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7. Context matters: using an Evidence to Decision (EtD) framework to develop and encourage uptake of opioid deprescribing guideline recommendations at the point-of-care

Author

Langford, Aili V., Bero, Lisa, Lin, Chung-Wei Christine, Blyth, Fiona M., Doctor, Jason N., Holliday, Simon, Jeon, Yun-Hee, Moullin, Joanna C., Murnion, Bridin, Nielsen, Suzanne, Penm, Jonathan, Reeve, Emily, Reid, Sharon, Wale, Janet, Osman, Rawa, Gnjidic, Danijela, and Schneider, Carl R.

Published
2024
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8. Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial

Author

McLachlan, Hanan, Webb, Melissa, Hamilton, Melanie, Ahedi, Harbeer, Barber, Angie, Mak, Wendy, Mathieson, Stephanie, Petrova, Veronika, Bompoint, Severine, Shan, Sana, Murnion, Bridin, Buckley, Nicholas, Demirkol, Apo, Wrigley, Paul, Needs, Christopher, Brooks, Louise, Cantori, Samuel, Preisz, Paul, Aitken, James, Allan, Sujata, Burke, Michael, Cameron, Greg, Cepeda, Francisco Javier Valencia, Davis, Christopher, Dullur, Jayasree, Emmanuel, Joseph, Errey, Catherine, Fieuw-Makaroff, Sabine, Gaudry, Adam, Genua, L, Longhurst, Ian, McCroary, Kenneth, Merhi, Diana, Nguyen, Tanya, Obayd, Zahra Rassoly, Penm, Michelle, Pobbathi, Sharan, Poh, William S, Schnitzler, Paul, Shahnaz, Sabiha, Tan, Ven, Tang, Danny, Tan, Brian, Thu, Win Kyaw, Triantopolous, Thrasivolous, Venkatesan, Ramana, Wong, Wicky Chun Fai, Yang, Shu Ching, Jones, Caitlin M P, Day, Richard O, Koes, Bart W, Latimer, Jane, Maher, Chris G, McLachlan, Andrew J, Billot, Laurent, and Lin, Chung-Wei Christine

Published
2023
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13. Reply to Ballou and Kube

Author

Jones, Caitlin M. P., Lin, Chung-Wei Christine, Blease, Charlotte, Lawson, Jen, Abdel Shaheed, Christina, Maher, Christopher G., Jones, Caitlin M. P., Lin, Chung-Wei Christine, Blease, Charlotte, Lawson, Jen, Abdel Shaheed, Christina, and Maher, Christopher G.

Published
2024
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15. Analgesia for non-specific low back pain.

Author

Jones, Caitlin M. P., Underwood, Martin, Chou, Roger, Schoene, Mark, Sabzwari, Saniya, Cavanagh, Jarrod, and Lin, Chung-Wei Christine

Subjects
THERAPEUTIC use of narcotics, BENZODIAZEPINES, CHRONIC pain treatment, NONSTEROIDAL anti-inflammatory agents, ADRENOCORTICAL hormones, COMBINATION drug therapy, CUTANEOUS therapeutics, MEDICAL protocols, PATIENT safety, ACUTE diseases, MUSCLE relaxants, HERBAL medicine, TRANQUILIZING drugs, ORAL drug administration, TREATMENT duration, ANALGESIA, ANALGESICS, ANTIDEPRESSANTS, PLANT extracts, PAIN management, DRUG efficacy, NARCOTICS, EVIDENCE-based medicine, LUMBAR pain, ACETAMINOPHEN, ANTICONVULSANTS, CANNABINOIDS, HOMEOPATHIC agents
Published
2024
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19. How is postoperative pain after hip and knee replacement managed? An analysis of two large hospitals in Australia.

