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Pharmacologic and Non-Pharmacologic Interventions for HIV-Neuropathy Pain. A Systematic Review and a Meta-Analysis

Background and Objectives: Among HIV infection symptoms, sensory neuropathy (HIV-SN) remains a main cause of suffering, with incidence varying from 13–50%. So far, numerous pharmacological and non-pharmacological treatments have been tested, although few evidence-based analgesic options are availabl...

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Autores principales: Amaniti, Aikaterini, Sardeli, Chrysanthi, Fyntanidou, Varvara, Papakonstantinou, Panagiota, Dalakakis, Ioannis, Mylonas, Antonios, Sapalidis, Konstantinos, Kosmidis, Christoforos, Katsaounis, Athanasios, Giannakidis, Dimitrios, Koulouris, Charilaos, Aidoni, Zoi, Michalopoulos, Nikolaos, Zarogoulidis, Paul, Kesisoglou, Isaak, Ioannidis, Aris, Vagionas, Anastasios, Romanidis, Konstantinos, Oikonomou, Panagoula, Grosomanidis, Vasilios
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956009/
https://www.ncbi.nlm.nih.gov/pubmed/31795171
http://dx.doi.org/10.3390/medicina55120762
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author Amaniti, Aikaterini
Sardeli, Chrysanthi
Fyntanidou, Varvara
Papakonstantinou, Panagiota
Dalakakis, Ioannis
Mylonas, Antonios
Sapalidis, Konstantinos
Kosmidis, Christoforos
Katsaounis, Athanasios
Giannakidis, Dimitrios
Koulouris, Charilaos
Aidoni, Zoi
Michalopoulos, Nikolaos
Zarogoulidis, Paul
Kesisoglou, Isaak
Ioannidis, Aris
Vagionas, Anastasios
Romanidis, Konstantinos
Oikonomou, Panagoula
Grosomanidis, Vasilios
author_facet Amaniti, Aikaterini
Sardeli, Chrysanthi
Fyntanidou, Varvara
Papakonstantinou, Panagiota
Dalakakis, Ioannis
Mylonas, Antonios
Sapalidis, Konstantinos
Kosmidis, Christoforos
Katsaounis, Athanasios
Giannakidis, Dimitrios
Koulouris, Charilaos
Aidoni, Zoi
Michalopoulos, Nikolaos
Zarogoulidis, Paul
Kesisoglou, Isaak
Ioannidis, Aris
Vagionas, Anastasios
Romanidis, Konstantinos
Oikonomou, Panagoula
Grosomanidis, Vasilios
author_sort Amaniti, Aikaterini
collection PubMed
description Background and Objectives: Among HIV infection symptoms, sensory neuropathy (HIV-SN) remains a main cause of suffering, with incidence varying from 13–50%. So far, numerous pharmacological and non-pharmacological treatments have been tested, although few evidence-based analgesic options are available. We conducted an up-to-date systematic review and meta-analysis of the literature in order to evaluate the efficacy and safety of pharmacologic and non-pharmacologic treatments for pain control, in patients with HIV neuropathy. Materials and Methods: We searched MEDLINE, EMBASE, Scopus/Elsevier, The Cochrane Central Register of Controlled Trials (CENTRAL), USA Clinical Trials registry, and The International Web of Science up to April 2019. All randomized controlled trials evaluating efficacy and safety of non-pharmacologic and pharmacologic therapies were included. Efficacy was defined as pain reduction during the study period. Safety was estimated from adverse events. A meta-analysis was performed whenever possible. Results: 27 randomized controlled trials (RCTs) were included for analysis (7 evaluating non pharmacologic interventions, 20 pharmacologic therapies). Non-pharmacologic studies (n = 742) involved seven different therapeutic modalities. Only Acupuncture/Moxibustion showed pain reduction over placebo, Gracely Pain Scale Mean (SD): Acu/Moxa 0.85 (0.12), placebo 1.10 (0.09), p = 0.05. Pharmacologic studies, involving 2516 patients revealed efficacy for capsaicin 8% over placebo (mean difference −8.04 [95% CI: −14.92 −1.15], smoked cannabis (where pooling data for meta-analysis was not possible) and recombinant Nerve Growth Factor. Conclusion: Despite various modalities for pain control in HIV-SN, strongest evidence exists for capsaicin 8% and smoked cannabis, although of low methodological quality. Among non-pharmacologic modalities, only Acu/Moxa gave a marginal beneficial effect in one study, possibly limited by inherent methodological flaws.
