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Status of N-of-1 Trials in Chronic Pain Management: A Narrative Review

N-of-1 trials are randomized controlled clinical trials conducted exclusively on a single patient. The ultimate aim of N-of-1 trials is to optimize a strategy in a particular individual. Chronic pain is a common but refractory clinical problem. Its diverse etiologies and broad variations among patie...

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Autores principales: He, Wanying, Cui, Zichan, Chen, Yin, Wang, Fang, Li, Fengxian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8586287/
https://www.ncbi.nlm.nih.gov/pubmed/34528159
http://dx.doi.org/10.1007/s40122-021-00314-4
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author He, Wanying
Cui, Zichan
Chen, Yin
Wang, Fang
Li, Fengxian
author_facet He, Wanying
Cui, Zichan
Chen, Yin
Wang, Fang
Li, Fengxian
author_sort He, Wanying
collection PubMed
description N-of-1 trials are randomized controlled clinical trials conducted exclusively on a single patient. The ultimate aim of N-of-1 trials is to optimize a strategy in a particular individual. Chronic pain is a common but refractory clinical problem. Its diverse etiologies and broad variations among patients often lead to the requirement of individualizing medicine. Thus, chronic pain represents a classical condition for N-of-1 clinical trials. Studies have indicated that N-of-1 benefits patients with chronic pain, multiple comorbidities, and uncertain variations during therapies; however, this approach it is not yet adopted as the first choice in pain clinics. To dissect the current status of N-of-1 in chronic pain management, as well as the limitations for its implementation, we herein studied all N-of-1 studies related to chronic pain by searching three major databases (PubMed, ClinicalTrial.gov, Cochrane Library) for publications between 1985 and 2020. Of 35 eligibility papers, 19 were selected for analysis. Results confirmed that N-of-1 trials have solved the refractory cases including osteoarthritis, chronic musculoskeletal pain, and neuropathic pain; however, none of the trials dealt with cancer pain. Longer time and more efforts are needed from investigators when carrying out N-of-1 trials, which inevitably result in implementation difficulties. Of note, all recruited trials were conducted in developed countries. As mobile devices have been introduced and protocols improve, renewed interest in the implementation of N-of-1 trials will occur. Collectively, a previously underestimated conflict between “precision medicine” and “poor implementation” has put N-of-1 in a challenging position for chronic pain management.
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spelling pubmed-85862872021-11-23 Status of N-of-1 Trials in Chronic Pain Management: A Narrative Review He, Wanying Cui, Zichan Chen, Yin Wang, Fang Li, Fengxian Pain Ther Review N-of-1 trials are randomized controlled clinical trials conducted exclusively on a single patient. The ultimate aim of N-of-1 trials is to optimize a strategy in a particular individual. Chronic pain is a common but refractory clinical problem. Its diverse etiologies and broad variations among patients often lead to the requirement of individualizing medicine. Thus, chronic pain represents a classical condition for N-of-1 clinical trials. Studies have indicated that N-of-1 benefits patients with chronic pain, multiple comorbidities, and uncertain variations during therapies; however, this approach it is not yet adopted as the first choice in pain clinics. To dissect the current status of N-of-1 in chronic pain management, as well as the limitations for its implementation, we herein studied all N-of-1 studies related to chronic pain by searching three major databases (PubMed, ClinicalTrial.gov, Cochrane Library) for publications between 1985 and 2020. Of 35 eligibility papers, 19 were selected for analysis. Results confirmed that N-of-1 trials have solved the refractory cases including osteoarthritis, chronic musculoskeletal pain, and neuropathic pain; however, none of the trials dealt with cancer pain. Longer time and more efforts are needed from investigators when carrying out N-of-1 trials, which inevitably result in implementation difficulties. Of note, all recruited trials were conducted in developed countries. As mobile devices have been introduced and protocols improve, renewed interest in the implementation of N-of-1 trials will occur. Collectively, a previously underestimated conflict between “precision medicine” and “poor implementation” has put N-of-1 in a challenging position for chronic pain management. Springer Healthcare 2021-09-16 2021-12 /pmc/articles/PMC8586287/ /pubmed/34528159 http://dx.doi.org/10.1007/s40122-021-00314-4 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Review
He, Wanying
Cui, Zichan
Chen, Yin
Wang, Fang
Li, Fengxian
Status of N-of-1 Trials in Chronic Pain Management: A Narrative Review
title Status of N-of-1 Trials in Chronic Pain Management: A Narrative Review
title_full Status of N-of-1 Trials in Chronic Pain Management: A Narrative Review
title_fullStr Status of N-of-1 Trials in Chronic Pain Management: A Narrative Review
title_full_unstemmed Status of N-of-1 Trials in Chronic Pain Management: A Narrative Review
title_short Status of N-of-1 Trials in Chronic Pain Management: A Narrative Review
title_sort status of n-of-1 trials in chronic pain management: a narrative review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8586287/
https://www.ncbi.nlm.nih.gov/pubmed/34528159
http://dx.doi.org/10.1007/s40122-021-00314-4
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