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61. AIM Clinical Appropriateness Guidelines for Interventional Pain Management

Management 4 Epidural Injection Procedures and Diagnostic Selective Nerve Root Blocks Description Epidural steroid injection (ESI) involves the administration of corticosteroid via insertion of a needle into the epidural space surrounding the spinal nerve root. Despite the lack of consistent evidence to support its efficacy, the procedure is widely used in patients with chronic back, neck and radicular pain. In 2014, the US Food and Drug Administration issued a drug safety communication about epidural (...) cumulative dose of steroid must be documented and may not exceed 240 mg of methylprednisolone or triamcinolone or 36 mg of betamethasone or 45 mg of dexamethasone. Contraindications and Risks The following conditions should prompt further evaluation prior to considering ESI: ? New onset of low back pain or neck pain in the setting of established malignancy, or where there is a suspicion of malignancy based on the clinical presentation ? New onset of low back pain or neck pain in persons with risk factors

2019 AIM Specialty Health

62. Assessment and Management of Pain (Third Edition)

Assessment and Management of Pain (Third Edition) Clinical Best Practice Guidelines DECEMBER 2013 Assessment and Management of Pain Third EditionDisclaimer These guidelines are not binding on nurses or the organizations that employ them. The use of these guidelines should be flexible, and based on individual needs and local circumstances. They neither constitute a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time (...) and published in its entirety, without modification, in any form, including in electronic form, for educational or non-commercial purposes. Should any adaptation of the material be required for any reason, written permission must be obtained from the Registered Nurses’ Association of Ontario. Appropriate credit or citation must appear on all copied materials as follows: Registered Nurses’ Association of Ontario (2013). Assessment and Management of Pain (3 rd ed.). T oronto, ON: Registered Nurses

2013 Registered Nurses' Association of Ontario

63. Pelvic Girdle Pain in the Antepartum Population: Physical Therapy Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Section on Women's Health and the Orthopaedic Section of the American Full Text available with Trip Pro

the use of exercise in the antepartum population with PGP. The American College of Obstetrics and Gynecologists (ACOG) and the Canadian Clinical Practice Guidelines (CPGs) have recommended exercise for health benefits because of the low risk and minimal adverse effects for the antepartum population. The 2 systematic reviews as well as the recent randomized controlled trials (RCTs) were nonspecific in the application of exercise to heterogeneous groups of pregnancy low back pain (PLBP) and PGP (...) , Massachusetts Lennox Hoyte MD—OB/Gyn, University of South Florida Medical Group, Tampa, Florida Tonya Satteson, BA, Bulter, Pennsylvania (consumer) | Classification The primary ICD-10 codes and conditions associated with PGP during pregnancy are as follows: R10.2, pelvic pain; M54.5, low back pain (LBP); M53.3, sacrococcygeal disorders not elsewhere classified; O26.9, pregnancy-related condition, unspecified; R29.3, abnormal posture; M48.48, fatigue (stress) fracture of vertebra, sacral and sacrococcygeal

2017 American Physical Therapy Association

64. Management of chronic pain

, resulting in significant suffering and disability. 2-4 While in many cases it is accepted that a cure is unlikely, the impact on quality of life, mood and function can be significantly reduced by appropriate measures. Chronic pain not only has an impact on affected individuals and their families, it also has substantial economic costs. For example, back pain alone was estimated to cost £12 billion per annum in the UK in 1998, and arthritis-associated pain costs around 2.5% of the gross national product (...) of their form, are recommended in the management of patients with chronic pain. A Advice to stay active should be given in addition to exercise therapy for patients with chronic low back pain to improve disability in the long term. Advice alone is insufficient. 2 • Key recommendations6 | Management of chronic pain 3 Assessment and planning of care 3.1 ASSESSMENT TOOLS There is consensus that it is good practice to assess severity, impact and type of pain before the initiation of treatment, to guide

