Analgesia in patients with adhesion-related chronic abdominal and pelvic pain after surgery: a systematic review

Figures & data

Table 1. Cochrane Collaboration’s tool for bias risk assessment.

Table 2. Newcastle–Ottawa score for cohort studies and case-control studies.

Newcastle–Ottawa Quality Assessment Scale of cohort/case control studies	Silverman 2012 [22]	Martelluci 2012 [23]	Gupta 2014 [24]	Wong 2015 [25]
Selection
Representativeness of the exposed cohort	1	1	0	0
Selection of the non-exposed cohort	1	0	0	0
Ascertainment of exposure	1	0	0	0
Demonstration that outcome of interest was not present at the start of study	1	1	1	1
Selection total score	4	2	1	1
Comparability
Comparability of the cohorts	2	0	0	0
Comparability total score	2	0	0	0
Outcome
Assessment of outcome	0	0	0	0
Was follow up long enough for outcomes to occur	1	1	1	1
Adequacy of follow up of cohorts	0	1	1	1
Outcome total score	7	4	3	3

Figure 1. PRISMA flow chart.

Table 3. Characteristics of included studies.

Study	Silverman 2012 [22]	Martelluci 2012 [23]	Wong 2015 [25]	Gupta 2014 [24]
Participants	n = 18	n = 17	n = 1	n = 1
Age	26–77 years	35–71 years	28 years	60 years
Sex	Female	Female (n = 14)	Female	Female
Previous surgery	All abdominal of pelvic surgery	One possibly no intra-abdominal surgery	Abdominal and pelvic surgery	Abdominal surgery
Pain assessment	Likert-scale	Visual analogue rating scale	Numeric rating scale	Visual analogue rating scale
Baseline pain score (mean ± SD)	6.15 ± 0.72 Pregabalin	8.2 ± 0.9	8	8
	5.80 ± 0.96 Placebo
Type of intervention	Pregabalin or Placebo (blinded)	Sacral nerve modulation, 8 devices were implanted	Physical therapy ‘Soft tissue mobilisation’	Trans abdominis plane nerve modulation
	Pregabalin (open label)
Pain score after therapy (mean ± SD)	1.13 ± 1.15 Pregabalin	2.0 ± 1.4	1.0	0
	1.68 ± 1.93 Placebo
Time of treatment	8 weeks blinded phase, 4 weeks open label	1 month	6 weeks	2 weeks
Follow up	3 months	6–36 months	12 months	3 months
Drop outs	n = 8	None	None	None

Figure 2. Study design Silverman et al.

Silverman A, Samuels Q, Gikas H, et al. Pregabalin for the treatment of abdominal adhesion pain: a randomized, double-blind, placebo-controlled trial. Am J Ther. 2012;19(6):419–428.

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Martellucci J, Naldini G, Del Popolo G, et al. Sacral nerve modulation in the treatment of chronic pain after pelvic surgery. Colorectal Dis. 2012;14(4):502–507.

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Gupta M, Goodson R. Transverse abdominal plane neurostimulation for chronic abdominal pain: a novel technique. Pain Phys. 2014;17:E619–E622.

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Wong YY, Smith RW, Koppenhaver S. Soft tissue mobilization to resolve chronic pain and dysfunction associated with postoperative abdominal and pelvic adhesions: a case report. J Orthop Sports Phys Ther. 2015;45(12):1006–1016.

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