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Attal N, Bouhassira D, Colvin L. Advances and challenges in neuropathic pain: a narrative review and future directions. Br J Anaesth 2023; 131:79-92. [PMID: 37210279 DOI: 10.1016/j.bja.2023.04.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/20/2023] [Accepted: 04/05/2023] [Indexed: 05/22/2023] Open
Abstract
Over the past few decades, substantial advances have been made in neuropathic pain clinical research. An updated definition and classification have been agreed. Validated questionnaires have improved the detection and assessment of acute and chronic neuropathic pain; and newer neuropathic pain syndromes associated with COVID-19 have been described. The management of neuropathic pain has moved from empirical to evidence-based medicine. However, appropriately targeting current medications and the successful clinical development of drugs acting on new targets remain challenging. Innovative approaches to improving therapeutic strategies are required. These mainly encompass rational combination therapy, drug repurposing, non-pharmacological approaches (such as neurostimulation techniques), and personalised therapeutic management. This narrative review reports historical and current perspectives regarding the definitions, classification, assessment, and management of neuropathic pain and explores potential avenues for future research.
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Affiliation(s)
- Nadine Attal
- Inserm U987, UVSQ-Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France.
| | - Didier Bouhassira
- Inserm U987, UVSQ-Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Lesley Colvin
- University of Dundee, Ninewells Medical School, Ninewells Hospital, Dundee, UK
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Hukins C, Duce B. Usefulness of self-administered questionnaires in screening for direct referral for polysomnography without sleep physician review. J Clin Sleep Med 2022; 18:1405-1412. [PMID: 35034687 PMCID: PMC9059604 DOI: 10.5664/jcsm.9876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To evaluate self-administered screening questionnaires (Epworth, Berlin, OSA50 and STOP-Bang questionnaires) in patients considered for polysomnography for probable OSA suitable for direct polysomnography without sleep specialist review and to evaluate the usefulness of combining questionnaires in this population. METHODS Retrospective review of tertiary sleep center referrals (November 2017 to April 2020) where ≥ 3 screening questionnaires were completed, and type 1 polysomnography was performed. Sensitivity, specificity, positive and negative predictive values, and Likelihood ratios to detect AHI ≥15 or ≥30 were calculated for each questionnaire (with or without ESS ≥ 8) or any positive questionnaire with ESS ≥ 8. RESULTS 2,152 patients were included. The questionnaires were completed in the majority (Epworth 96%, Berlin 77%, OSA50 84% and STOP-Bang 90%) of referrals. Berlin was most sensitive (82.5% and 85% to detect AHI ≥ 15 and ≥ 30 respectively) but least specific (23% both thresholds). STOP-Bang was least sensitive (66% and 42% respectively) but most specific (68% and 60% respectively). Sensitivity declined if combined with ESS ≥ 8. Combining any questionnaire with ESS ≥ 8 returned intermediate sensitivity of 61% and 73% and specificity of 49% and 47% for AHI ≥ 15 and ≥ 30 respectively. STOP-Bang alone was predictive of OSA on multivariate analysis but was only associated with a clinically insignificant positive Likelihood Ratio. However, STOP-Bang is associated with unacceptable false positive and negative rates which did not support its use. CONCLUSIONS Self-administered questionnaires are inadequate in patients under consideration for polysomnography and should not be used as clinical support for suitability of direct polysomnography without sleep specialist review. Combining questionnaires causes deteriorated performance.
