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Quality of meta-analyses of non-opioid, pharmacological, perioperative interventions for chronic postsurgical pain: a systematic review
  1. Rachel H McGregor1,
  2. Freda M Warner1,2,
  3. Lukas D Linde1,3,
  4. Jacquelyn J Cragg1,2,
  5. Jill A Osborn3,4,
  6. Vishal P Varshney3,4,
  7. Stephan K W Schwarz3 and
  8. John L K Kramer1,3
  1. 1International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
  4. 4Department of Anesthesia, Providence Healthcare, Vancouver, British Columbia, Canada
  1. Correspondence to Dr John L K Kramer, Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada; kramer{at}icord.org

Abstract

Background In an attempt to aggregate observations from clinical trials, several meta-analyses have been published examining the effectiveness of systemic, non-opioid, pharmacological interventions to reduce the incidence of chronic postsurgical pain.

Objective To inform the design and reporting of future studies, the purpose of our study was to examine the quality of these meta-analyses.

Evidence review We conducted an electronic literature search in Embase, MEDLINE, and the Cochrane Database of Systematic Reviews. Published meta-analyses, from the years 2010 to 2020, examining the effect of perioperative, systemic, non-opioid pharmacological treatments on the incidence of chronic postsurgical pain in adult patients were identified. Data extraction focused on methodological details. Meta-analysis quality was assessed using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) critical appraisal tool.

Findings Our search yielded 17 published studies conducting 58 meta-analyses for gabapentinoids (gabapentin and pregabalin), ketamine, lidocaine, non-steroidal anti-inflammatory drugs, and mexiletine. According to AMSTAR 2, 88.2% of studies (or 15/17) were low or critically low in quality. The most common critical element missing was an analysis of publication bias. Trends indicated an improvement in quality over time and association with journal impact factor.

Conclusions With few individual trials adequately powered to detect treatment effects, meta-analyses play a crucial role in informing the perioperative management of chronic postsurgical pain. In light of this inherent value and despite a number of attempts, high-quality meta-analyses are still needed.

PROSPERO registration number CRD42021230941.

  • pain
  • postoperative
  • chronic pain
  • pharmacology

Data availability statement

Data sharing not applicable as no datasets generated and/or analyzed for this study. Not applicable.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analyzed for this study. Not applicable.

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Footnotes

  • RHM and FMW are joint first authors.

  • Twitter @StephanKSchwarz

  • Contributors RHM: Responsible for study design and protocol, screening, data extraction, data interpretation, drafting the manuscript, and final manuscript approval. FMW: Responsible for study design and protocol, screening, data extraction, data interpretation, drafting the manuscript, and final manuscript approval. LDL: Contributed to data interpretation, revising the paper for intellectual content, and final manuscript approval. JJC: Contributed to data interpretation, revising the paper for intellectual content, and final manuscript approval. JAO: Contributed to data interpretation, revising the paper for intellectual content, and final manuscript approval. VPV: Contributed to data interpretation, revising the paper for intellectual content, and final manuscript approval. SKWS: Contributed to data interpretation, revising the paper for intellectual content, and final manuscript approval. JLKK: Contributed to study design, data interpretation, drafting the manuscript, revising the paper for intellectual content, and final manuscript approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.