Daily Anesthesiology Research Analysis
An updated NeuPSIG meta-analysis refines first-, second-, and third-line recommendations for neuropathic pain, balancing efficacy and harm across pharmacologic and neuromodulatory options. Perioperative mental health matters: preoperative psychological distress predicted 30-day complications and 1-year mortality, while a large SEER analysis mapped stroke mortality risk in cancer patients, informing risk stratification relevant to perioperative care.
Summary
An updated NeuPSIG meta-analysis refines first-, second-, and third-line recommendations for neuropathic pain, balancing efficacy and harm across pharmacologic and neuromodulatory options. Perioperative mental health matters: preoperative psychological distress predicted 30-day complications and 1-year mortality, while a large SEER analysis mapped stroke mortality risk in cancer patients, informing risk stratification relevant to perioperative care.
Research Themes
- Evidence-based neuropathic pain therapeutics
- Perioperative risk prediction and mental health
- Onco-cardiovascular outcomes relevant to perioperative care
Selected Articles
1. Pharmacotherapy and non-invasive neuromodulation for neuropathic pain: a systematic review and meta-analysis.
Across 313 randomized trials (48,789 adults), tricyclic antidepressants, α2δ-ligands, and SNRIs showed first-line efficacy (NNT ~4.6–8.9) with acceptable harms, whereas opioids, BTX-A, and rTMS had weaker or lower-certainty benefits and were recommended as third-line. Capsaicin 8% patches and topical agents received weak second-line recommendations. The analysis was preregistered, applied RoB2 and GRADE, and provides updated, balanced guidance.
Impact: This comprehensive, preregistered meta-analysis directly informs clinical decision-making in neuropathic pain, clarifying benefit–harm trade-offs across major therapies. It is likely to influence practice patterns in pain medicine, including anesthesiology-led pain services.
Clinical Implications: Prioritize TCAs, α2δ-ligands, and SNRIs as first-line; reserve opioids, BTX-A, and rTMS for refractory cases; consider capsaicin 8% patches/topicals as second-line adjuncts. Monitor tolerability and tailor by comorbidities, accessibility, and patient preference.
Key Findings
- 313 randomized, double-blind, placebo-controlled trials (48,789 adults) synthesized with PROSPERO registration and GRADE/ROB2.
- First-line efficacy: TCAs (NNT 4.6; NNH 17.1), α2δ-ligands (NNT 8.9; NNH 26.2), SNRIs (NNT 7.4; NNH 13.9).
- Second-/third-line: capsaicin 8% patches (NNT 13.2; high NNH), BTX-A (NNT 2.7; low-certainty breadth), rTMS (NNT 4.2; low certainty), opioids (NNT 5.9; NNH 15.4; low certainty).
Methodological Strengths
- Pre-registered on PROSPERO with explicit inclusion/exclusion criteria and duplicate data extraction
- Applied Cochrane RoB2 and GRADE with risk difference modeling to derive NNT/NNH
Limitations
- Heterogeneity across etiologies, interventions, and outcome definitions; modest effect sizes for several modalities
- Limited duration (≥3 weeks) of many trials; uncertainty remains for some neuromodulation and topical therapies
Future Directions: Head-to-head comparative RCTs over longer durations, pragmatic trials in real-world populations, and refined patient stratification (phenotypes, biomarkers) to personalize therapy.
2. Preoperative psychological distress is associated with mortality within 1 year of non-cardiac surgery.
In a VISION sub-cohort (n=938 with complete K6), higher preoperative psychological distress independently predicted 30-day postoperative complications (AOR 1.12) and 1-year mortality (AOR 1.09) after non-cardiac surgery. Sensitivity analyses implicated depressive, but not anxiety, symptoms as the main driver.
Impact: Links routinely measurable preoperative mental health to hard outcomes, suggesting an actionable risk domain beyond traditional physiological indices.
Clinical Implications: Incorporate brief psychological screening (e.g., K6 or depression screens) into preoperative evaluation and consider perioperative mental health support to mitigate risk.
Key Findings
- Among 938 patients with complete K6 data, 7.9% died within 1 year after non-cardiac surgery.
- Higher preoperative distress predicted 30-day complications (AOR 1.12; 95% CI 1.02–1.22) and 1-year mortality (AOR 1.09; 95% CI 1.02–1.18) after multivariable adjustment.
- Depressive symptoms, not anxiety, primarily drove the association with 1-year mortality.
Methodological Strengths
- Prospective cohort framework (VISION) with standardized K6 assessment on day of surgery
- Adjusted for key confounders including demographics, surgery type, comorbidity, and smoking
Limitations
- Subsample size is modest and from 2011–2012, limiting precision and contemporary generalizability
- Self-reported distress and single preoperative timepoint; residual confounding remains possible
Future Directions: Randomized or pragmatic trials testing perioperative mental health interventions (e.g., brief psychotherapy, collaborative care) on surgical outcomes are warranted.
3. Temporal trends and risk factors associated with stroke mortality among cancer patients.
In SEER data from 5.9 million cancer patients (2000–2020), 2.0% died of stroke. Stroke mortality risk was highest in younger patients (≤39 years; SMR 2.31) and those receiving no cancer treatment (SMR 1.36), with declines over time across cancer types. Older age, male sex, non-white race, and nervous system, respiratory, and head/neck cancers increased risk, whereas receipt of chemotherapy or radiotherapy was associated with lower risk.
Impact: Quantifies stroke mortality risk across cancers at national scale, highlighting high-risk subgroups relevant to perioperative and survivorship planning.
Clinical Implications: For cancer patients—especially younger, untreated, and those with nervous system, respiratory, or head/neck cancers—optimize vascular risk assessment and prevention, and coordinate perioperative planning with oncology and neurology.
Key Findings
- Among 5,922,533 first primary cancer patients, 56,686 (2.0%) died from stroke.
- Highest SMR for stroke death in ≤39 years (2.31) and in patients receiving no cancer treatment (1.36).
- Risk increased with older age (HR 1.11), male sex (HR 1.06), non-white race (HR 1.13), and nervous system (HR 3.42), respiratory (HR 1.38), head/neck (HR 1.37) cancers; chemotherapy and radiotherapy associated with reduced risk (HR 0.69 each).
Methodological Strengths
- Very large, population-based cohort with 20 years of coverage
- Use of SMR, APC, and multivariable hazard models to quantify risk and trends
Limitations
- Retrospective registry data lack granular stroke subtype, treatment details, and residual confounding control
- Associations cannot establish causality; treatment selection bias likely
Future Directions: Prospective studies integrating cancer stage, therapy details, and vascular risk factors; evaluate targeted prevention strategies in high-risk subgroups.