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Affiliation(s)
- Craig Hukins
- Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Wolloongabba, QLD
| | - Brett Duce
- Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Wolloongabba, QLD
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Chai-Coetzer CL, Eastwood PR. Diagnosing OSA in primary care: The utility of clinical judgement, screening questionnaires and portable monitoring. Respirology 2021; 26:908-909. [PMID: 34427021 DOI: 10.1111/resp.14139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Ching Li Chai-Coetzer
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Peter R Eastwood
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Momsen AMH, Stapelfeldt CM, Nielsen CV, Nielsen MBD, Rugulies R, Jensen C. Screening instruments for predicting return to work in long-term sickness absence. Occup Med (Lond) 2017; 67:101-108. [PMID: 27445321 DOI: 10.1093/occmed/kqw093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Multiple somatic symptoms are common and may cause prolonged sickness absence (SA) and unsuccessful return to work (RTW). Aims To compare three instruments and their predictive and discriminative abilities regarding RTW. Methods A longitudinal cohort study of participants recruited from two municipal job centres, with at least 8 weeks of SA. The instruments used were the Symptom Check List of somatic distress (SCL-SOM) (score 0-48 points), the Bodily Distress Syndrome Questionnaire (BDSQ) (0-120 points) and the one-item self-rated health (SRH) (1-5 points). The instruments' predictive value was explored in a time-to-event analysis. Different cut-points were analysed to find the highest number of correctly classified RTW cases, identified in a register on public transfer payments. Results The study involved 305 subjects. The adjusted relative risk regarding prediction of RTW was 0.89 [95% confidence interval (CI) 0.83-0.95], 0.89 (95% CI 0.83-0.95) and 0.78 (95% CI 0.70-0.86) per 5-, 10- and 1-point increase in the SCL-SOM, BDSQ and SRH, respectively. After mutual adjustment for the three instruments, only the prediction of RTW from SRH remained statistically significant 0.81 (95% CI 0.72-0.92). The highest sensitivity (86%) was found by SRH at the cut-point ≤5, at which 62% were correctly classified. Conclusions All three instruments predicted RTW, but only SRH remained a significant predictor after adjustment for the SCL-SOM and BDSQ. The SRH provides an efficient alternative to more time-consuming instruments such as SCL-SOM or BDSQ for estimating the chances of RTW among sickness absentees.
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Affiliation(s)
- A-M H Momsen
- DEFACTUM, Social & Health Services and Labour Market, Central Denmark Region, 8000 Aarhus C, Denmark
| | - C M Stapelfeldt
- DEFACTUM, Social & Health Services and Labour Market, Central Denmark Region, 8000 Aarhus C, Denmark
| | - C V Nielsen
- Department of Public Health, Section of Clinical Social Medicine and Rehabilitation, Aarhus University, 8000 Aarhus C, Denmark
| | - M B D Nielsen
- COWI, 2800 Lyngby, Denmark.,The National Research Centre for the Working Environment, 2100 Copenhagen, Denmark
| | - R Rugulies
- The National Research Centre for the Working Environment, 2100 Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, 1014 Copenhagen K, Denmark.,Department of Psychology, University of Copenhagen, 1353 Copenhagen K, Denmark
| | - C Jensen
- National Centre for Occupational Rehabilitation, 3884 Rauland, Norway.,Department of Public Health and General Practice, Norwegian University of Science and Technology, 7491 Trondheim, Norway
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Dimitrov L, Macavei V. Can Screening Tools for Obstructive Sleep Apnea Predict Postoperative Complications? A Systematic Review of the Literature. J Clin Sleep Med 2016; 12:1293-300. [PMID: 27448417 DOI: 10.5664/jcsm.6136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/16/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a common, underdiagnosed condition that is associated with significant morbidity and mortality in the perioperative setting. Increasing evidence suggests that the utility of preoperative screening tools may go beyond identification of OSA, to the prediction of perioperative complications. The primary objective of this study was to systematically review the literature on all studies assessing whether high risk scores on the STOP-Bang questionnaire, American Society of Anesthesiologists (ASA) checklist, and the Berlin Questionnaire (BQ) are associated with higher rates of postoperative complications. METHODS A systematic review of English language records was performed using Medline, EMBASE, and PsychInfo with additional studies identified by manual search through reference lists. Only studies that evaluated the ability of the STOP-Bang, the BQ, and ASA checklist to predict postoperative complications in adults were included. RESULTS Twelve studies were included in the final review. Eight studies looked at STOP-Bang, 3 at the Berlin Questionnaire, and 2 at the ASA Checklist. Significant differences across study characteristics prevented a meta-analysis and the studies were evaluated qualitatively. CONCLUSIONS The ASA checklist, Berlin Questionnaire, and STOP-Bang questionnaire may be able to risk stratify patients for perioperative and postoperative complications. Further research is required, with a particular focus on specific surgery types and adjustment of potentially confounding factors in the analysis.