2013 SIGN

65. Neck pain - non-specific: Scenario: Management

of primary medical care primary care [ ], narrative reviews The diagnosis and treatment of nonspecific neck pain and whiplash [ ], The diagnosis and treatment of nonspecific neck pain and whiplash [ ], Advances in the diagnosis and management of neck pain [ ], and what CKS considers good clinical practice. Analgesics Few clinical trials have evaluated drugs for neck pain, so treatment is often based on generalization from studies performed for back pain [ ]. Two moderately sized placebo controlled trials (...) established short term (2-8 days) benefit for topical diclofenac in people with neck and upper back pain secondary to suspected muscle and joint disease. Although evidence is insufficient to assess the effects of drugs to treat neck pain, CKS considers it is reasonable to extrapolate evidence from trials of these drugs for back pain and other painful musculoskeletal conditions. Lifestyle measures Although there is no trial evidence, expert opinion in review articles [ ; ] recommends that: Postural aspects

2018 NICE Clinical Knowledge Summaries

66. Neck pain - cervical radiculopathy: Scenario: Management

asymptomatic or only mildly incapacitated [ ]. Few non-surgical treatments have been studied for cervical radiculopathy and few randomized controlled trials have specifically tested drug treatments for cervical radicular pain [ ]. Although evidence is insufficient to assess the effects of drugs to treat neck pain, CKS considers it is reasonable to extrapolate evidence from trials of these drugs for back pain and other painful musculoskeletal conditions. There is no evidence for the effectiveness of low (...) Neck pain - cervical radiculopathy: Scenario: Management Scenario: Management | Management | Neck pain - cervical radiculopathy | CKS | NICE Search CKS… Menu Scenario: Management Neck pain - cervical radiculopathy: Scenario: Management Last revised in September 2018 Scenario: Management From age 16 years onwards. Management If (suggesting a serious spinal abnormality) are present, refer urgently or arrange immediate assessment, depending on clinical judgement. If the person has severe

2018 NICE Clinical Knowledge Summaries

67. Neck pain - cervical radiculopathy: How should I assess someone with suspected cervical radiculopathy?

, for papulovesicular rash, petechiae or purpura. Consider examining for Kernig's sign (painful/resisted extension of leg bent at hip and knee) and Brudzinski's sign (reflective flexion of the knees when patient is on his/her back and the neck is bent forwards) to demonstrate nuchal rigidity if meningitis is suspected. Exclude of neck pain. A combination of tests can be used to help identify cervical radiculopathy, including: The Spurling test — flex the neck laterally, rotate and then press on top of the person's (...) Neck pain - cervical radiculopathy: How should I assess someone with suspected cervical radiculopathy? Assessment | Diagnosis | Neck pain - cervical radiculopathy | CKS | NICE Search CKS… Menu Assessment Neck pain - cervical radiculopathy: How should I assess someone with suspected cervical radiculopathy? Last revised in September 2018 How should I assess someone with suspected cervical radiculopathy? Take a detailed medical history and conduct a physical examination to distinguish neuropathic

2018 NICE Clinical Knowledge Summaries

68. Neck pain - acute torticollis: Scenario: Management

in the diagnosis and management of neck pain [ ], and Cochrane systematic reviews Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment [ ], and Exercises for mechanical neck disorders [ ], and what CKS considers good clinical practice. Few clinical trials have evaluated drugs for neck pain, so treatment is often based on generalization from studies performed for back pain [ ]. Muscle relaxants can alleviate pain and improve function in people (...) Neck pain - acute torticollis: Scenario: Management Scenario: Management | Management | Neck pain - acute torticollis | CKS | NICE Search CKS… Menu Scenario: Management Neck pain - acute torticollis: Scenario: Management Last revised in September 2018 Scenario: Management From age 16 years onwards. How should I manage someone with acute torticollis? Offer people with acute torticollis oral analgesics (for example, ibuprofen, paracetamol or codeine) — the choice depends on the severity of pain

