Management of Acute Pain From Non-Low Back, Musculoskeletal Injuries A Systematic Review and Network Meta-analysis of Randomized Trials

被引：64

作者：

Busse, Jason W. ^{[1
]}

Sadeghirad, Behnam ^{[2
]}

Oparin, Yvgeniy ^{[3
]}

Chen, Eric ^{[4
]}

Goshua, Anna ^{[5
]}

May, Curtis ^{[6
]}

Hong, Patrick J. ^{[7
]}

Agarwal, Arnav ^{[8
]}

Chang, Yaping ^{[2
]}

Ross, Stephanie A. ^{[9
]}

Emary, Peter ^{[10
]}

Florez, Ivan D. ^{[11
]}

Noor, Salmi T. ^{[9
]}

Yao, William ^{[12
]}

Lok, Annie ^{[13
]}

Ali, Syed Hussain ^{[14
]}

Craigie, Samantha ^{[2
]}

Couban, Rachel ^{[2
]}

Morgan, Rebecca L. ^{[15
]}

Culig, Kayli ^{[16
]}

Brar, Sonia ^{[17
]}

Akbari-Kelachayeh, Khashayar ^{[18
]}

Pozdnyakov, Alex ^{[19
]}

Shergill, Yaad ^{[2
]}

Sivananthan, Laxsanaa ^{[20
]}

Zihayat, Bahareh ^{[21
]}

Das, Aninditee ^{[22
]}

Guyatt, Gordon H. ^{[9
]}

机构：

[1] McMaster Univ, Dept Anesthesia, Michael G DeGroote Sch Med, HSC-2V9,1280 Main St West, Hamilton, ON L8S 4K1, Canada

[2] McMaster Univ, Natl Pain Ctr, MDCL 2112,1280 Main St West, Hamilton, ON L8S 4K1, Canada

[3] 10 Mallard Marsh Crescent, Richmond Hill, ON L4E 4M2, Canada

[4] 11314 72 Ave Northwest, Edmonton, AB T6G 0B6, Canada

[5] 51 Dudley Lane,Apartment 412, Stanford, CA 94305 USA

[6] 5311 8 Rd, Richmond, BC V6V 1S4, Canada

[7] 3704-761 Bay St, Toronto, ON M5G 2R2, Canada

[8] Univ Toronto, Dept Med, C David Naylor Bldg,6 Queens Pk Crescent West, Toronto, ON M5S 3H2, Canada

[9] McMaster Univ, Dept Hlth Evidence & Impact, Med Ctr, 1280 Main St West,2C Area, Hamilton, ON L8S 4K1, Canada

[10] Langs Community Hlth Ctr, 1145 Concess Rd, Cambridge, ON N3H 4L5, Canada

[11] Univ Antioquia, Segundo Piso Hosp Infant San Vicente Fdn, Dept Pediat, Hosp Infantil San Vicente Fdn, Calle 67 51-27,Segundo Piso, Medellin 050001, Colombia

[12] 89 Carling St, Hamilton, ON L8S 1N1, Canada

[13] 88 Dunmail Dr, Scarborough, ON M1V 1J5, Canada

[14] 7283 Highway 20, Smithville, ON L0R 2A0, Canada

[15] McMaster Univ, 1280 Main St West, Hamilton, ON L8S 4K1, Canada

[16] 1001 Bay St,1317, Toronto, ON M5S 3A6, Canada

[17] 157 Woodstream Dr, Grand Isl, NY 14072 USA

[18] 53 Pinewood Dr, Thornhill, ON L4J 5N8, Canada

[19] Michael DeGroote Ctr Learning & Discovery MDCL 30, 1280 Main St West, Hamilton, ON L8S 4K1, Canada

[20] Univ Limerick, Grad Entry Med Sch, Castletroy V94 T9PX, Co Limerick, Ireland

[21] Kerman Univ Med Sci, Fac Pharm, 7 Avicenna St, Kerman 76169, Iran

[22] 68A Brenda Crescent, Toronto, ON M1K 3C6, Canada

来源：

ANNALS OF INTERNAL MEDICINE | 2020年 / 173卷 / 09期

关键词：

ACUTE WHIPLASH; PARAFON FORTE; INCONSISTENCY; CONSISTENCY; ASSUMPTIONS; DIFFERENCE; FLEXERIL; QUALITY;

D O I：

10.7326/M19-3601

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Patients and clinicians can choose from several treatment options to address acute pain from non-low back, musculoskeletal injuries. Purpose: To assess the comparative effectiveness of outpatient treatments for acute pain from non-low back, musculoskeletal injuries by performing a network meta-analysis of randomized clinical trials (RCTs). Data Sources: MEDLINE, EMBASE, CINAHL, PEDro (Physiotherapy Evidence Database), and Cochrane Central Register of Controlled Trials to 2 January 2020. Study Selection: Pairs of reviewers independently identified interventional RCTs that enrolled patients presenting with pain of up to 4 weeks' duration from non-low back, musculoskeletal injuries. Data Extraction: Pairs of reviewers independently extracted data. Certainty of evidence was evaluated by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Data Synthesis: The 207 eligible studies included 32 959 participants and evaluated 45 therapies. Ninety-nine trials (48%) enrolled populations with diverse musculoskeletal injuries, 59 (29%) included patients with sprains, 13 (6%) with whiplash, and 11 (5%) with muscle strains; the remaining trials included various injuries ranging from nonsurgical fractures to contusions. Topical nonsteroidal anti-inflammatory agents (NSAIDs) proved to have the greatest net benefit, followed by oral NSAIDs and acetaminophen with or without diclofenac. Effects of these agents on pain were modest (around 1 cm on a 10-cm visual analogue scale, approximating the minimal important difference). Regarding opioids, compared with placebo, acetaminophen plus an opioid improved intermediate pain (1 to 7 days) but not immediate pain (<= 2 hours), tramadol was ineffective, and opioids increased the risk for gastrointestinal and neurologic harms (all moderate-certainty evidence). Limitations: Only English-language studies were included. The number of head-to-head comparisons was limited. Conclusion: Topical NSAIDs, followed by oral NSAIDs and acetaminophen with or without diclofenac, showed the most convincing and attractive benefit-harm ratio for patients with acute pain from non-low back, musculoskeletal injuries. No opioid achieved benefit greater than that of NSAIDs, and opioids caused the most harms.

引用

页码：730 / +

页数：12

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