Finally paediatric, microbiological, animal and cadaveric research was also excluded. Refworks web based

bibliographical management software was used to assist study selection. Identified studies from all databases (except Internurse) were combined. Following the removal of duplicate papers 1633 remained. Figure 1 summarizes the selection process. All papers were initially sorted by title. The abstracts of papers were read when the paper appeared relevant from the title or when it was unclear from the title Inhibitors,research,lifescience,medical if the paper was relevant (73 abstracts read). If the abstract suggested that there was original research about musculoskeletal pain at end of life, the paper was read (12 papers). These twelve papers were read by a second person to independently validate the inclusion criteria. Four relevant papers and one ‘letter to the editor’ were included in this review. They comprised of three case studies and two epidemiological

Inhibitors,research,lifescience,medical studies. One paper, a case study [21], located through Internurse was also included making a total of six relevant studies Inhibitors,research,lifescience,medical in the review. Figure 1 Selection of Included Studies. Quality assessment Quality assessment of research is important to assess trustworthiness [22]. However, eligibility criteria were deliberately kept broad to maximise the information available. Although case studies are generally considered to provide a weak level of evidence they do provide valid and useful information about complex clinical situations [22]. They also alert practitioners to rare side effects and benefits of disease and treatments [23,24]. Hence they were Inhibitors,research,lifescience,medical included in this review. Despite the importance of critical appraisal no research was excluded on the basis of quality assessment.

Due to the diversity of impetuses behind the papers a standard proforma was not used to extract data, rather relevant facts were extracted Inhibitors,research,lifescience,medical though multiple readings of the papers. Case study data is summarised in Table 2 and epidemiological studies in Table 3. Table 2 Study characteristics and key findings: case studies Table 3 Study characteristics and key findings: epidemiological studies Results Case reports Lewin et al’s [25] letter described the use of cervical cordotomy for musculoskeletal TCL pain in a 67 year old man with metastatic oesophageal Src inhibitor cancer and rheumatoid arthritis (RA). Following chemotherapy he had persistent, severe right hip and buttock pain at the site of an earlier total hip replacement, which restricted mobility. As he responded poorly to opioids and had a prognosis of less than a year the cordotomy was performed enabling the patient to mobilise independently till he died eleven months later. Katz et al [26] discussed the case of an elderly woman with lymphoma and a non-small cell lung cancer. Her main symptom was pain due to advanced left hip OA. This severely restricted her ability to mobilise.