Author

Ferreira, Giovanni E., Patanwala, Asad E., Turton, Hannah, Langford, Aili V., Harris, Ian A., Maher, Chris G., McLachlan, Andrew J., Glare, Paul, and Lin, Chung-Wei Christine

Subjects
TOTAL knee replacement, TOTAL hip replacement, POSTOPERATIVE pain, KNEE surgery, ARTHROPLASTY, INAPPROPRIATE prescribing (Medicine), ANALGESIA
Abstract

Background: Multimodal analgesia regimens are recommended for the postoperative period after hip and knee replacement surgeries. However, there are no data on practice patterns for analgesic use in the immediate postoperative period after hip and knee replacements in Australia. Objectives: To describe analgesic prescribing patterns in the inpatient postoperative phase for patients undergoing hip and knee replacement. Methods: Retrospective study of electronic medical record data from two major hospitals in Sydney, Australia. We identified analgesic medication prescriptions for all patients aged 18 years and older who underwent hip or knee replacement surgery in 2019. We extracted data on pain medications prescribed while in the ward up until discharge. These were grouped into distinct categories based on the Anatomical Therapeutic Chemical classification. We described the frequency (%) of pain medications used by category and computed the average oral morphine equivalent daily dose (OMEDD) during hospitalisation. Results: We identified 1282 surgeries in 1225 patients. Patients had a mean (SD) age of 69 (11.8) years; most (57.1%) were female. Over 99% of patients were prescribed opioid analgesics and paracetamol during their hospital stay. Most patients (61.4%) were managed with paracetamol and opioids only. The most common prescribed opioid was oxycodone (87.3% of patients). Only 19% of patients were prescribed nonsteroidal anti-inflammatories (NSAIDs). The median (IQR) average daily OMEDD was 50.2 mg (30.3–77.9). Conclusion: We identified high use of opioids analgesics as the main strategies for pain control after hip and knee replacement in hospital. Other analgesics were much less frequently used, such as NSAIDs, and always in combination with opioids and paracetamol. [ABSTRACT FROM AUTHOR]

Published
2024
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22. The McKenzie method for (sub)acute non-specific low back pain

Author

Almeida, Matheus O., Narciso Garcia, Alessandra, Menezes Costa, Luciola C., van Tulder, Maurits W., Lin, Chung Wei Christine, and Machado, Luciana A.C.

Subjects
Adult, Acute Pain/therapy, Treatment Outcome, Low Back Pain/therapy, Quality of Life, Humans, Pharmacology (medical), Exercise Therapy
Abstract

BACKGROUND: There is widespread agreement amongst clinicians that people with non-specific low back pain (NSLBP) comprise a heterogeneous group and that their management should be individually tailored. One treatment known by its tailored design is the McKenzie method (e.g. an individualized program of exercises based on clinical clues observed during assessment).OBJECTIVES: To evaluate the effectiveness of the McKenzie method in people with (sub)acute non-specific low back pain.SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and two trials registers up to 15 August 2022.SELECTION CRITERIA: We included randomized controlled trials (RCTs) investigating the effectiveness of the McKenzie method in adults with (sub)acute (less than 12 weeks) NSLBP.DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane.MAIN RESULTS: This review included five RCTs with a total of 563 participants recruited from primary or tertiary care. Three trials were conducted in the USA, one in Australia, and one in Scotland. Three trials received financial support from non-commercial funders and two did not provide information on funding sources. All trials were at high risk of performance and detection bias. None of the included trials measured adverse events. McKenzie method versus minimal intervention (educational booklet; McKenzie method as a supplement to other intervention - main comparison) There is low-certainty evidence that the McKenzie method may result in a slight reduction in pain in the short term (MD -7.3, 95% CI -12.0 to -2.56; 2 trials, 377 participants) but not in the intermediate term (MD -5.0, 95% CI -14.3 to 4.3; 1 trial, 180 participants). There is low-certainty evidence that the McKenzie method may not reduce disability in the short term (MD -2.5, 95% CI -7.5 to 2.0; 2 trials, 328 participants) nor in the intermediate term (MD -0.9, 95% CI -7.3 to 5.6; 1 trial, 180 participants). McKenzie method versus manual therapy There is low-certainty evidence that the McKenzie method may not reduce pain in the short term (MD -8.7, 95% CI -27.4 to 10.0; 3 trials, 298 participants) and may result in a slight increase in pain in the intermediate term (MD 7.0, 95% CI 0.7 to 13.3; 1 trial, 235 participants). There is low-certainty evidence that the McKenzie method may not reduce disability in the short term (MD -5.0, 95% CI -15.0 to 5.0; 3 trials, 298 participants) nor in the intermediate term (MD 4.3, 95% CI -0.7 to 9.3; 1 trial, 235 participants). McKenzie method versus other interventions (massage and advice) There is very low-certainty evidence that the McKenzie method may not reduce disability in the short term (MD 4.0, 95% CI -15.4 to 23.4; 1 trial, 30 participants) nor in the intermediate term (MD 10.0, 95% CI -8.9 to 28.9; 1 trial, 30 participants).AUTHORS' CONCLUSIONS: Based on low- to very low-certainty evidence, the treatment effects for pain and disability found in our review were not clinically important. Thus, we can conclude that the McKenzie method is not an effective treatment for (sub)acute NSLBP.

