Pharmacotherapy for the Prevention of Chronic Pain after Surgery in Adults: An Updated Systematic Review and Meta-analysis, 2021, Carley et al

Carley ME, Chaparro LE, Choinière M, Kehlet H, Moore RA, Van Den Kerkhof E, Gilron I.,
Pharmacotherapy for the Prevention of Chronic Pain after Surgery in Adults: An Updated Systematic Review and Meta-analysis. Anesthesiology. 2021 Aug 1;135(2):304-325. doi: 10.1097/ALN.0000000000003837. PMID: 34237128.

PubMed: https://pubmed.ncbi.nlm.nih.gov/34237128/

Free full text link: https://pubs.asahq.org/anesthesiolo...acotherapy-for-the-Prevention-of-Chronic-Pain

Abstract

Background:
Chronic postsurgical pain can severely impair patient health and quality of life. This systematic review update evaluated the effectiveness of systemic drugs to prevent chronic postsurgical pain.

Methods:
The authors included double-blind, placebo-controlled, randomized controlled trials including adults that evaluated perioperative systemic drugs. Studies that evaluated same drug(s) administered similarly were pooled. The primary outcome was the proportion reporting any pain at 3 or more months postsurgery.

Results:
The authors identified 70 new studies and 40 from 2013. Most evaluated ketamine, pregabalin, gabapentin, IV lidocaine, nonsteroidal anti-inflammatory drugs, and corticosteroids.

Some meta-analyses showed statistically significant-but of unclear clinical relevance-reductions in chronic postsurgical pain prevalence after treatment with pregabalin, IV lidocaine, and nonsteroidal anti-inflammatory drugs.

Meta-analyses with more than three studies and more than 500 participants showed no effect of ketamine on prevalence of any pain at 6 months when administered for 24 h or less (risk ratio, 0.62 [95% CI, 0.36 to 1.07]; prevalence, 0 to 88% ketamine; 0 to 94% placebo) or more than 24 h (risk ratio, 0.91 [95% CI, 0.74 to 1.12]; 6 to 71% ketamine; 5 to 78% placebo), no effect of pregabalin on prevalence of any pain at 3 months (risk ratio, 0.88 [95% CI, 0.70 to 1.10]; 4 to 88% pregabalin; 3 to 80% placebo) or 6 months (risk ratio, 0.78 [95% CI, 0.47 to 1.28]; 6 to 68% pregabalin; 4 to 69% placebo) when administered more than 24 h, and an effect of pregabalin on prevalence of moderate/severe pain at 3 months when administered more than 24 h (risk ratio, 0.47 [95% CI, 0.33 to 0.68]; 0 to 20% pregabalin; 4 to 34% placebo).

However, the results should be interpreted with caution given small study sizes, variable surgical types, dosages, timing and method of outcome measurements in relation to the acute pain trajectory in question, and preoperative pain status.

Conclusions:
Despite agreement that chronic postsurgical pain is an important topic, extremely little progress has been made since 2013, likely due to study designs being insufficient to address the complexities of this multifactorial problem.

 

Code:

https://twitter.com/AndrewMoorepain/status/1437699525146206209

 

To be fair, building an entire model of evidence on a "garbage in" principle was always going to be a problem. The problem with belief in a turd polishing process is that there is no such thing anywhere ever, especially when steps are literally taken to make sure that the garbage would be so thoroughly mixed in with the rest as to be impossible to disentangle.

All that has been accomplished by lowering standards is that standards were lowered. I'm not sure what people expected step #2 to be but that's the only thing it was always going to accomplish. It's not even limited to medicine, health care or science either, this is the basis being deregulatory pushes, the lowering of standards with the expectation that it will somehow improve things. It never does. Never has. Never will.