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Addressing the unmet need of chronic pain: providing the evidence for treatments of pain
In 2014, we were awarded a UK National Institute for Health Research (NIHR) Systematic Reviews Programme Grant to undertake systematic reviews and appraisal of the evidence for pharmacological and non-pharmacological interventions in chronic pain.
The grant focuses on three areas of significant unmet need in the UK population:
- Pain in children
- Chronic non-cancer pain (neuropathic)
- Cancer pain (neuropathic)
In each area we proposed new and updated reviews, as well as overviews and rapid reviews. In all three areas we are completing or updating single technology reviews for pharmacological treatments, leading where possible to an overview review of a class of treatment. For the non-pharmacological interventions, we focus on self-management treatments identified as promising or desirable.
1. Pain in children
We proposed titles in paracetamol, ibuprofen, diclofenac, other NSAIDs, and codeine, an overview review on pain in the community, two rapid reviews on the pharmacotherapy of chronic pain and cancer pain, and an update of psychological treatments for chronic pain.
2. Chronic non-cancer pain (neuropathic)
We proposed titles in opioids (morphine, fentanyl, bupenorphrine, oxycodone, hydromorphone, and tapentadol), antidepressants such as venlafaxine, common SSRIs, and the anti-epileptic leviracetam. Reviews requiring updating are topical analgesics (NSAIDs, rubefacients, capsaican), local anaesthetic (lidocaine), antidepressant (duloxetine) and opioids (methadone and tramadol). Three new non-pharmacological reviews are needed in psychological, physiotherapy and educational treatments. An overview review on opioids and a rapid overview review of topical analgesics are planned.
3. Cancer pain (neuropathic)
Updates are needed in opioids (morphine, methadone, and hydromorphone), analgesics (paracetamol, NSAIDs), and adjuvant ketamine. New opioid reviews (fentanyl, buprenorphine, oxycodone, tramadol, and tapentadol) are needed, as are paracetamol combinations (codeine, tramadol, and hydrocodone). This will allow two overviews: opioids and analgesics, and three rapid reviews: adjuvant analgesic drugs, the management of adverse effects (antiemetics, laxatives, opioid sparing), and non-pharmacological interventions.
The series of reviews was completed in June 2017. The National Institute for Health Research (NIHR) is the largest single funder of the Cochrane Pain, Palliative and Supportive Care Review Group. For more information, please contact Managing Editor Anna Erskine.