Efficacy of pharmacological and non-pharmacological therapy on chronic cancer pain intensity of adults with cancer: A network meta-analysis protocol.

Background: Chronic cancer pain is very common symptom in cancer patients, but this issue has not been satisfactorily resolved by the conventional three-step analgesic therapy. There are multiple non-pharmacological interventions for managing chronic cancer pain, but we haven't reached a consensus on which non pharmacological treatment is the best and these treatments are lack of high-quality evidence. In order to identify the most effective non-pharmaceutical therapy alternatives and investigate further possible medication interventions, this study will use network meta-analysis to assess the therapeutic effects of pharmacological and non-pharmacological treatments on chronic cancer pain patients and support clinical decision-making by prioritizing therapies according to the most valuable clinical outcomes for these patients.

Methods and analysis: We will carry out a systematic search of published randomized controlled trials (group, crossover, and parallel) in the PubMed, Web of Science, Cochrane Library, MEDLINE, Embase, and CINAHL databases, without language or date restrictions, in accordance with the PRISMA for Network Meta-Analyses (PRISMA-NMA) guidelines. Included studies must evaluate the effects of pharmacological and non-pharmacological treatments in patients with chronic cancer pain. Adult chronic cancer pain patients (≥ 18 years old) receiving pharmacological or non-pharmacological treatment will be our target participants. Our primary outcomes will be pain intensity, total effective rate of treatment, onset time, and quality of Life (QoL); Adverse reaction will be our secondary outcome. We'll utilize the mean difference (MD) for continuous variables, the odds ratio (OR) for binary variables, and the 95% confidence interval (CI) for interval estimates. The Cochrane Bias Risk Tool (RoB2.0) will be used to assess the bias risk of every RCT trial included in NMA. We will use Review Manager 5.3 software to conduct heterogeneity testing and meta-analysis. The network meta-analysis will be performed by ADDIS1.16.8 software. The Confidence in Network Meta-analysis (CINeMA) framework will be used to evaluate the level of confidence in the NMA results. Besides, we will use SUCRA for ranking the network meta-analysis results, and we will also apply normalized entropy to verify the accuracy of the SUCRA ranking outcomes.

Discussion: This network meta-analysis will compare the efficacy of pharmacological versus non-pharmacological treatments for pain intensity in chronic cancer pain patients. The final analysis results may be significantly heterogeneous, because the population with cancerous pain suffers from different types of cancers. Owing to the databases primary reliance on our listed databases for inclusion, potentially valuable research will be overlooked.

Registration: This study has been registered in the PROSPERO database (CRD42024505214).