Melanie Anderson, MLIS Library & Information ...

How an Pain e found? Preliminary analysis of searching for pain topics for systematic reviews Melanie Anderson, MLIS Library & Information Services, University Health Network, Toronto, Canada

Su je t Headings relating to Pain assigned to papers that were sele ted for in lusion, y type of pain studied

Introduction Pain can be a complicated topic to perform a systematic search for, with many subject headings and keywords to consider. In order to gain insight into how to effectively find studies addressing pain for systematic reviews, this is a preliminary analysis of how systematic reviewers are currently searching for pain topics, and how that compares to how articles about pain topics are indexed in medical databases. Methods Of 14 systematic reviews published in 2017 under the Pain, Palliative and Supportive Care group in the OVID Cochrane Database of Systematic Reviews, nine formed the basis for this analysis. The remaining five were excluded either because they were about analgesia or anesthesia and not directly about pain, or because they were reviews of Cochrane reviews and therefore did not search any database other that the Cochrane Database of Systematic Reviews. Both the database selection and the use of subject headings and keywords relating to pain pulled from the search strategies of the systematic reviews, as well as the indexing and keywords from the records for the articles selected for inclusion in the systematic reviews were examined. Diagrams 1

All of the studies that the reviewers selected for inclusion in each of the 9 reviews were searched in Medline, Embase and Cochrane Central (all OVID). Subject headings relating to pain were recorded for each study. The circles below show the number of subject headings assigned to different pain topics by database, and which subject headings were noted most often. Below ea h ir le is a ote for ho a y arti les ere ’t i a gi e data ase, a d ho ofte there as ’t a pai related su je t heading.

6 included papers

16 included papers

In Medline, with no pain related MeSH: 2 Not in Central: 1

11 included papers

Not in Medline: 2 Not in Embase: 2 Not in Central: 3

Not in Central: 1

Type of Pain Cancer pain

Chronic noncancer

# databases over base 3*

Pain section of (OVID) Medline strategy

Wiffen (2)

0

7. exp Pain/ 8. (pain* or nocicept* or neuropath*).mp.

Derry

0

9. exp Pain/ 10. (pain* or nocicept* or neuropath*).mp.

Eccleston

0

1. exp Pain, Intractable/ or exp Chronic Pain/ 2. Fibromyalgia/ 3. exp Headache Disorders/ 4. exp Arthritis/ 5. (pain* or headache* or migraine* or neuralgia* or neuropath* or arthriti* or osteoarthriti*).mp.

Fibromyalgia

Johnson

7

8. exp Fibromyalgia/ 9. Fibromyalgi$.tw. 10. Fibrositis.tw.

Neuropathic

Ju

4

1. exp Neuralgia/ 2. exp Peripheral Nervous System Diseases/ 3. exp Somatosensory Disorders/ 4. ((pain* or discomfort*) adj5 (central or complex or rheumat* or muscl* or muscul* or myofasci* or nerv* or neuralg* or neuropath*)).tw. 5. ((neur* or nerv*) adj5 (compress* or damag*)).tw.

Cooper

0

1. exp NEURALGIA/ 2. exp PERIPHERAL NERVOUS SYSTEM DISEASES/ 3. exp SOMATOSENSORY DISORDERS/ 4. ((pain* or discomfort*) adj10 (central or complex or nerv* or neuralg* or neuropath*)).mp. 5. ((neur* or nerv*) adj6 (compress* or damag*)).mp.

Postoperative

Not in Medline: 9 In Medline, with no MeSH: 1 In Medline, with no pain related MeSH: 1 Not in Embase: 3 Not in Central: 7 In Central with no SH: 3

Not in Medline: 2 In Medline, with no MeSH: 1 In Medline, with no pain related MeSH: 19 Not in Embase: 3 In Embase, with no pain related SH: 20 Not in Central: 6 In Central, with no pain related SH: 19 In Central, with no SH: 4

Su je t Headi gs relati g to Pai assig ed to papers that ere sele ted for i lusio diagra 1 • Neuropathic pain articles were assigned specific pain subject headings which did not describe neuropathic pain as defined by the search strategies used by the reviewers (headache, back pain, etc.) • Many of the pain SH assigned were broad (Pain, Pain assessment, etc.) – indicating possible usefulness of multi-angled strategies. Eg. (Fibromyalgia string OR (Pain string AND (myalg* OR muscle*) string)) rather than (Fibromyalgia string) on its own • About 40% of the articles selected for inclusion in a postoperative pain review did not have a pain related subject heading in all three databases Pain related keywords from the titles and abstracts of included papers (diagram 2) • All of the articles selected for inclusion in the chronic non- a er pai re ie used hro i pai somewhere in the title or abstract • A large number of the articles selected for the postoperative pain reviews did not have any pain related terms in the title or abstract

Wiffen (1)

0

2. exp NEURALGIA/ 3. exp PERIPHERAL NERVOUS SYSTEM DISEASES/ 4. exp SOMATOSENSORY DISORDERS/ 5. ((pain* or discomfort*) adj10 (central or complex or nerv* or neuralg* or neuropath*)).mp. 6. ((neur* or nerv*) adj6 (compress* or damag*)).mp.

