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      Current methods and challenges for acute pain clinical trials

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          Abstract

          This article reviews current methods and challenges and provides recommendations for future design and conduct of clinical trials of interventions to treat acute pain.

          Abstract

          Introduction:

          The clinical setting of acute pain has provided some of the first approaches for the development of analgesic clinical trial methods.

          Objectives:

          This article reviews current methods and challenges and provides recommendations for future design and conduct of clinical trials of interventions to treat acute pain.

          Conclusion:

          Growing knowledge about important diverse patient factors as well as varying pain responses to different acute pain conditions and surgical procedures has highlighted several emerging needs for acute pain trials. These include development of early-phase trial designs that minimize variability and thereby enhance assay sensitivity, minimization of bias through blinding and randomization to treatment allocation, and measurement of clinically relevant outcomes such as movement-evoked pain. However, further improvements are needed, in particular for the development of trial methods that focus on treating complex patients at high risk of severe acute pain.

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          Most cited references99

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          Evidence-based surgical care and the evolution of fast-track surgery.

          Optimization of postoperative outcome requires the application of evidence-based principles of care carefully integrated into a multimodal rehabilitation program. To assess, synthesize, and discuss implementation of "fast-track" recovery programs. Medline MBASE (January 1966-May 2007) and the Cochrane library (January 1966-May 2007) were searched using the following keywords: fast-track, enhanced recovery, accelerated rehabilitation, and multimodal and perioperative care. In addition, the synthesis on the many specific interventions and organizational and implementation issues were based on data published within the past 5 years from major anesthesiological and surgical journals, using systematic reviews where appropriate instead of multiple references of original work. Based on an increasing amount of multinational, multicenter cohort studies, randomized studies, and meta-analyses, the concept of the "fast-track methodology" has uniformly provided a major enhancement in recovery leading to decreased hospital stay and with an apparent reduction in medical morbidity but unaltered "surgery-specific" morbidity in a variety of procedures. However, despite being based on a combination of evidence-based unimodal principles of care, recent surveys have demonstrated slow adaptation and implementation of the fast-track methodology. Multimodal evidence-based care within the fast-track methodology significantly enhances postoperative recovery and reduces morbidity, and should therefore be more widely adopted. Further improvement is expected by future integration of minimal invasive surgery, pharmacological stress-reduction, and effective multimodal, nonopioid analgesia.
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            Predictors of postoperative pain and analgesic consumption: a qualitative systematic review.

            Pain is a subjective and multidimensional experience that is often inadequately managed in clinical practice. Effective control of postoperative pain is important after anesthesia and surgery. A systematic review was conducted to identify the independent predictive factors for postoperative pain and analgesic consumption. The authors identified 48 eligible studies with 23,037 patients included in the final analysis. Preoperative pain, anxiety, age, and type of surgery were four significant predictors for postoperative pain. Type of surgery, age, and psychological distress were the significant predictors for analgesic consumption. Gender was not found to be a consistent predictor as traditionally believed. Early identification of the predictors in patients at risk of postoperative pain will allow more effective intervention and better management. The coefficient of determination of the predictive models was less than 54%. More vigorous studies with robust statistics and validated designs are needed to investigate this field of interest.
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              Clinical trial registration: a statement from the International Committee of Medical Journal Editors.

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                Author and article information

                Journal
                Pain Rep
                Pain Rep
                PAIREP
                Painreports
                Pain Reports
                Wolters Kluwer (Philadelphia, PA )
                2471-2531
                May-Jun 2019
                02 April 2018
                : 4
                : 3
                : e647
                Affiliations
                Departments of [a ]Anesthesiology and Perioperative Medicine and
                [b ]Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
                [c ]Pain, Research Education and Policy Program, Public Health and Community Medicine Program, Tufts University School of Medicine, Boston, MA, USA
                [d ]Desjardins Associates, Maplewood, NJ, USA
                [e ]Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark
                Author notes
                [* ]Corresponding author. Address: Department of Anesthesiology, Queen's University, 76 Stuart St, Kingston, ON K7L 2V7, Canada. Tel.: 613-548-7827; fax: 613-548-1375. E-mail address: gilroni@ 123456queensu.ca (I. Gilron).
                Article
                PAINREPORTS-D-17-0061 00035
                10.1097/PR9.0000000000000647
                6749920
                31583333
                3a4c3939-7660-4ebe-8312-92960f6a1697
                Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.

                This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0 (CC BY-ND) which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.

                History
                : 28 August 2017
                : 16 January 2018
                : 31 January 2018
                Categories
                12
                ACTTION Special Issue on Clinical Trials of Pain Treatments
                Custom metadata
                TRUE

                clinical trial,acute pain,analgesic trial
                clinical trial, acute pain, analgesic trial

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