PubMed Health⌕ Search

Biomedical subjects

D Fishbain

Publications and source records attributed to D Fishbain.

8 recordsLinked to original sources
PubMed2000

What is the quality of the implemented meta-analytic procedures in chronic pain treatment meta-analyses?

OBJECTIVE: Meta-analysis (MA) is the application of quantitative techniques for the purposes of summarizing data from individual studies. This type of review has many advantages over traditional reviews. However, different investigators performing MAs on the same data set have reached different conclusions. These reliability problems have been attributed to differences in the quality of the implemented meta-analytic procedures. We, therefore, examined the chronic pain treatment meta-analytic literature for MA procedure quality and for the consistency of conclusions. DESIGN, SETTING, PARTICIPANTS, OUTCOME MEASURES: Chronic pain treatment MAs were isolated according to inclusion/exclusion criteria. Data from these MAs were abstracted into structured tables. Table format reflected eight meta-analytic procedures identified previously as being important to MA implementation quality. These were: adequacy of retrieval, publication bias, inclusion/exclusion criteria, abstraction of data, quality, homogeneity/heterogeneity, independence, and statistical versus clinical interpretation. Each meta-analytic procedure was then independently rated by two raters. Rating results were then analyzed by procedure for each individual MA for percentage scores out of 100%, and mean scores. For MAs addressing the same topic area (pain facility treatment, antidepressant treatment, manipulation treatment) direction of effect size was noted. Mean effect sizes were calculated for these subgroups. RESULTS: Sixteen chronic pain treatment MAs fulfilled inclusion/exclusion criteria. Mean procedure ratings indicated that four procedures may not be implemented adequately. These were publication bias, abstraction of data, quality, and homogeneity/heterogeneity. There was wide MA implementation score variability, with 37.5% scoring less than 50%. The effect sizes of the MA subgroups demonstrated replicate nonvariability. CONCLUSIONS: Some meta-analytic procedures could be interpreted to be implemented inadequately in some chronic pain treatment MAs. There is wide variability between individual chronic pain treatment MAs on adequacy of implementation of these procedures. However, the effect sizes of the different MA subgroups demonstrated consistency. This finding indicates that for these MA subgroups, MA results are consistent between authors. In addition, chronic pain MAs, as compared with other groups of MAs, appear to address some of the procedures in a more adequate fashion. Future chronic pain MAs should concentrate on improving the quality of their methods with particular emphasis on the above four procedures. Because of potential validity problems with these results, these data cannot and should not be used to make administrative decisions about previous MAs.

Chronic Disease↗
PubMed2000

Evidence-based data on pain relief with antidepressants.

This structured review addresses the issue of whether antidepressants have an antinociceptive (analgesic) effect for chronic pain independent of their antidepressant effect. In order to answer this question, human acute pain studies, individual placebo-controlled studies for the treatment of specific chronic pain syndromes, and metaanalytic studies were reviewed and placed into table format. Analysis of this evidence led to the following conclusions: The evidence was consistent in indicating that overall antidepressants may have an antinociceptive effect in chronic pain, and that these drugs were effective for neuropathic pain. There was also some evidence that these drugs could be effective for psychogenic or somatoform disorder-associated pain. This evidence also strongly suggested that serotonergic-noradrenergic antidepressants may have a more consistent antinociceptive effect than the serotonergic antidepressants. Finally, this evidence indicated that antidepressants could be effective for pain associated with some specific pain syndromes, such as chronic low back pain, osteoarthritis or rheumatoid arthritis, fibrositis or fibromyalgia, and ulcer healing. Possible reasons for the conflicting results of studies in this area are presented, and problems that could limit the validity of the conclusions of this review are discussed.

Animals↗
PubMed1992

Chronic cervical pain: radiculopathy or brachialgia. Noninterventional treatment.

Chronic cervical pain is not always attributable to radiculopathy. Pain may derive from peripheral myofascial syndromes and/or central inflammatory root irritation from degradation of discal proteoglycans. This concept is presented with its application in 30 patients with follow-up observations up to 30 months. Twelve of twenty-five achieving a pain level of 0 (out of a possible 10), ten of twenty-five had a pain level of 2, and three of twenty-five had a pain level of 4. Five cases were considered to be failures because of patient noncompliance. Treatment was multidisciplinary: aggressive physical medicine, behavioral medicine, vocational, and recreational rehabilitation with the goal of a return to socioeconomic productivity or previous lifestyle, secondary to which pain relief or control follows. Emphasis was placed on the restoration of musculoskeletal physiology to normal with behavioral modification, good body mechanics and the application of engineering/ergonomic principles at work or recreation.

Behavior Therapy↗
PubMed1989

Millon Behavioral Health Inventory norms for chronic pain patients.

The Millon Behavioral Health Inventory (MBHI) is being used more widely in pain treatment settings; however, normative data on a large sample of chronic pain patients have not been published. In the present study, norms were established for 247 chronic pain patients. The chronic pain patient norms then were compared statistically to norms for non-medical population. Overall, the results showed that the score distributions for chronic pain patients and normals were similar on most MBHI scales. The differences that were found are consistent with other research on pain patients and indicate that chronic pain patients are more likely to be depressed and anxious. Differences in scales between chronic pain patients and controls may be explained by state vs. trait factors. In evaluating chronic pain patients by personality tests, one needs to keep in mind state-trait problems and their potential influence on test results.

Adaptation, Psychological↗