guangzhou, China
                [19] 19Department of Gastrointestinal Surgery, First Affiliated Hospital of Naval Medical University , Shanghai, China
                Author notes

                Edited by: Katsuya Kami, Takarazuka University, Japan

                Reviewed by: Tatsunori Ikemoto, Aichi Medical University, Japan; Kazuhiro Shimo, Kobe Gakuin University, Japan

                *Correspondence: Guo-En Fang fangguoen@ 123456aliyun.com

                This article was submitted to Family Medicine and Primary Care, a section of the journal Frontiers in Medicine

                Article
                10.3389/fmed.2021.756940
                8654102
                34901069
                ebf86a75-2883-4cb1-8b23-cf257ad1e412
                Copyright © 2021 Zhang, Hu, Xiong, Peng, Hu, Kong, Wang, Guo, Bi, Li, Ao, Wang, Bai, Fang, Ma, Liao, Liu, Zhu, Zhang, Liu, Fang and Wang.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 11 August 2021
                : 25 October 2021
                Page count
                Figures: 1, Tables: 7, Equations: 0, References: 64, Pages: 16, Words: 10542
                Categories
                Medicine
                Systematic Review

                exercise,training,neuropathic pain,chronic pain,expert consensus

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