2019 NICE Clinical Knowledge Summaries

69. Neck pain - acute torticollis: How should I assess someone with suspected acute torticollis?

to exclude cervical radiculopathy. Consider looking for Kernig's sign (painful/resisted extension of leg bent at hip and knee) and Brudzinski's sign (reflective flexion of the knees when patient is on his/her back and the neck is bent forwards) to demonstrate nuchal rigidity if meningitis is suspected. Identify and urgently refer people with indicative of serious spinal pathology. Exclude of neck pain. Basis for recommendation These recommendations are extrapolated from the British Medical Journal (BMJ (...) Neck pain - acute torticollis: How should I assess someone with suspected acute torticollis? Assessment | Diagnosis | Neck pain - acute torticollis | CKS | NICE Search CKS… Menu Assessment Neck pain - acute torticollis: How should I assess someone with suspected acute torticollis? Last revised in September 2018 How should I assess someone with suspected acute torticollis? Acute torticollis is diagnosed clinically — in typical cases which present within 1–2 days of onset of symptoms

2019 NICE Clinical Knowledge Summaries

70. Neuropathic pain - drug treatment: Pregabalin

, abdominal distension, dry mouth (common); gastroesophageal reflux disease, salivary hypersecretion, oral hypoaesthesia (uncommon). Rarely: ascites, pancreatitis, swollen tongue, dysphagia. Metabolism and nutrition — increased appetite and weight gain. Some people with diabetes mellitus may need to adjust hypoglycaemic medicines. Musculoskeletal and connective tissue — muscle cramp, arthralgia, back pain, limb pain, cervical spasm (common); joint swelling, myalgia, muscle twitching, neck pain, muscle (...) Neuropathic pain - drug treatment: Pregabalin Pregabalin | Prescribing information | Neuropathic pain - drug treatment | CKS | NICE Search CKS… Menu Pregabalin Neuropathic pain - drug treatment: Pregabalin Last revised in February 2020 Pregabalin Is pregabalin licensed for neuropathic pain? Pregabalin is licensed for the treatment of peripheral or central neuropathic pain in adults [ ]. However, the National Institute for Health and Care Excellence (NICE) recommends pregabalin as a first-line

2017 NICE Clinical Knowledge Summaries

71. Neuropathic pain - drug treatment: Gabapentin

); pancreatitis (frequency unknown). Infections and infestations — viral infection (very common); pneumonia, respiratory infection, urinary tract infection, otitis media (common). Metabolism and nutrition — anorexia, increased appetite (common); hyperglycaemia (uncommon); hyponatraemia (frequency unknown). Musculoskeletal and connective tissue — arthralgia, myalgia, back pain, twitching (common); rhabdomyolysis, myoclonus (frequency unknown). Nervous system — dizziness, somnolence, ataxia (very common (...) Neuropathic pain - drug treatment: Gabapentin Gabapentin | Prescribing information | Neuropathic pain - drug treatment | CKS | NICE Search CKS… Menu Gabapentin Neuropathic pain - drug treatment: Gabapentin Last revised in February 2020 Gabapentin Is gabapentin licensed for neuropathic pain? Gabapentin is licensed for the treatment of peripheral neuropathic pain such as painful diabetic neuropathy and postherpetic neuralgia in adults [ ]. However, the National Institute for Health and Care

2016 NICE Clinical Knowledge Summaries

72. Neck pain - whiplash injury: How should I assess someone with suspected whiplash injury?

information, see the section on in the CKS topic on . Consider examining for Kernig's sign (painful/resisted extension of leg bent at hip and knee) and Brudzinski's sign (reflective flexion of the knees when patient is on his/her back and the neck is bent forwards) to demonstrate nuchal rigidity if meningitis is suspected. Palpate the neck for tenderness. Inspect the skin — for example, for papulovesicular rash, petechiae or purpura. Assess any associated injuries. Exclude other causes of neck pain (...) Neck pain - whiplash injury: How should I assess someone with suspected whiplash injury? Assessment | Diagnosis | Neck pain - whiplash injury | CKS | NICE Search CKS… Menu Assessment Neck pain - whiplash injury: How should I assess someone with suspected whiplash injury? Last revised in October 2018 How should I assess someone with suspected whiplash injury? In people with neck pain following sudden extension, flexion or rotation of the neck: Take a detailed medical history, ask about