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Affiliation(s)
- Lilia Dimitrov
- Respiratory Department, Newham University Hospital, London, UK
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Abstract
Background The misuse and abuse of opioid medications in many developed nations is a health crisis, leading to increased health-system utilization, emergency department visits, and overdose deaths. There are also increasing concerns about opioid abuse and diversion in patients with cancer, even at the end of life. Aims To evaluate the current literature on opioid misuse and abuse, and more specifically the identification and assessment of opioid-abuse risk in patients with cancer. Our secondary aim is to offer the most current evidence of best clinical practice and suggest future directions for research. Materials and methods Our integrative review included a literature search using the key terms “identification and assessment of opioid abuse in cancer”, “advanced cancer and opioid abuse”, “hospice and opioid abuse”, and “palliative care and opioid abuse”. PubMed, PsycInfo, and Embase were supplemented by a manual search. Results We found 691 articles and eliminated 657, because they were predominantly non cancer populations or specifically excluded cancer patients. A total of 34 articles met our criteria, including case studies, case series, retrospective observational studies, and narrative reviews. The studies were categorized into screening questionnaires for opioid abuse or alcohol, urine drug screens to identify opioid misuse or abuse, prescription drug-monitoring programs, and the use of universal precautions. Conclusion Screening questionnaires and urine drug screens indicated at least one in five patients with cancer may be at risk of opioid-use disorder. Several studies demonstrated associations between high-risk patients and clinical outcomes, such as aberrant behavior, prolonged opioid use, higher morphine-equivalent daily dose, greater health care utilization, and symptom burden.
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Affiliation(s)
- Ashley-Nicole Carmichael
- School of Pharmacy, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, USA
| | - Laura Morgan
- School of Pharmacy, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, USA
| | - Egidio Del Fabbro
- Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, USA
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Quaranta VN, Dragonieri S, Carratù P, Falcone VA, Carucci E, Ranieri T, Ventura V, Resta O. A new approach for the assessment of sleepiness and predictivity of obstructive sleep apnea in drivers: A pilot study. Lung India 2016; 33:14-9. [PMID: 26933301 PMCID: PMC4748658 DOI: 10.4103/0970-2113.173061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Falling asleep behind the wheel is one of the most relevant consequences of obstructive sleep apnea (OSA). We created a new screening questionnaire, named the Driver Sleepiness Score (DSS), aiming to assess sleepiness in drivers with suspected OSA. The primary aim of our study was to evaluate sleepiness in drivers with a suspicion of OSA by the DSS in order to assess its correlation with the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and total sleep time with oxyhemoglobin saturation below 90% (TST90). We also aimed to assess the diagnostic accuracy of DSS for three different cutoffs of AHI (AHI = 5, AHI = 15, AHI = 30), which allow stratification of the severity of OSA. MATERIALS AND METHODS Seventy-three driving patients at risk for OSA participated in the study. DSS and the Epworth Sleepiness Scale (ESS) were both administered in operator-dependent modality and in randomized sequence. RESULTS The DSS showed higher accuracy in screening patients with mild OSA [area under curve (AUC): 0.88 vs 0.74] and moderate OSA (AUC: 0.88 vs 0.79), whereas ESS showed higher accuracy in screening patients with severe OSA (AUC: 0.91 vs 0.78). A DSS score ≥ 7 is the optimal cutoff for distinguishing true positives from false positives for the presence of OSA and for its different severity levels. The administration of both questionnaires increases the accuracy for the detection of all OSA severity levels. CONCLUSIONS If validated, DSS may qualify as a new screening tool specifically for drivers with the suspicion of having OSA, in combination with the ESS.
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Affiliation(s)
| | | | | | | | - Elisa Carucci
- Department of Respiratory Diseases, University of Bari, Bari, Italy
| | - Teresa Ranieri
- Department of Respiratory Diseases, University of Bari, Bari, Italy
| | | | - Onofrio Resta
- Department of Respiratory Diseases, University of Bari, Bari, Italy
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El Tallawy HN, Farghaly WM, Rageh TA, Saleh AO, Mestekawy TA, Darwish MM, Abd El Hamed MA, Ali AM, Mahmoud DM. Construction of standardized Arabic questionnaires for screening neurological disorders (dementia, stroke, epilepsy, movement disorders, muscle and neuromuscular junction disorders). Neuropsychiatr Dis Treat 2016; 12:2245-53. [PMID: 27621635 PMCID: PMC5012614 DOI: 10.2147/ndt.s109328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A screening questionnaire is an important tool for early diagnosis of neurological disorders, and for epidemiological research. This screening instrument must be both feasible and valid. It must be accepted by the community and must be sensitive enough. So, the aim of this study was to prepare different Arabic screening questionnaires for screening different neurological disorders. This study was carried out in three stages. During the first stage, construction of separate questionnaires designed for screening the five major neurological disorders: cerebrovascular stroke, dementias, epilepsy, movement disorders, and muscle and neuromuscular disorders were done. Validation of the screening questionnaires was carried out in the second stage. Finally, questionnaire preparation was done in the third stage. Questions with the accepted sensitivity and specificity in each questionnaire formed the refined separate questionnaires.