Gaskell

1

5. Pain, postoperative/ 6. ((postoperative adj4 pain*) or (post-operative adj4 pain*) or post-operative-pain* or (post* adj4 pain*) or (postoperative adj4 analgesi*) or (postoperative adj4 analgesi*) or 'post-operative analgesi*').mp. 7. ((post-surgical adj4 pain*) or ('post surgical' adj4 pain*) or (post-surgery adj4 pain*)).mp. 8. ('pain-relief after surg*' or 'pain following surg*' or 'pain control after').mp. 9. (('post surg*' or post-surg*) and (pain* or discomfort)).mp. 10. ((pain* adj4 'after surg*') or (pain* adj4 'after operat*') or (pain* adj4 'follow* operat*') or (pain* adj4 'follow* surg*')).mp. 11. ((analgesi* adj4 'after surg*') or (analgesi* adj4 'after operat*') or (analgesi* adj4 'follow* operat*') or (analgesi* adj4 'follow* surg*')).mp.

Ziehm

3

1. exp Pain/ 2. Pain, Postoperative/ 3. pain*.mp.

Base 3 : All of the SRs i luded sear hes of Medli e, Embase, and Cochrane Central. Medline and Embase were OVID in all cases. Cochrane was sometimes OVID, sometimes Wiley.

49 included papers

Observations Searches performed by the reviewers (table 1) • All nine reviews included searches of Medline, Embase and Cochrane Central. Four included additional databases, ranging between one and seven • Three of the reviews used the subject headings from their Medline searches in their Embase searches • NOT a er is used i the key ord stri g of the pai se tio of the hro i o -cancer pain Embase search, but not in the Medline search for the same review • Based on records of included articles, more synonyms could be useful in the postoperative pain search strategies

Searches performed by the reviewers Systematic Review

56 included papers

Table 1

Systematic Reviews Cooper, T. E., Chen, J., Wiffen, P. J., Derry, S., Carr, D. B., Aldington, D., . . . Moore, A. R. (2017). Morphine for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews(10). Derry, S., Wiffen, P. J., Moore, A. R., McNicol, E. D., Bell, R. F., Carr, D. B., . . . Wee, B. (2017). Oral nonsteroidal anti-inflammatory drugs (NSAIDs) for cancer pain in adults. Cochrane Database of Systematic Reviews(7). Eccleston, C., Fisher, E., Thomas, K. H., Hearn, L., Derry, S., Stannard, C., . . . Moore, A. R. (2017). Interventions for the reduction of prescribed opioid use in chronic non-cancer pain. Cochrane Database of Systematic Reviews(11). Gaskell, H., Derry, S., Wiffen, P. J., & Moore, A. R. (2017). Single dose oral ketoprofen or dexketoprofen for acute postoperative pain in adults. Cochrane Database of Systematic Reviews(10). Johnson, M. I., Claydon, L. S., Herbison, P. G., Jones, G., & Paley, C. A. (2017). Transcutaneous electrical nerve stimulation (TENS) for fibromyalgia in adults. Cochrane Database of Systematic Reviews(10). Ju, Y. Z., Wang, K., Cui, S. H., Yao, Y., Liu, M. S., Zhou, J., . . . Xia, J. (2017). Acupuncture for neuropathic pain in adults. Cochrane Database of Systematic Reviews(12). (1) Wiffen, P. J., Derry, S., Bell, R. F., Rice, S. C. A., Tolle, R. T., Phillips, T., & Moore, A. R. (2017). Gabapentin for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews(10). (2) Wiffen, P. J., Derry, S., Moore, A. R., McNicol, E. D., Bell, R. F., Carr, D. B., . . . Wee, B. (2017). Oral paracetamol (acetaminophen) for cancer pain. Cochrane Database of Systematic Reviews(7). Ziehm, S., Rosendahl, J., Barth, J., Strauss, B. M., Mehnert, A., & Koranyi, S. (2017). Psychological interventions for acute pain after open heart surgery. Cochrane Database of Systematic Reviews(7).

Limitations This method of analysis requires heavy time investments, and the number of systematic reviews as well as the depth of examination was limited as a result. Concrete recommendations cannot be made based on this analysis. In future, a larger team will use this preliminary work to plan a more systematic examination. Results In these reviews, primarily Medline, Embase, and Cochrane Central were searched, although some included between one and seven additional databases. The pain related search terms varied significantly both between and within specific pain topics. The articles selected for inclusion in these systematic reviews share some subject headings across pain topics, however some headings or keywords are unique to a specific pain topic. There are a notable number of included studies whose records do not include pain related subject headings and/or pain related keywords and would therefore potentially be difficult to find through database searching using pain terms. Discussion In this preliminary analysis, potential patterns are identified in the search strategies of recent pain topic Cochrane systematic reviews as well as in the bibliographic records of papers selected for inclusion in these reviews.

Diagram 2

For each type of pain, the titles and abstracts were scanned for the pain related term used in the largest number of records, that term was noted, and the records with that term were removed from the next scan. This process was repeated until all records were accounted for – records with no pain related keywords were included, articles that were not in the database were not included.

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