Evidence map›Paper›PMID 25477978›Full record

ReviewHepatitis monthly2014

The therapeutic use of analgesics in patients with liver cirrhosis: a literature review and evidence-based recommendations.

Farnad Imani, Mahsa Motavaf, Saeid Safari, Seyed Moayed Alavian

3 registry-linked trialsOpen access · hybridAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Hepatitis monthly, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 42 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 4 pooled it
13.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02593721 phase2 / phase3completednot on this mapstarted 2015, after this paper: background citation

Hypoalgesic Effect of Median Nerve Neural Mobilization Versus Ibuprofen Pharmacologic Treatment in Patients With Cervicobrachial Pain

TypeinterventionalSponsorUniversidad Europea de MadridRan2015 to 2015Enrolled50ConditionsCervicobrachial NeuralgiaArmsMedian Nerve Neural Mobilization, Ibuprofen
NCT02595294 nacompletednot on this mapstarted 2015, after this paper: background citation

Hypoalgesic Effect of Neural Mobilization in Cervicobrachial Pain Compared to a Controlled Group

TypeinterventionalSponsorUniversidad Europea de MadridRan2015 to 2015Enrolled52ConditionsCervicobrachial NeuralgiaArmsCervical Lateral Glide neural mobilization
NCT02596815 nacompletednot on this mapstarted 2015, after this paper: background citation

Hypoalgesic Effect of Median Nerve Neural Mobilization in Cervicobrachial Pain Compared to a Controlled Group

TypeinterventionalSponsorUniversidad Europea de MadridRan2015 to 2015Enrolled51ConditionsCervicobrachial NeuralgiaArmsMedian Nerve Neural Mobilization, Goniometer
3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 4 syntheses or guidelines pooled it, 121 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 3 institutions in 1 country.

Farnad ImaniDepartment of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, IR Iran.
Mahsa MotavafDepartment of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, IR Iran ; Department of Molecular Hepatology, Middle East Liver Disease Center, Tehran, IR Iran.
Saeid SafariDepartment of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, IR Iran.
Seyed Moayed AlavianDepartment of Molecular Hepatology, Middle East Liver Disease Center, Tehran, IR Iran ; Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
Iran University of Medical Sciences · IRBaqiyatallah University of Medical Sciences · IRTarbiat Modares University · IR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

contextPain management in cirrhotic patients is a major clinical challenge for medical professionals. Unfortunately there are no concrete guidelines available regarding the administration of analgesics in patients with liver cirrhosis. In this review we aimed to summarize the available literature and suggest appropriate evidence-based recommendations regarding to administration of these drugs. EVIDENCE ACQUISITION: An indexed MEDLINE search was conducted in July 2014, using keywords "analgesics", "hepatic impairment", "cirrhosis", "acetaminophen or paracetamol", "NSAIDs or nonsteroidal anti-inflammatory drugs", "opioid" for the period of 2004 to 2014. All randomized clinical trials, case series, case report and meta-analysis studies with the above mentioned contents were included in review process. In addition, unpublished information from the Food and Drug Administration are included as well.

resultsParacetamol is safe in patients with chronic liver disease but a reduced dose of 2-3 g/d is recommended for long-term use. Non-steroidal anti-inflammatory drugs (NSAIDs) are best avoided because of risk of renal impairment, hepatorenal syndrome, and gastrointestinal hemorrhage. Most opioids can have deleterious effects in patients with cirrhosis. They have an increased risk of toxicity and hepatic encephalopathy. They should be administrated with lower and less frequent dosing in these patients and be avoided in patients with a history of encephalopathy or addiction to any substance.

conclusionsNo evidence-based guidelines exist on the use of analgesics in patients with liver disease and cirrhosis. As a result pain management in these patients generates considerable misconception among health care professionals, leading under-treatment of pain in this population. Providing concrete guidelines toward the administration of these agents will lead to more efficient and safer pain management in this setting.

Indexed as

AcetaminophenAdverse Drug EventsHepatic CirrhosisPain Management

Identifiers

PMID25477978
PMCPMC4250965
OpenAlexW2112914937

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.