Published
2023

23. Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial

Author

Jones, Caitlin M P, primary, Day, Richard O, additional, Koes, Bart W, additional, Latimer, Jane, additional, Maher, Chris G, additional, McLachlan, Andrew J, additional, Billot, Laurent, additional, Shan, Sana, additional, Lin, Chung-Wei Christine, additional, McLachlan, Hanan, additional, Webb, Melissa, additional, Hamilton, Melanie, additional, Ahedi, Harbeer, additional, Barber, Angie, additional, Mak, Wendy, additional, Mathieson, Stephanie, additional, Petrova, Veronika, additional, Bompoint, Severine, additional, Murnion, Bridin, additional, Buckley, Nicholas, additional, Demirkol, Apo, additional, Wrigley, Paul, additional, Needs, Christopher, additional, Brooks, Louise, additional, Cantori, Samuel, additional, Preisz, Paul, additional, Aitken, James, additional, Allan, Sujata, additional, Burke, Michael, additional, Cameron, Greg, additional, Cepeda, Francisco Javier Valencia, additional, Davis, Christopher, additional, Dullur, Jayasree, additional, Emmanuel, Joseph, additional, Errey, Catherine, additional, Fieuw-Makaroff, Sabine, additional, Gaudry, Adam, additional, Genua, L, additional, Longhurst, Ian, additional, McCroary, Kenneth, additional, Merhi, Diana, additional, Nguyen, Tanya, additional, Obayd, Zahra Rassoly, additional, Penm, Michelle, additional, Pobbathi, Sharan, additional, Poh, William S, additional, Schnitzler, Paul, additional, Shahnaz, Sabiha, additional, Tan, Ven, additional, Tang, Danny, additional, Tan, Brian, additional, Thu, Win Kyaw, additional, Triantopolous, Thrasivolous, additional, Venkatesan, Ramana, additional, Wong, Wicky Chun Fai, additional, and Yang, Shu Ching, additional

Published
2023
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24. Patient‐targeted interventions for opioid deprescribing: An overview of systematic reviews.

Author

Langford, Aili V., Schneider, Carl R., Lin, Chung‐Wei Christine, Bero, Lisa, Collins, Jack C., Suckling, Benita, and Gnjidic, Danijela

Subjects
DEPRESCRIBING, OPIOIDS, LIFE change events, MEDICAL personnel, OPIOID receptors, PHYSICAL mobility
Abstract

Background: Deprescribing (reduction or cessation) of prescribed opioids can be challenging for both patients and healthcare professionals. Objective: To synthesize and evaluate evidence from systematic reviews examining the effectiveness and outcomes of patient‐targeted opioid deprescribing interventions for all types of pain. Methods: Systematic searches were conducted in five databases with results screened against predetermined inclusion/exclusion criteria. Primary outcomes were (i) reduction in opioid dose, reported as change in oral Morphine Equivalent Daily Dose (oMEDD) and (ii) success of opioid deprescribing, reported as the proportion of the sample for which opioid use declined. Secondary outcomes included pain severity, physical function, quality of life and adverse events. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Findings: Twelve reviews were eligible for inclusion. Interventions were heterogeneous in nature and included pharmacological (n = 4), physical (n = 3), procedural (n = 3), psychological or behavioural (n = 3) and mixed (n = 5) interventions. Multidisciplinary care programmes appeared to be the most effective intervention for opioid deprescribing; however, the certainty of evidence was low, with significant variability in opioid reduction across interventions. Conclusions: Evidence is too uncertain to draw firm conclusions about specific populations who may derive the greatest benefit from opioid deprescribing, warranting further investigation. [ABSTRACT FROM AUTHOR]

Published
2023
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27. Recommendations for terminology and the identification of neuropathic pain in people with spine-related leg pain. Outcomes from the NeuPSIG working group