2018 NICE Clinical Knowledge Summaries

73. Neck pain - whiplash injury: Scenario: Whiplash injury

be prescribed for people with acute whiplash-associated disorders (WAD) grades II and III experiencing severe pain (pain on the Visual Analogue Scale [VAS] of more than 8) for a limited period of time. Few randomized controlled trials have specifically tested drug treatments for neck pain. Although evidence is insufficient to assess the effects of drugs to treat neck pain, it is reasonable to extrapolate evidence from trials of these drugs for back pain and other painful musculoskeletal conditions (...) Neck pain - whiplash injury: Scenario: Whiplash injury Scenario: Whiplash injury | Management | Neck pain - whiplash injury | CKS | NICE Search CKS… Menu Scenario: Whiplash injury Neck pain - whiplash injury: Scenario: Whiplash injury Last revised in October 2018 Scenario: Whiplash injury From age 16 years onwards. How do I manage whiplash injury in primary care? Offer self-care advice: Provide reassurance that recovery from whiplash-associated disorder usually occurs within the first 2 to 3

2016 NICE Clinical Knowledge Summaries

74. Pain Management Programs – Which Patient for Which Program?

input by a clinical psychologist and physiotherapist) for patients with chronic back pain at Westmead Hospital. The program comprised 5 one hour sessions with the clinical psychologist over 5 weeks, and 10 two hour physiotherapy exercise sessions over the same 5 weeks (a total of 15 hours). The results indicated the combined intervention had some effect on disability, pain beliefs, and pain coping strategies, but not on depression severity. When similar methods were applied to similar chronic pain (...) later (Williams et al., 1999). Marhold et al. (2001) found that a 6 session (2 hours per session) CBT program for patients with mildly and moderately disabled back pain patients, achieved significant improvements only in the mildly disabled patients, suggesting the intervention was not sufficiently powerful for the more disabled cases. Finally, a systematic review (Guzman et al., 2001) of randomised controlled trial (RCT) studies of psychosocial treatments for patients with chronic, moderate

2017 Agency for Clinical Innovation

75. Treatment of pelvic pain associated with endometriosis: a committee opinion

symptomsandsideeffectsislessthanthatwhichwouldstim- ulate endometriosis (76). Although norethindrone acetate is theonlyhormoneapprovedbytheUSFoodandDrugAdmin- istration for add-back therapy, other combinations of low- doseEandprogestogensalsohavebeenshowntobeeffective in decreasing hypoestrogenic side effects and maintaining bone density, and not adversely affecting the extent of pain relief achieved with GnRH-a treatment (52, 77). The add- backtherapyshouldbestartedatthesametimeastheagonist rather than delaying until a period (...) ). There are con?icting results regarding the effectiveness of continuous versus cyclic regimens for limiting the recurrence of pain and endometriomas (90–93). LONG-TERMMANAGEMENT Endometriosis potentially is a chronic disease that can result insigni?cantmorbidity.Consequently,along-termmanage- ment plan isbene?cial. Endometriosis is best viewed primar- ily as a medical disease with surgical back-up. Individuals withchronicsuper?cialorpresumeddiseaseshouldbetreated medically, reserving surgery for those having

2014 Society for Assisted Reproductive Technology

76. Guidance for Members on Driving and Pain

the potential to affect driving performance through adverse effects on physical function and cognition. For example, musculoskeletal conditions can cause difficulty with the physical act of driving e.g. people with low back pain may experience difficulties using foot pedals. 4 Tests of ‘on road’ driving performance show that patients with chronic non-malignant pain perform poorly compared to matched healthy controls. 5 When surveyed, 70% of chronic pain patients indicated that pain limited their driving (...) Guidance for Members on Driving and Pain Driving and Pain Guidance for Faculty of Pain Medicine Members Introduction Road traffic accidents remain a significant public health problem in the UK. In 2016 there were over 180,000 casualties resulting from driving accidents in Britain. 1 Despite a steady decline in deaths on UK roads (from a peak in 1966), around 1800 people a year still die in road accidents. This figure has remained largely unchanged since 2010. The top two contributing factors

