Systematic review of pharmacological therapies for the management of ischaemic pain in patients with non-reconstructable critical limb ischaemia.
AffiliationMilford Care Centre, Castletroy, Limerick, Ireland; Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.
peripheral vascular disease
MetadataShow full item record
CitationSystematic review of pharmacological therapies for the management of ischaemic pain in patients with non-reconstructable critical limb ischaemia. 2017 BMJ Support Palliat Care
JournalBMJ supportive & palliative care
AbstractCritical limb ischaemia (CLI) is a severe manifestation of peripheral arterial disease, characterised by chronic ischaemic rest pain, ulcers or gangrene. Management of ischaemic pain is challenging in patients with no options for revascularisation and optimal pharmacological therapies have not been established.
To identify and evaluate the effectiveness of pharmacological therapies to treat ischaemic pain secondary to non-reconstructable CLI.
This systematic review was reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. Comprehensive searches of three electronic databases, a PubMed-related articles link search, grey literature search and hand-searches of the bibliographies of relevant papers and textbooks were performed. Studies recruiting adult patients with CLI of any aetiology were eligible for inclusion. Surgical and revascularisation procedures, and all invasive interventions were excluded.
Of 792 studies, six met full inclusion criteria. These studies researched the use of intravenous lidocaine, intravenous ketamine, oral gabapentin and the combination of transdermal buprenorphine and epidural morphine/ropivacaine infusion. All studies showed an improvement in severity of ischaemic pain in CLI but with varying side effect profiles and quality. The extracted studies showed substantial heterogeneity and therefore a meta-analysis was not performed.
The pharmacological management of pain secondary to non-reconstructable CLI is a challenging review topic. No recommendations of pharmacological agents can be made following this review but a number of novel approaches to manage pain in this cohort have shown positive results and require further investigation.
The following license files are associated with this item:
- Creative Commons
Except where otherwise noted, this item's license is described as Archived with thanks to BMJ supportive & palliative care
- Lumbar sympathectomy techniques for critical lower limb ischaemia due to non-reconstructable peripheral arterial disease.
- Authors: Karanth VK, Karanth TK, Karanth L
- Issue date: 2016 Dec 13
- Intravenous naftidrofuryl for critical limb ischaemia.
- Authors: Smith FB, Bradbury AW, Fowkes FG
- Issue date: 2000
- Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin: systematic review and economic evaluation.
- Authors: Simpson EL, Duenas A, Holmes MW, Papaioannou D, Chilcott J
- Issue date: 2009 Mar
- Venous Arterialisation for Salvage of Critically Ischaemic Limbs: A Systematic Review and Meta-Analysis.
- Authors: Schreve MA, Vos CG, Vahl AC, de Vries JP, Kum S, de Borst GJ, Ünlü Ç
- Issue date: 2017 Mar