Author

Schmid, Annina B., primary, Tampin, Brigitte, additional, Baron, Ralf, additional, Finnerup, Nanna B., additional, Hansson, Per, additional, Hietaharju, Aki, additional, Konstantinou, Kika, additional, Lin, Chung-Wei Christine, additional, Markman, John, additional, Price, Christine, additional, Smith, Blair H., additional, and Slater, Helen, additional

Published
2023
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30. Opioid analgesia for acute low back pain and neck pain (the OPAL trial):a randomised placebo-controlled trial

Author

Jones, Caitlin M P, Day, Richard O, Koes, Bart W, Latimer, Jane, Maher, Chris G, McLachlan, Andrew J, Billot, Laurent, Shan, Sana, Lin, Chung-Wei Christine, Jones, Caitlin M P, Day, Richard O, Koes, Bart W, Latimer, Jane, Maher, Chris G, McLachlan, Andrew J, Billot, Laurent, Shan, Sana, and Lin, Chung-Wei Christine

Abstract

BACKGROUND: Opioid analgesics are commonly used for acute low back pain and neck pain, but supporting efficacy data are scarce. We aimed to investigate the efficacy and safety of a judicious short course of an opioid analgesic for acute low back pain and neck pain.METHODS: OPAL was a triple-blinded, placebo-controlled randomised trial that recruited adults (aged ≥18 years) presenting to one of 157 primary care or emergency department sites in Sydney, NSW, Australia, with 12 weeks or less of low back or neck pain (or both) of at least moderate pain severity. Participants were randomly assigned (1:1) using statistician-generated randomly permuted blocks to guideline-recommended care plus an opioid (oxycodone-naloxone, up to 20 mg oxycodone per day orally) or guideline-recommended care and an identical placebo, for up to 6 weeks. The primary outcome was pain severity at 6 weeks measured with the pain severity subscale of the Brief Pain Inventory (10-point scale), analysed in all eligible participants who provided at least one post-randomisation pain score, by use of a repeated measures linear mixed model. Safety was analysed in all randomly assigned eligible participants. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615000775516).FINDINGS: Between Feb 29, 2016, and March 10, 2022, 347 participants were recruited (174 to the opioid group and 173 to the placebo group). 170 (49%) of 346 participants were female and 176 (51%) were male. 33 (19%) of 174 participants in the opioid group and 25 (15%) of 172 in the placebo group had discontinued from the trial by week 6, due to loss to follow-up and participant withdrawals. 151 participants in the opioid group and 159 in the placebo group were included in the primary analysis. Mean pain score at 6 weeks was 2·78 (SE 0·20) in the opioid group versus 2·25 (0·19) in the placebo group (adjusted mean difference 0·53, 95% CI -0·00 to 1·07, p=0·051). 61 (35%) of 174 partic

Published
2023

31. Surgical versus non-surgical treatment for sciatica:systematic review and meta-analysis of randomised controlled trials

Author

Liu, Chang, Ferreira, Giovanni E., Abdel Shaheed, Christina, Chen, Qiuzhe, Harris, Ian A., Bailey, Christopher S., Peul, Wilco C., Koes, Bart, Lin, Chung Wei Christine, Liu, Chang, Ferreira, Giovanni E., Abdel Shaheed, Christina, Chen, Qiuzhe, Harris, Ian A., Bailey, Christopher S., Peul, Wilco C., Koes, Bart, and Lin, Chung Wei Christine

Abstract

OBJECTIVE: To investigate the effectiveness and safety of surgery compared with non-surgical treatment for sciatica. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organisation International Clinical Trials Registry Platform from database inception to June 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials comparing any surgical treatment with non-surgical treatment, epidural steroid injections, or placebo or sham surgery, in people with sciatica of any duration due to lumbar disc herniation (diagnosed by radiological imaging). DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data. Leg pain and disability were the primary outcomes. Adverse events, back pain, quality of life, and satisfaction with treatment were the secondary outcomes. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst pain or disability). Data were pooled using a random effects model. Risk of bias was assessed with the Cochrane Collaboration's tool and certainty of evidence with the grading of recommendations assessment, development, and evaluation (GRADE) framework. Follow-up times were into immediate term (≤six weeks), short term (>six weeks and ≤three months), medium term (>three and <12 months), and long term (at 12 months). RESULTS: 24 trials were included, half of these investigated the effectiveness of discectomy compared with non-surgical treatment or epidural steroid injections (1711 participants). Very low to low certainty evidence showed that discectomy, compared with non-surgical treatment, reduced leg pain: the effect size was moderate at immediate term (mean difference -12.1 (95% confidence interval -23.6 to -0.5)) and short term (-11.7 (-18.6 to -4.7)), and small at medium term (-6.5 (-11.0 to -2.1)). Negligible effects were noted at long term (-2.3 (-4.5 to

