Publications by authors named "Ian Gilron"
Article Synopsis
- Preclinical studies highlight the importance of glial cells in pain mechanisms, leading to a systematic review of human trials on glia-modulating drugs for pain treatment.
- The review included 26 trials with a total of 2,132 participants, focusing on the effects of drugs like minocycline and pentoxifylline, but found significant variability among studies and no conclusive evidence of effectiveness.
- Future research is encouraged to identify optimal glial-targeted drugs, the ideal timing and duration for their use, and improved designs for clinical trials to better assess their potential in pain management.
Article Synopsis
- Dexmedetomidine is being increasingly used in surgeries involving general anesthesia, but its impact on patient outcomes needs further evaluation.
- A systematic review of 44 randomized controlled trials with nearly 5904 participants indicated that intraoperative dexmedetomidine significantly improved recovery quality after surgery.
- The study found a 99% likelihood of any benefit from its use and an 88% chance of achieving a meaningful improvement in recovery, along with a reduction in chronic pain incidence.
Background: Prescription opioid use places a considerable economic burden on health care systems. Older patients undergoing surgical procedures for painful conditions commonly receive opioids pre- and postoperatively, and are susceptible to adverse reactions. This study explores predictors of prolonged postoperative opioid use among older patients after lumbar spine surgery and the consequences in terms of health care utilization and costs.
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- Fibromyalgia causes chronic pain and sleep disturbances, and current treatment options only significantly help 30-60% of patients; therefore, a study will examine the effectiveness of combining melatonin and pregabalin in treating this condition.
- The trial will involve 54 adults diagnosed with fibromyalgia, assessing pain levels and other health outcomes over 6 weeks while comparing the combination treatment to the individual medications.
- Ethical approval for the trial has been secured, and it is registered for transparency and adherence to research standards.
Article Synopsis
- * A multicenter clinical trial called PLAN will study the effects of intravenous lidocaine versus a placebo in over 1,600 patients undergoing breast cancer surgery, measuring outcomes like persistent pain incidence and opioid use at various time points post-surgery.
- * If successful, the trial could establish lidocaine infusion as a standard treatment to reduce chronic pain and opioid reliance in breast cancer patients, potentially lowering healthcare costs and improving overall patient well-being.
Pragmatic, randomized, controlled trials hold the potential to directly inform clinical decision making and health policy regarding the treatment of people experiencing pain. Pragmatic trials are designed to replicate or are embedded within routine clinical care and are increasingly valued to bridge the gap between trial research and clinical practice, especially in multidimensional conditions, such as pain and in nonpharmacological intervention research. To maximize the potential of pragmatic trials in pain research, the careful consideration of each methodological decision is required.
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- Chronic postsurgical pain (CPSP) is a common issue following musculoskeletal and orthopedic surgeries and significantly affects patients' quality of life, leading to a need for effective preventive interventions.
- This study will conduct a systematic review and network meta-analysis of randomized trials to evaluate the effectiveness and potential harms of various pharmacological and psychological treatments aimed at preventing CPSP.
- The research will involve thorough searches of multiple medical databases, focusing on trials that include adults undergoing relevant surgeries, with outcomes measured at least three months post-operation, and will also explore factors like sex and surgery type to assess any specific treatment effects.
Article Synopsis
- Pain management for chronic pain patients with depression is difficult and the effectiveness of intermittent theta-burst stimulation (iTBS) is being studied.
- A retrospective review of 104 patients treated with iTBS showed significant reductions in depression and pain scores after treatment.
- The findings indicate potential benefits of iTBS for patients experiencing both chronic pain and depression, warranting further research into this treatment modality.
Background: Postoperative patient-centred outcome measures are essential to capture the patient's experience after surgery. Although a large number of pharmacologic opioid minimisation strategies (i.e.
View Article and Find Full Text PDFIntroduction: Dexmedetomidine is a promising pharmaceutical strategy to minimise opioid use during surgery. Despite its growing use, it is uncertain whether dexmedetomidine can improve patient-centred outcomes such as quality of recovery and pain.
Methods And Analysis: We will conduct a systematic review and meta-analysis following the recommendations of the .
Article Synopsis
- - Recent shifts in clinical research recognize patients as valuable contributors beyond just participants, highlighting their importance in every phase of the research process.
- - Engaging patients from the outset leads to research that is more relevant and practical for those affected by specific conditions, with increased support from research funders and regulatory bodies.
- - A meeting organized by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials sought to create guidelines for better patient engagement in clinical pain research, focusing on aspects like representation, timing, and effective communication.
Article Synopsis
- The study investigates pain management strategies used by community-dwelling adults in the U.S. and Canada, focusing on the types of treatments and combinations employed, as well as their correlations with individual characteristics and country context.
