“Evidence” in chronic pain – establishing best practice in the reporting of systematic reviews

The Effects of Graded Motor Imagery and Its Components on Chronic Pain: A Systematic Review and Meta-Analysis

“…For the category for 'other' sources of bias, the reviewers were particularly concerned with similarity of pain scores at baseline as this is recommended by other quality assessment tools such as PEDro 9 . In the 'other' source of bias category we also included evaluation of sample sizes (i.e., less than 50 participants per treatment arm considered a high risk of bias) 24 . These items were added as we anticipated that studies identified were likely to be small and, as such, these factors were more likely to represent a significant source of bias.…”

Pragmatic Decisions Over Nonsteroidal Antiinflammatory Drug Treatment in Osteoarthritis — Continuous Versus Intermittent: Figure 1.

“…The trial had all the criteria of a high quality study: central randomization and a double-dummy design to ensure blinding; it was large, involving 858 patients, and it was of long duration, lasting 22 weeks. Most known sources of bias were therefore excluded, and the trial met criteria for good evidence in chronic pain trials 16 .…”

Milnacipran for Neuropathic Pain and Fibromyalgia in Adults

“…Response rates for both doses of milnacipran were around 25% for Composite 1 and 18% for composite 2, and 8% or 9% lower with placebo, giving NNTs of 11 to 14, with no significant difference between doses or outcome. The higher (worse) NNTs for the composite outcomes reflect the fact that these are more difficult to achieve than the individual components alone, as well as a potential for overestimation of treatment effect with imputation of efficacy results from patients who have withdrawn from the study (Moore 2010a). …”

“…Newer trials also tend to be longer, up to 12 weeks, and longer trials provide a more rigorous and valid assessment of efficacy in chronic conditions. New standards have evolved for assessing efficacy in neuropathic pain, and we are now applying stricter criteria for inclusion of trials and assessment of outcomes, and are more aware of problems that may affect our overall assessment (Moore 2010a;. To summarise some of the recent insights that make a new review necessary, over and above including more trials:…”

“…Where there is an imbalance of withdrawals due to lack of efficacy or adverse events between active and placebo treatment arms, this may lead to an overestimate of efficacy (Moore 2010a). For this reason, we chose also to review data on two composite outcomes where present, since these were presented using baseline observation carried forward for withdrawals (i.e.…”