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spelling pubmed-69560092020-01-23 Pharmacologic and Non-Pharmacologic Interventions for HIV-Neuropathy Pain. A Systematic Review and a Meta-Analysis Amaniti, Aikaterini Sardeli, Chrysanthi Fyntanidou, Varvara Papakonstantinou, Panagiota Dalakakis, Ioannis Mylonas, Antonios Sapalidis, Konstantinos Kosmidis, Christoforos Katsaounis, Athanasios Giannakidis, Dimitrios Koulouris, Charilaos Aidoni, Zoi Michalopoulos, Nikolaos Zarogoulidis, Paul Kesisoglou, Isaak Ioannidis, Aris Vagionas, Anastasios Romanidis, Konstantinos Oikonomou, Panagoula Grosomanidis, Vasilios Medicina (Kaunas) Review Background and Objectives: Among HIV infection symptoms, sensory neuropathy (HIV-SN) remains a main cause of suffering, with incidence varying from 13–50%. So far, numerous pharmacological and non-pharmacological treatments have been tested, although few evidence-based analgesic options are available. We conducted an up-to-date systematic review and meta-analysis of the literature in order to evaluate the efficacy and safety of pharmacologic and non-pharmacologic treatments for pain control, in patients with HIV neuropathy. Materials and Methods: We searched MEDLINE, EMBASE, Scopus/Elsevier, The Cochrane Central Register of Controlled Trials (CENTRAL), USA Clinical Trials registry, and The International Web of Science up to April 2019. All randomized controlled trials evaluating efficacy and safety of non-pharmacologic and pharmacologic therapies were included. Efficacy was defined as pain reduction during the study period. Safety was estimated from adverse events. A meta-analysis was performed whenever possible. Results: 27 randomized controlled trials (RCTs) were included for analysis (7 evaluating non pharmacologic interventions, 20 pharmacologic therapies). Non-pharmacologic studies (n = 742) involved seven different therapeutic modalities. Only Acupuncture/Moxibustion showed pain reduction over placebo, Gracely Pain Scale Mean (SD): Acu/Moxa 0.85 (0.12), placebo 1.10 (0.09), p = 0.05. Pharmacologic studies, involving 2516 patients revealed efficacy for capsaicin 8% over placebo (mean difference −8.04 [95% CI: −14.92 −1.15], smoked cannabis (where pooling data for meta-analysis was not possible) and recombinant Nerve Growth Factor. Conclusion: Despite various modalities for pain control in HIV-SN, strongest evidence exists for capsaicin 8% and smoked cannabis, although of low methodological quality. Among non-pharmacologic modalities, only Acu/Moxa gave a marginal beneficial effect in one study, possibly limited by inherent methodological flaws. MDPI 2019-11-28 /pmc/articles/PMC6956009/ /pubmed/31795171 http://dx.doi.org/10.3390/medicina55120762 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Amaniti, Aikaterini
Sardeli, Chrysanthi
Fyntanidou, Varvara
Papakonstantinou, Panagiota
Dalakakis, Ioannis
Mylonas, Antonios
Sapalidis, Konstantinos
Kosmidis, Christoforos
Katsaounis, Athanasios
Giannakidis, Dimitrios
Koulouris, Charilaos
Aidoni, Zoi
Michalopoulos, Nikolaos
Zarogoulidis, Paul
Kesisoglou, Isaak
Ioannidis, Aris
Vagionas, Anastasios
Romanidis, Konstantinos
Oikonomou, Panagoula
Grosomanidis, Vasilios
Pharmacologic and Non-Pharmacologic Interventions for HIV-Neuropathy Pain. A Systematic Review and a Meta-Analysis
title Pharmacologic and Non-Pharmacologic Interventions for HIV-Neuropathy Pain. A Systematic Review and a Meta-Analysis
title_full Pharmacologic and Non-Pharmacologic Interventions for HIV-Neuropathy Pain. A Systematic Review and a Meta-Analysis
title_fullStr Pharmacologic and Non-Pharmacologic Interventions for HIV-Neuropathy Pain. A Systematic Review and a Meta-Analysis
title_full_unstemmed Pharmacologic and Non-Pharmacologic Interventions for HIV-Neuropathy Pain. A Systematic Review and a Meta-Analysis
title_short Pharmacologic and Non-Pharmacologic Interventions for HIV-Neuropathy Pain. A Systematic Review and a Meta-Analysis
title_sort pharmacologic and non-pharmacologic interventions for hiv-neuropathy pain. a systematic review and a meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956009/
https://www.ncbi.nlm.nih.gov/pubmed/31795171
http://dx.doi.org/10.3390/medicina55120762
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