Review Methods Search Strategy: A systematic search was conducted across a wide-ranging set of data- bases: Ovid Medline, including In-Process & Other Non-Indexed Citations, Ovid Embase, Ebsco CINAHL and Cochrane Library. The preliminary search strategy was devel- oped on Ovid Medline using both text words and Medical subject headings from January 2006 to February 2017 restricted to English language humans. The search strategy was modified to capture indexing systems of the other databases. (Search strategies available upon request). To identify additional papers, the following website was searched: palliave care knowledge network Furthermore electronic tables of content for the last two years were scanned for British Journal of Anaesthesia, Journal of Pain and Symptom Management, Pain and Palliative medicine. Reference lists of systemac reviews were checked for any relevant studies. The search- es generated 288 citaons aſter removing duplicates and irrelevant records. Figure 1 represents the flow of informaon through the different phases of the review. Inclusion: Studies reporting Palliave care or cancer paents on opioid analgesics who have been referred and had intervenonal procedures as an adjunct to pain manage- ment. Studies published in English from 2006 to current. Exclusion: Studies set in a non-Organizaon for Economic Cooperaon and Development (OECD) countries; Case series studies con- sisng of less than 25 paents; non-english language studies Study selection/Quality Assessment/Data Extraction: Study selection was based upon review of the abstract by two independent reviewers. The full text was then assessed independently using a pre-designed eligibility form according to inclusion criteria. Any discrepancies between the two review- ers were resolved by consensus or by re- course to a third reviewer. Context In the majority of cancer paents, pain can be well controlled with convenonal analgesics, in accordance with the WHO three step analgesic ladder. However, in some paents convenonal analgesic strategies fail to provide effecve pain relief. In these paents, intervenonal pain techniques, such as neural blockade, may be indicated. Paents who need advanced intervenonal pain management will almost certainly already be taking high doses of opioids. Despite reducons in opioid analgesia pre and post intervenonal procedure, there remain issues regarding opioid toxicity following the intervenon. This raises implicaons for paent safety and wellbeing and highlights a need for local guidance/protocol to reduce such risks by following the best evidence base to support paent management. Key Findings The number of papers idenfied via our search strategy and review methodology is shown on page 2. This process resulted in fourteen abstracts being idenfied as meeng the inclusion / exclusion criteria. Upon review of the full texts, none of these papers met the objecve of this rapid review and all were excluded. Whilst some of the papers examined intervenonal pain management in the populaon of interest, no reference was made to the outcomes of interest, i.e. opioid toxicity and its management. Other reasons for exclusion included non-OECD countries (3), examinaon of only four cases (1) and no reference to intervenonal pain management (2). Four of the fourteen papers were systemac reviews; as no relevant papers were idenfied via our original search, relevant references from the systemac reviews were also checked but no papers were idenfied as meeng the objecve of this rapid review. There is a lack of evidence to support paent management pre/post intervenonal procedure to minimise the risk of opioid toxicity. This highlights a need for primary research to invesgate this issue and, in the first place, to establish what proporon of palliave care paents on opioid analgesics are referred and go on to have intervenonal procedures, and what proporon of these go on to experience problems with opioid toxicity post intervenon. A. Reliability of evidence Not applicable B. Consistency of evidence Not applicable C. Relevance of evidence Not applicable What processes decrease the risk of opioid toxicity following interventional procedures for uncontrolled pain in palliative care or cancer patients?
4
Embed
What processes decrease the risk of opioid toxicity following interventional …palliativecare.walescancerresearchcentre.com/uploads/... · 2017-08-30 · interventional procedures,
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Review Methods
Search Strategy: A systematic search was
conducted across a wide-ranging set of data-
bases: Ovid Medline, including In-Process &
Other Non-Indexed Citations, Ovid Embase,
Ebsco CINAHL and Cochrane Library.
The preliminary search strategy was devel-
oped on Ovid Medline using both text words
and Medical subject headings from January
2006 to February 2017 restricted to English
language humans. The search strategy was
modified to capture indexing systems of the
other databases. (Search strategies available
upon request).
To identify additional papers, the following
website was searched: palliative care
knowledge network
Furthermore electronic tables of content for the last two years were scanned for British Journal of Anaesthesia, Journal of Pain and Symptom Management, Pain and Palliative medicine. Reference lists of systematic reviews were
checked for any relevant studies. The search-
es generated 288 citations after removing
duplicates and irrelevant records. Figure 1
represents the flow of information through
the different phases of the review.
Inclusion: Studies reporting Palliative care or
cancer patients on opioid analgesics who
have been referred and had interventional
procedures as an adjunct to pain manage-
ment. Studies published in English from 2006
to current.
Exclusion: Studies set in a non-Organization
for Economic Cooperation and Development
(OECD) countries; Case series studies con-
sisting of less than 25 patients; non-english
language studies
Study selection/Quality Assessment/Data
Extraction: Study selection was based upon
review of the abstract by two independent
reviewers. The full text was then assessed
independently using a pre-designed eligibility
form according to inclusion criteria.
Any discrepancies between the two review-
ers were resolved by consensus or by re-
course to a third reviewer.
Context
In the majority of cancer patients, pain can be well controlled with conventional
analgesics, in accordance with the WHO three step analgesic ladder. However, in
some patients conventional analgesic strategies fail to provide effective pain relief.
In these patients, interventional pain techniques, such as neural blockade, may be
indicated. Patients who need advanced interventional pain management will
almost certainly already be taking high doses of opioids. Despite reductions in
opioid analgesia pre and post interventional procedure, there remain issues
regarding opioid toxicity following the intervention. This raises implications for
patient safety and wellbeing and highlights a need for local guidance/protocol to
reduce such risks by following the best evidence base to support patient
management.
Key Findings
The number of papers identified via our search strategy and review methodology is
shown on page 2. This process resulted in fourteen abstracts being identified as
meeting the inclusion / exclusion criteria. Upon review of the full texts, none of
these papers met the objective of this rapid review and all were excluded. Whilst
some of the papers examined interventional pain management in the population of
interest, no reference was made to the outcomes of interest, i.e. opioid toxicity and
its management. Other reasons for exclusion included non-OECD countries (3),
examination of only four cases (1) and no reference to interventional pain
management (2). Four of the fourteen papers were systematic reviews; as no
relevant papers were identified via our original search, relevant references from the
systematic reviews were also checked but no papers were identified as meeting the
objective of this rapid review.
There is a lack of evidence to support patient management pre/post interventional
procedure to minimise the risk of opioid toxicity. This highlights a need for primary
research to investigate this issue and, in the first place, to establish what proportion
of palliative care patients on opioid analgesics are referred and go on to have
interventional procedures, and what proportion of these go on to experience
problems with opioid toxicity post intervention.
A. Reliability of evidence
Not applicable
B. Consistency of evidence
Not applicable
C. Relevance of evidence
Not applicable
What processes decrease the risk of opioid toxicity following interventional procedures for
uncontrolled pain in palliative care or cancer patients?
List of studies reviewed at full-text with reasons
Critical appraisal / data extraction forms
Search strategies
List of excluded references from the systematic reviews
This report should be cited as follows: Palliative Care Evidence Review Service. A rapid review: What processes decrease the risk of opioid toxicity following interventional procedures for uncontrolled pain in palliative care or cancer patients? Cardiff: Palliative Care Evidence Review Service (PaCERS); 2017 May
Permission Requests: All inquiries regarding permission to reproduce any content of this review