By performing high-quality systematic reviews and meta-analyses, the Anesthesiology Systematic Review Lab addresses clinically relevant questions about a broad range of topics related to anesthesiology, including acute and chronic pain.
Here are some examples of our recent work.
Prevalence of smoking in adults with spinal cord stimulators: A systematic review and meta-analysis
Conclusions: The estimated prevalence of smoking in patients with spinal cord stimulation is 2.5 times greater than in that of the general population. Future research should focus on development, testing and deployment of tailored smoking cessation treatments for these patients. Read the review.
The effect of spinal cord stimulation on pain medication reduction in intractable spine and limb pain: A systematic review of randomized controlled trials and meta-analysis
Conclusions: In patients with intractable spine or limb pain, spinal cord stimulation was associated with increased odds of reducing pain medication consumption. However, results should be treated with caution because available data were limited, and clinical significance of these findings requires further study. Read the review.
Effects of general anesthetic agents in adults receiving electroconvulsive therapy: A systematic review
Conclusions: While the relationship between electroconvulsive therapy (ECT) seizure length and efficacy remains unclear, all the available induction agents in this review would be appropriate for ECT. When clinicians need to prolong seizure length, methohexital or the addition of a short-acting opioid to methohexital or propofol should be considered. The small variations in emergence and recovery times should not govern the choice of an induction agent. Read the review.
Characteristics of physicians who prescribe opioids for chronic pain: A meta-narrative systematic review
Conclusions: This systematic review provides the foundation for the development of prospective studies aimed at further elucidating the constellation of mechanisms that influences physicians who manage pain and prescribe opioids. Read the review.
A systematic review and meta-analysis of unguided electronic and mobile health technologies for chronic pain — Is it time to start prescribing electronic health applications?
Conclusions: Electronic health (eHealth) and mobile health (mHealth) interventions had significant effects on multiple short- and intermediate-term outcome measures recommended in the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) guidelines. Given widespread availability and low cost to patients, clinicians treating patients with chronic pain could consider using eHealth and mHealth interventions as part of a multidisciplinary pain treatment strategy. Read the review.
Spinal stimulation for the treatment of intractable spine and limb pain: A systematic review of RCTs and meta-analysis
Conclusions: In patients with intractable spine or limb pain, spinal stimulation was associated with better pain reduction than was medical therapy. New stimulation technology was likely associated with better pain reduction than was conventional stimulation. Read the review.
Ultrasound-guided lumbar medial branch blocks and intra-articular facet joint injections: A systematic review and meta-analysis
Conclusions: Ultrasound-guided lumbar medial branch blocks and facet joint injections are associated with a significant risk of incorrect needle placement when confirmed by fluoroscopy or computerized tomography (CT). The technical limitations of ultrasound and individual patient factors could contribute to the risk of incorrect needle placement. Read the review.
Effects of slow deep breathing on acute clinical pain in adults: A systematic review and meta-analysis of randomized controlled trials
Conclusions: Very low certainty evidence suggests that slow deep breathing may reduce acute pain intensity. Further research is needed to identify patients who are candidates for slow deep breathing and to determine the best approach to deliver this therapy. Read the review.
Lidocaine for postoperative pain after cardiac surgery: A systematic review
Conclusions: Due to the favorable risk profile of topical lidocaine and the need for further advancements in the postoperative care of adults after cardiac surgery, topically administered lidocaine could be considered for incorporation into established postoperative recovery protocols. Read the review.
Electromyography and therapeutic response to lumbosacral epidural steroid injections: A systematic review
Conclusions: The findings of this systematic review suggest associations exist between positive electromyography-confirmed lumbosacral radiculopathy and pain outcomes after epidural steroid injections in some but not all studies. Read the review.
Prevalence of postamputation pain and its subtypes: A meta-analysis with meta-regression
Conclusions: The prevalence of postamputation pain is high in patients with nontraumatic lower-extremity amputations. Ongoing research that uses a taxonomy for postamputation pain is needed to fully delineate the prevalence of postamputation pain subtypes. Read the review.
Prevalence of chronic pain after spinal cord injury: A systematic review and meta-analysis
Conclusions: This systematic review and meta-analysis extends the findings of previous studies by reporting the prevalence of chronic pain after spinal cord injury based on the International Spinal Cord Injury Pain (ISCIP) classification system, thereby reducing clinical heterogeneity in the reporting of pain prevalence related to spinal cord injury. Read the review.
Infectious complications of dorsal root ganglion stimulation: A systematic review and pooled analysis of incidence
Conclusions: This is the first systematic review and pooled analysis that followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to report infectious complications of dorsal root ganglion stimulation (DRGS) by stage (trial vs. implant vs. revision). Dorsal root ganglion stimulation trial appears to be low risk for infection, but that risk is significantly increased with DRGS implant. Our findings highlight the need for further study of infectious complications, their risks and optimal prophylaxis. Read the review.