Innovations In Clinical Neuroscience

Pain Management August 2016

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Hot Topics in Pain Management [August 2016] 20 RESULTS Study selection. As shown in Figure 1, the database search identified 1759 documents. After three reviewers read the title, abstract and full-text according to the inclusion and exclusion criteria, 16 articles were eventually selected for inclusion. Characteristic of the CPGs. Table 1 shows the summary of the characteristics of included CPGs. The sixteen CPGs were published between 2004 and 2014. Among the 16 included CPGs, 12 CPGs were original, and five were updated versions. With the exception of the CPGs published by Latin American, South American, and Middle East regions, all the included CPGs were developed using an evidence-based approach. The 16 CPGs selected focused on the assessment and pharmacological and interventional treatments. In terms of funding, CPGs were financed independently by professional organizations, governments and academic societies, except for one CPG developed in Latin America that did not disclose a funding source. Of the sixteen selected CPGs, ten CPGs were developed by medical societies, four by governmental agencies, and two by professional organizations (Additional files 1 and 2). CPGs appraisal results using the AGREE-II instrument. Three reviewers evaluated the 16 included CPGs using the AGREE II instrument. Table 2 summarizes the results of the scores for each CPG. None of the selected CPGs performed satisfactorily, that is, none achieved a score of greater than 50% in all six AGREE II instrument domains. The highest score was obtained in the "Clarity and Presentation" domain, followed by the "Scope and Purpose", "Editorial Independence", "Rigor of Development", "Stakeholder Involvement", and "Applicability" domains. The lowest scores among all six AGREE II domains were obtained for the "Applicability" domain. The results of the inter-rater reliability assessments among the three reviewers are presented in Table 3. Reliability of the assessment using the AGREE II instrument showed high scores in general. With the exception of Domain 4, classified as substantial, ICC score of the remaining domains was graded as very good according to the scale by Landis and Koch. Recommendations of the CPGs. As shown in Table 4, we summarized the consensus treatment recommendations. The anticonvulsants pregabalin and gabapentin, low-dose TCAs, SSNRIs duloxetine and v enlafaxine, and topical lidocaine showed efficacy for the management of NP and were recommended as first- line and second-line medications, respectively. DISCUSSION AND CONCLUSION In the present study, we evaluated the quality of CPGs and consistency of the recommendations of CPGs for the management of NP to assist physicians in the selection of the appropriate recommendations. Our review demonstrated that the overall quality of the CPGs based on the AGREE II instrument was poor. However, we found consistency in the recommendations stated in the 16 CPGs with respect to drug treatment. The AGREE II instrument allows the evaluation of various aspects of the guidelines, including integrity, reproducibility, and transparency of guidelines among six domains. Each domain has a different value and concern. Domain 1, "Scope and Purpose," is concerned with the overall aim of the guideline, the specific health questions being addressed, and the target population (items 1–3). Domain 2, "Stakeholder Involvement," focuses on the extent to which the guideline was developed by the appropriate stakeholders and represents the views of its intended users (items 4–6). Domain 3, "Rigor of Development," relates to the process used to gather and synthesize the evidence, the methods to formulate the recommendations, and update them (items 7–14). Domain 4, "Clarity of Presentation," deals with the language, structure, and format of the guideline (items 15–17). Domain 5, "Applicability" pertains to the likely barriers and facilitators to implementation, strategies to improve uptake, and resource implications of applying the guideline (items 18–21). Domain 6, "Editorial Independence" is concerned with the formulation of recommendations not being unduly biased with competing interests (items 22–23). Our study showed that four domains concerning "Stakeholder

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