2017 Faculty of Pain Medicine

77. Developmental rheumatology in children: Scenario: Growing pains

for specialist assessment, using clinical judgement to determine the urgency, if any of the following are present: features. Pain that is: Unilateral or asymmetric. Persistent or increasing in severity. Widespread (for example upper limbs and back). Occurring in the morning or with activities. Localised to a joint. An atypical history. Systemic symptoms (for example fatigue, malaise, decreased appetite). Abnormalities on physical examination (for example refusal to bear weight, limp, or changes in gait (...) Developmental rheumatology in children: Scenario: Growing pains Scenario: Growing pains | Management | Developmental rheumatology in children | CKS | NICE Search CKS… Menu Scenario: Growing pains Developmental rheumatology in children: Scenario: Growing pains Last revised in April 2019 Scenario: Growing pains From birth to 16 years. When should I consider referring a child with growing pains? Management in the community (for example by a physiotherapist with paediatric expertise) is usually

2019 NICE Clinical Knowledge Summaries

78. Greater trochanteric pain syndrome (trochanteric bursitis): Differential diagnosis

the knee; often accompanied by low back pain. Examination: symptoms can be reproduced by the straight leg raising test or by the femoral nerve stretch test. For more information, see the CKS topic on . Basis for recommendation The information on the clinical features of conditions that can present similarly to greater trochanteric pain syndrome is based on expert opinion from two review articles [ ; ] and the medical textbook Oxford Textbook of Rheumatology [ ]. © . (...) Greater trochanteric pain syndrome (trochanteric bursitis): Differential diagnosis Differential diagnosis | Diagnosis | Greater trochanteric pain syndrome (trochanteric bursitis) | CKS | NICE Search CKS… Menu Differential diagnosis Greater trochanteric pain syndrome (trochanteric bursitis): Differential diagnosis Last revised in August 2016 Differential diagnosis Conditions which can present similarly to greater trochanteric pain syndrome include: Soft-tissue conditions Iliotibial band

2019 NICE Clinical Knowledge Summaries

79. Analgesia - mild-to-moderate pain: Scenario: Weak opioids

back pain and osteoarthritis. For more information, see the supporting evidence sections in the CKS topics on and . The adverse effect profile of tramadol is similar to codeine and dihydrocodeine, although it has a greater potential for drug interactions than either codeine or dihydrocodeine. Use of weak opioids in children Codeine and dihydrocodeine are licensed for use in children [ ; ]. However, following a review by the European Medicines Agency (EMA), the use of codeine as an analgesic (...) Analgesia - mild-to-moderate pain: Scenario: Weak opioids Scenario: Weak opioids | Management | Analgesia - mild-to-moderate pain | CKS | NICE Search CKS… Menu Scenario: Weak opioids Analgesia - mild-to-moderate pain: Scenario: Weak opioids Last revised in September 2015 Scenario: Weak opioids Which weak opioid should I prescribe? Adults Codeine, dihydrocodeine, or tramadol may be prescribed for the treatment of mild-to-moderate pain in people who have an inadequate response to paracetamol

2015 NICE Clinical Knowledge Summaries

80. Consensus Practice Guidelines on Interventions for Lumbar Facet Joint Pain from a Multispecialty, International Working Group Full Text available with Trip Pro

of treatment is a source of contention and scientific debate. Regarding prevalence, the cited frequency of lumbar facet joint pain ranges from as low as 4.8% in the multicenter National Low Back Pain Survey evaluating final diagnoses of 2374 patients with low back pain (LBP) referred to an orthopedic or neurosurgical spine surgeon, to over 50% in systematic reviews on prevalence studies using varying criteria for diagnostic blocks performed by interventional pain physicians. The wide disparity in reported (...) considered for sections pertaining to risk mitigation and complications. Keywords used to address guideline topics were tailored to individual questions and included ‘facet’, ‘low back pain’, ‘zygapophysial’, ‘zygapophyseal’, ‘radiofrequency’, ‘denervation’, ‘ablation’ and ‘arthritis’. Conclusions for each topic were graded on a scale from A to D, or as insufficient, according to the US Preventative Services Task Force grading of evidence guidelines, with the level of certainty rated as high, medium

2020 American Society of Regional Anesthesia and Pain Medicine

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