Background: Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. Methods: A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. Results:Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. Conclusion: We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries. Post Operative Pain Management Modalities Employed in Clinical Trials for Adult Patients in LMIC; A Systematic Review
Objective: To quantify pain services in Pakistan and classify them according to the International Association for the Study of Pain guidelines. Method: The study was conducted at the Aga Khan University, Karachi, from January to June 2022, and comprised data of all public and private tertiary care hospitals anywhere in Pakistan that were registered with the Pakistan Medical Council till November 25, 2021. Data was collected using a predesigned Google form. Data was obtained primarily via email and secondarily by a phone call in a structured format. The facilities providing dedicated pain management services were classified according to the International Association for the Study of Pain guidelines. Results: Of 118 hospitals, 45(38.1%) were in the public sector and 73(61.8%) were in the private sector. Overall, 78(65.2%) had no pain treatment services, while 40(34.2%) had such services. Of these 40(34.2%) facilities, 25(62.5%) were classified as pain centres, 11(27.5%) were pain clinics and 4(10%) were pain practices. In terms of per 100,000 population, there were 0.0193 pain services, 0.0351 pain physicians, 0.025 nursing staff and 0.02 administrative staff in the country. Physiotherapy was present in 37(92.5%) hospitals, psychiatry and psychology as allied services were used in 38(95%), acupuncture was integrated into the practice in 25(62.5%), while 39(97.5%) hospitals offered interventional procedures. Also, 9(22.5%) hospitals offered advanced training in pain medicine. Conclusion: A severe shortage of chronic pain services in Pakistan was found. Key Words: Chronic pain, Health resources, Multidisciplinary pain centres, Surveys and questionnaires, Allied health personnel.
Background: Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. Methods: A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. Results: Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. Conclusion: We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries.
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