Banca de DEFESA: NAHADJA TAHAYNARA BARROS LEAL

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : NAHADJA TAHAYNARA BARROS LEAL
DATE: 17/02/2025
TIME: 14:00
LOCAL: Departamento de Enfermagem
TITLE:

DRUG THERAPIES FOR PAIN MANAGEMENT IN AMPUTE
PATIENTS: SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS.

KEY WORDS:

Keywords: Amputation. Pain. Pain management. Drug therapy. Nursing

PAGES: 85
BIG AREA: Ciências da Saúde
AREA: Enfermagem
SUMMARY:

Introduction: Pain is the most prevalent clinical manifestation after amputation. Approximately 70% of amputees experience some type of pain, and even at low intensity, it causes suffering and changes their lives in some way. There is no consensus in the scientific literature on the most appropriate way to manage this event, and there
are numerous therapies. In the field of drug therapies, there are several promising modalities, and the analysis of the evidence is important to support safe therapeutic choices for the patient. Objective: to evaluate the efficacy and safety of the use of drug therapies for pain management in patients undergoing amputation surgeries. Methodology: this is an overview of a systematic review and network meta-analysis, to be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Network Meta-Analyses (PRISMA-NMA) and will be registered in the International prospective register of systematic reviews (PROSPERO) database. The search was carried out in September 2024, by two researchers simultaneously in the databases, Cochrane Library, Latin American and Caribbean Literature on Health Sciences (LILACS), National Library of Medicine and National Institutes of Health (PUBMED), Scientific Electronic Library Online (SCIELO), Science Direct, Web of Science and Wiley Online Library, Elsevier's Scopus (SCOPUS), CINAHL and Google Scholar. All Cochrane Systematic Reviews (CSRs) and non-Cochrane Systematic Reviews (non-CSRs) with or without meta-analysis, which described the population aged 18 years or older, with the use of pharmacological therapies for pain management in patients undergoing amputation surgeries, were included in the study. There was no time restriction for the selection of studies or regarding the language of the publications, duplicate texts in the databases were excluded with the aid of the EndNot®️ Software and then imported into Rayyan®️ in order to perform the initial screening of the studies. Data were extracted and stored in a Microsoft Excel®️ 2010 spreadsheet. Network meta-analysis was performed using R®️ software, considering 95% confidence intervals. Methodological quality analysis was performed using the Assessment of Multiple Systematic Reviews (AMSTAR 2). Results: A total of 1,262 texts were identified in the databases and, after applying the eligibility criteria, 17 articles were included in the systematic review, involving 17,011 participants in total, aged between 19 and 92 years, in Canada (3), United Kingdom (3), Australia (2), Spain (2), China (2), South Africa (1), Brazil (1), United States (1), Finland (1), New Zealand (1). The studies were conducted with patients who had lower and upper limb amputations, acute, chronic pain, and phantom limb pain. The most commonly used tools for measuring pain were the Visual Analogue Scale (VAS) 11 (6.5%), Numeric Rating Scale (NRS) 10 (5.8%) and the McGill Pain Questionnaire (MPQ) 5 (2.9%). The studies addressed the use of botulinum toxin, opioids, N-methyl D-Aspartate (NMDA) receptor antagonists, anticonvulsants, antidepressants, calcitonins and anesthetics, as well as 8 complementary integrative therapies, with the use of mirror therapy 5 (29.5%) and graduated motor imagery 3 (17.6%) prevailing. Regarding the AMSTAR 2 evaluation, most studies obtained a methodology quality assessment between moderate 7 (41.2%) and critically low 7 (41.2%); the remaining studies were classified as low 3 (17.6%). Conclusion: Based on the analysis of the scientific evidence gathered in the studies, it is not possible to state that there are effective and safe drug therapies for pain management in amputee patients without causing clinically relevant adverse effects. Memantine, ketamine, gabapentin, amitriptyline, calcitonin, morphine and epidural analgesics have been mentioned. There is little evidence with high methodological rigor to support current clinical practice on the use of drug therapies for pain management in amputation.

COMMITTEE MEMBERS:
Presidente - 4665456 - DANIELE VIEIRA DANTAS
Externo à Instituição - FERNANDO HIAGO DA SILVA DUARTE - SESAP
Externa ao Programa - 2140865 - GABRIELA DE SOUSA MARTINS MELO DE ARAUJO - nullInterna - 2553720 - KATIA REGINA BARROS RIBEIRO
Externa à Instituição - MARIANA PEREIRA DA SILVA