Published
2023

33. Effectiveness and cost-effectiveness of a progressive, individualised walking and education program for prevention of low back pain recurrence in adults: statistical analysis plan for the WalkBack randomised controlled trial.

Author

Pocovi, Natasha, primary, Graham, Petra L, additional, Lin, Chung-Wei Christine, additional, French, Simon D, additional, Latimer, Jane, additional, Merom, Dafna, additional, Tiedemann, Anne, additional, Maher, Christopher G, additional, Dongen, Johanna M van, additional, Clavisi, Ornella, additional, and Hancock, Mark J, additional

Published
2023
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47. OPAL:a randomised, placebo-controlled trial of opioid analgesia for the reduction of pain severity in people with acute spinal pain—a statistical analysis plan

Author

Jones, Caitlin M.P., Lin, Chung Wei Christine, Day, Richard O., Koes, Bart W., Latimer, Jane, Maher, Chris G., McLachlan, Andrew, Billot, Laurent, Jones, Caitlin M.P., Lin, Chung Wei Christine, Day, Richard O., Koes, Bart W., Latimer, Jane, Maher, Chris G., McLachlan, Andrew, and Billot, Laurent

Abstract

Background: Low back and neck pain are a leading cause of disease burden globally. Opioids are recommended in guidelines for acute low back and neck pain; however, there is a lack of compelling efficacy data to support this. Methods: The OPAL trial is a prospectively registered, triple-blinded, randomised, placebo-controlled trial. Patients with acute (≤12 weeks duration) back and/or neck pain receive guideline care plus either an opioid (oxycodone + naloxone, up to 20 mg per day) or a placebo for up to 6 weeks or earlier, if pain is resolved. The primary outcome is pain measured using the Pain Severity Score of the Brief Pain Inventory with the primary time point being 6 weeks. Secondary outcomes include physical function, time to recovery, quality of life, adverse events and risk of opioid misuse. Outcomes are collected at weeks 2, 4, 6, 12, 26 and 52. Analysis will be done on an intention-to-treat principle. p values of < 0.05 will be considered significant and 95% confidence intervals will be reported. Repeated-measures linear mixed models will be used to assess the effect of the treatment group on the primary outcome and continuous secondary outcomes. Adverse events will be compared between groups using Fisher’s exact test. Cost-effectiveness analyses will be conducted if a treatment effect on pain is seen at week 6. Subgroup analyses will be performed to assess whether pain duration and pain location are treatment effect modifiers. Discussion: The OPAL trial will provide important evidence about whether a short course of opioids is effective in the treatment of acute non-specific low back and/or neck pain. This pre-specified statistical analysis plan details the methodology for the analysis of the OPAL trial results. Trial registration: ACTRN12615000775516. The trial has completed recruitment. Follow-up on the last patient will be completed in March 2022.

Published
2022

50. Surgical versus non-surgical treatment for sciatica: systematic review and meta-analysis of randomised controlled trials.

Author

Chang Liu, Ferreira, Giovanni E., Shaheed, Christina Abdel, Chen, Qiuzhe, Harris, Ian A., Bailey, Christopher S., Peul, Wilco C., Koes, Bart, and Lin, Chung-Wei Christine

Subjects
SCIATICA treatment, STEROID drugs, CINAHL database, MEDICAL databases, META-analysis, MEDICAL information storage & retrieval systems, CONFIDENCE intervals, OPERATIVE surgery, STEROIDS, SYSTEMATIC reviews, TREATMENT effectiveness, DISCECTOMY, DESCRIPTIVE statistics, EPIDURAL injections, MEDLINE, PATIENT safety, PAIN management
Published
2023
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