- Data from a 2020 online survey with over 4,000 respondents revealed that common pain treatments include over-the-counter medications, living with pain, and exercise, with cannabis being a notable self-reported treatment.
- Participants were grouped into five clusters based on their treatment preferences, revealing varying reliance on medication, exercise, and self-care, with pain levels being a significant factor in treatment frequency.
Article Synopsis
- Pain experience is influenced by both incoming pain signals and the brain's ability to modulate these signals based on expectations and therapeutic relationships.
- A study involving 70 adults with chronic pain receiving intravenous lidocaine found that higher treatment expectations correlated with greater pain reduction over 8 weeks.
- The research also highlighted the importance of a strong therapeutic alliance, linking it to both expectations and pain relief, suggesting that improving these factors could enhance treatment outcomes.
Background: Given the widespread recognition that postsurgical movement-evoked pain is generally more intense, and more functionally relevant, than pain at rest, the authors conducted an update to a previous 2011 review to re-evaluate the assessment of pain at rest and movement-evoked pain in more recent postsurgical analgesic clinical trials.
Methods: The authors searched MEDLINE and Embase for postsurgical pain randomized controlled trials and meta-analyses published between 2014 and 2023 in the setting of thoracotomy, knee arthroplasty, and hysterectomy using methods consistent with the original 2011 review. Included trials and meta-analyses were characterized according to whether they acknowledged the distinction between pain at rest and movement-evoked pain and whether they included pain at rest and/or movement-evoked pain as a pain outcome.
Article Synopsis
- A study was conducted comparing the effectiveness of alpha-lipoic acid (ALA), pregabalin, and their combination for treating neuropathic pain in peripheral neuropathies over a 6-week period in a randomized, double-blind trial.
- Results showed that pregabalin significantly reduced mean pain intensity more than ALA, with scores of 3.96 for pregabalin and 5.32 for ALA, while the combination provided no additional benefits.
- Quality of life assessments indicated that while ALA and pregabalin improved scores, the combination treatment did not show significant advantages, and there were no notable differences in adverse effects between the treatments.
Article Synopsis
- * The primary focus was on participants experiencing pain scores of 4 or higher on a 10-point scale in the days following discharge from various types of surgeries.
- * Results indicated that 31% of patients experienced moderate-to-severe pain just after discharge, increasing to 58% between 1 to 2 weeks later, indicating the need for improved pain management strategies for discharged surgical patients.
Many questions regarding the clinical management of people experiencing pain and related health policy decision-making may best be answered by pragmatic controlled trials. To generate clinically relevant and widely applicable findings, such trials aim to reproduce elements of routine clinical care or are embedded within clinical workflows. In contrast with traditional efficacy trials, pragmatic trials are intended to address a broader set of external validity questions critical for stakeholders (clinicians, healthcare leaders, policymakers, insurers, and patients) in considering the adoption and use of evidence-based treatments in daily clinical care.
View Article and Find Full Text PDFDrug therapy for fibromyalgia is limited by incomplete efficacy and dose-limiting adverse effects (AEs). Combining agents with complementary analgesic mechanisms-and differing AE profiles-could provide added benefits. We assessed an alpha-lipoic acid (ALA)-pregabalin combination with a randomized, double-blind, 3-period crossover design.
View Article and Find Full Text PDFThis study estimates the prevalence of prescription opioid use (POU) in the United States (US) in 2019-2020, both in the general population and specifically among adults with pain. It also identifies key geographic, demographic, and socioeconomic correlates of POU. Data were from the nationally-representative National Health Interview Survey 2019 and 2020 (N = 52,617).
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- The text discusses a scoping review aimed at examining the effectiveness of strategies to minimize opioid use during surgery, in light of the ongoing opioid epidemic.
- The review will focus on randomized controlled trials that evaluate how these opioid minimization strategies impact patient-centered outcomes, using a multidisciplinary approach that involves patient partners and knowledge users.
- The study aims to compile a comprehensive overview of clinical trials, compare their outcomes with established recommendations, and identify effective strategies for reducing opioid use in surgical settings.
Article Synopsis
- - Chronic daily headaches (CDH) are common and significantly impact patients' quality of life and the healthcare system, often being resistant to standard treatments and costly options.
- - This study conducts a randomized controlled trial with 56 adults to evaluate the effects of high-dose IV ketamine infusions versus a placebo on the frequency of headache days and other related symptoms over 28 days.
- - The trial aims to determine if ketamine is a safe and effective treatment for CDH, potentially offering a more accessible option for patients who struggle with ongoing headache issues despite current therapies.