نقش دارودرمانی ترکیبی در مدیریت و درمان فیبرومیالژیا در بزرگسالان
Appendices
Appendix 1. Search strategies
Cochrane Central Register of Controlled Trials (CENTRAL) (via the Cochrane LIbrary)
#1 MeSH descriptor: [Fibromyalgia] this term only
#2 MeSH descriptor: [Myofascial Pain Syndromes] explode all trees
#3 (fibromyalgia* or fibrositi* or myofascial pain):ti,ab,kw (Word variations have been searched)
#4 #1 or #2 or #3
#5 MeSH descriptor: [Drug Therapy, Combination] explode all trees
#6 (combin* or cotreat* or co‐treat* or coadministr* or co‐administr* or synerg* or isobol* or "add on*" or polytherapy):ti,ab,kw (Word variations have been searched)
#7 #5 or #6
#8 #4 and #7
MEDLINE (OVID)
1 Fibromyalgia/
2 exp Myofascial Pain Syndromes/
3 (fibromyalgia$ or fibrositi$ or myofascial pain).tw.
4 or/1‐3
5 exp Drug Therapy, Combination/
6 (combin$ or cotreat$ or co‐treat$ or coadministr$ or co‐administr$ or synerg$ or isobol$ or "add on$" or polytherapy).tw.
7 or/5‐6
8 4 and 7
9 randomized controlled trial.pt.
10 controlled clinical trial.pt.
11 randomized.ab.
12 placebo.ab.
13 drug therapy.fs.
14 randomly.ab.
15 trial.ab.
16 or/9‐15
17 exp animals/ not humans.sh.
18 16 not 17
19 8 and 18
Embase (OVID)
1 Fibromyalgia/
2 Myofascial pain syndromes/
3 (fibromyalgia$ or fibrositi$ or myofascial pain).tw.
4 or/1‐3
5 exp Drug Therapy, Combination/
6 (combin$ or cotreat$ or co‐treat$ or coadministr$ or co‐administr$ or synerg$ or isobol$ or "add on$" or polytherapy).tw.
7 or/5‐6
8 4 and 7
9 random$.tw.
10 factorial$.tw.
11 crossover$.tw.
12 cross over$.tw.
13 cross‐over$.tw.
14 placebo$.tw.
15 (doubl$ adj blind$).tw.
16 (singl$ adj blind$).tw.
17 assign$.tw.
18 allocat$.tw.
19 volunteer$.tw.
20 Crossover Procedure/
21 double‐blind procedure.tw.
22 Randomized Controlled Trial/
23 Single Blind Procedure/
24 or/9‐23
25 (animal/ or nonhuman/) not human/
26 24 not 25
27 8 and 26
Appendix 2. GRADE: criteria for assigning grade of evidence
The GRADE system uses the following criteria for assigning a quality level to a body of evidence (Schünemann 2011b).
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High: randomised trials; or double‐upgraded observational studies.
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Moderate: downgraded randomised trials; or upgraded observational studies.
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Low: double‐downgraded randomised trials; or observational studies.
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Very low: triple‐downgraded randomised trials; or downgraded observational studies; or case series/case reports.
Factors that may decrease the quality level of a body of evidence are:
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limitations in the design and implementation of available studies suggesting high likelihood of bias;
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indirectness of evidence (indirect population, intervention, control, outcomes);
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unexplained heterogeneity or inconsistency of results (including problems with subgroup analyses);
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imprecision of results (wide confidence intervals);
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high probability of publication bias.
Factors that may increase the quality level of a body of evidence are:
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large magnitude of effect;
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all plausible confounding would reduce a demonstrated effect or suggest a spurious effect when results show no effect;
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dose‐response gradient.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
| Any combination of two or more drugs compared with placebo or other comparators, or both, for fibromyalgia | ||
| Patient or population: adults with fibromyalgia Settings: community Intervention: any combination of two or more drugs (note: our searches found nine combinations of drugs) Comparison: placebo and/or other comparators | ||
| Outcome | Result | GRADE |
|---|---|---|
| Patient‐reported pain relief of 30% or greater | No or insufficient data for analysis for any combination of drugs | Very low quality, as no data for analysis |
| Patient‐reported pain relief of 50% or greater | No or insufficient data for analysis for any combination of drugs | Very low quality, as no data for analysis |
| Patient‐reported global impression of clinical change much or very much improved (moderate improvement) | No or insufficient data for analysis for any combination of drugs | Very low quality, as no data for analysis |
| Any pain‐related outcome indicating some improvement | No or insufficient data for analysis for any combination of drugs | Very low quality, as no data for analysis |
| Participants experiencing any adverse event | No or insufficient data for analysis for any combination of drugs | Very low quality, as no data for analysis |
| Participants experiencing any serious adverse event | No or insufficient data for analysis for any combination of drugs | Very low quality, as no data for analysis |
| Withdrawals due to adverse events | No or insufficient data for analysis for any combination of drugs | Very low quality, as no data for analysis |
| GRADE Working Group grades of evidence | ||
| First author, year | Trial comparisons | |||
|---|---|---|---|---|
| Placebo‐controlled | Combination vs. only 1 component | Combination vs. both components | Combination vs. other | |
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| aNicolodi 1996 compared a monoamine oxidase inhibitor, 5‐hydroxytryptophan, their combination, and amitriptyline. | ||||