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Affiliation(s)
| | | | - Tarek A Rageh
- Department of Neurology and Psychiatry, Faculty of Medicine
| | | | | | - Manal Mm Darwish
- Public Health Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Anwar M Ali
- Department of Neurology and Psychiatry, Faculty of Medicine
| | - Doaa M Mahmoud
- Department of Neurology and Psychiatry, Faculty of Medicine
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Abstract
PURPOSE The aim of this study was to determine the diagnostic value of three screening questionnaires in identifying Korean patients at high risk for obstructive sleep apnea (OSA) in a sleep clinic setting in Korea. MATERIALS AND METHODS Data were collected from 592 adult patients with suspected OSA who visited a sleep center. All patients completed the Sleep Apnea of Sleep Disorder Questionnaire (SA-SDQ), the Berlin questionnaire, and the STOP-Bang questionnaire. Estimated OSA risk was compared to a diagnosis of OSA. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each questionnaire. RESULTS The prevalence of OSA was 83.6% using an apnea-hypopnea index (AHI) ≥5/h and 58.4% for an AHI ≥15/h. The STOP-Bang questionnaire had a high sensitivity (97% for AHI ≥5/h, 98% for AHI ≥15/h), but the specificity was low (19% and 11%, respectively). In contrast, the sensitivity of the SA-SDQ was not high enough (68% for AHI ≥5/h, 74% for AHI ≥15/h) to be useful in a clinical setting, whereas the specificity was relatively good (66% and 61%, respectively). The sensitivity and specificity values of the Berlin questionnaire fell between those of the STOP-Bang questionnaire and the SA-SDQ. CONCLUSION The STOP-Bang questionnaire may be useful for screening OSA in a sleep clinic setting, but its specificity is lower than the acceptable level for this purpose. A new screening questionnaire with a high sensitivity and acceptable specificity is therefore needed in a sleep clinic setting.
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Affiliation(s)
- Bomi Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Mi Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoo-Sam Chung
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo-Sung Kim
- Department of Pulmonology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Francis JM, Grosskurth H, Changalucha J, Kapiga SH, Weiss HA. Systematic review and meta-analysis: prevalence of alcohol use among young people in eastern Africa. Trop Med Int Health 2014; 19:476-88. [PMID: 24479379 PMCID: PMC4065366 DOI: 10.1111/tmi.12267] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective Systematic review and meta-analysis of published studies of alcohol use among young people (age 15–24 years) in eastern Africa to estimate prevalence of alcohol use and determine the extent of use of standardised screening questionnaires in alcohol studies. Methods Five databases (MEDLINE, EMBASE, Global Health, Africa-wide, and PsycINFO) were searched for publications until 30th June 2013. Results were summarised using the guidelines on preferred reporting items for systematic reviews and meta-analyses (PRISMA) and on quality assessment using the modified quality assessment tool for systematic reviews of observational studies (QATSO). Heterogeneity was assessed using the I2 statistic (DerSimonian-Laird). Results We identified 2785 potentially relevant studies, of which 56 were eligible for inclusion. Only two studies (4%) used the standardised Alcohol Use Disorder Identification Test (AUDIT) questionnaire, and six studies (13%) used the Cut down, Annoyed, Guilt, Eye opener (CAGE) questionnaire. The reported median prevalence of alcohol use was ever-use 52% [interquartile range (IQR): 20–58%], use in the last month 28% (IQR: 17–37%), use in the last year 26% (IQR: 22–32%), and problem drinking as defined by CAGE or AUDIT 15% (IQR: 3–36%). We observed high heterogeneity between studies, with the highest prevalence of ever use of alcohol among university students (82%; 95%CI: 79–85%) and female sex workers (66%; 95%CI: 58–74%). Current use was most prevalent among male sex workers (69%; 95%CI: 63–75%). Conclusions Reported alcohol use and problem drinking were common among diverse groups of young people in eastern Africa, indicating the urgent need for alcohol-focused interventions in this population. Few studies have used standardised alcohol screening questionnaires. Epidemiological research to investigate alcohol-focused interventions in young people should aim to apply such questionnaires that should be validated for use in this population.
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Affiliation(s)
- Joel M Francis
- London School of Hygiene and Tropical Medicine, London, UK; National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
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