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81. Consensus Practice Guidelines on Interventions for Lumbar Facet Joint Pain

blocks and radiofrequency ablation (RFA) to treat low back pain (LBP), yet nearly all aspects of the procedures remain controversial. Methods After approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, letters were sent to a dozen pain societies, as well as representatives from the US Departments of Veterans Affairs and Defense. A steering committee was convened to select preliminary questions, which were revised by the full committee. Questions were (...) in clinical practice. In Trodu CTIon There are few conditions in interventional pain medicine as controversial as lumbar facet joint pain. Everything from incidence, to diagnostic criteria, patient selection for interventions and the effec- tiveness 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

2020 American Academy of Pain Medicine

82. Pain in Older People

a thorough history of the pain, presence of other co-morbidities, medication use and physical examination. 40 Particular attention should be paid to the presence of clinical red flags. Red flags were originally described in the context of lower back pain and are clinical indicators to serious underlying pathology, such as cancer, fractures or epidural abscess. Advanced age itself is a red flag. Other red flags include; pain that is progressive, pain that impairs sleep or is constant and non-mechanical (...) in nature, loss of weight, a history of malignancy and any back pain in the context of focal neurological deficits. Assessment should also focus on particular clinical situations where therapy is available that may modify the disease process, such as joint arthroplasty for osteoarthritis, ischaemic limb pain responsive to vascular surgery or rheumatoid arthritis for which multiple disease modifying drugs are useful. 41 Judicious use of investigations is recommended when one of the above conditions

2012 Australian and New Zealand Society for Geriatric Medicine

83. Hip pain in young adults

trochanter, buttock or lateral thigh can suggest trochanteric bursitis, a tear of the gluteus medius muscle or a snapping hip. 3 Patients with FAI most commonly report groin (88%), lateral hip (67%) and anterior thigh (35%) pain but may also complain of buttock (29%), knee (27%) and lower back (23%) pain. 4 Other conditions that present predominantly with groin pain (eg. osteitis pubis, incipient inguinal hernia, adductor tendinopathies) have been the focus of a previous review article 5 (...) the iliopsoas tendon is often audible and recreated when the hip is passively moved from flexion, abduction and external rotation to a position of extension with internal rotation. 7 Snapping from the ITB is more visible than it is audible and patients often refer to the sensation of subluxation or dislocation as the tensor fascia lata ‘snaps’ back and forth across the greater trochanter. 7 Gluteus muscle tears typically present with buttock pain, which is reproduced by palpation, but symptoms may also

2014 Clinical Practice Guidelines Portal

84. Acupuncture and Chinese Herbal Medicine for Women with Chronic Pelvic Pain

Acupuncture and Chinese Herbal Medicine for Women with Chronic Pelvic Pain Acupuncture and Chinese Herbal Medicine for Women with Chronic Pelvic Pain Scientific Impact Paper No. 30 February 2012Acupuncture and Chinese Herbal Medicine for Women with Chronic Pelvic Pain 1. Background Chronic pelvic pain (CPP) can be defined as intermittent or constant pain in the lower abdomen or pelvis of at least six months’ duration, not occurring exclusively with menstruation or intercourse and not associated (...) of research looking at biologically plausible mechanisms that could act to improve chronic pelvic pain through anti-inflammatory and other activities. 6–8 2.1 Acupuncture and CPP Acupuncture is a system of medicine that evolved in China over 2000 years ago. It involves the insertion of fine needles into specific, defined, points distributed over the body surface. Stimulation of these points is considered to be able to induce a local and systemic healing response. 9 Frequency of treatment varies from acute

2012 Royal College of Obstetricians and Gynaecologists

85. Chronic Pelvic Pain, Initial Management

pain. 2. Background and introduction Chronic pelvic pain can be defined as intermittent or constant pain in the lower abdomen or pelvis of a woman of at least 6 months in duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy. It is a symptom not a diagnosis. Chronic pelvic pain presents in primary care as frequently as migraine or low-back pain 1 and may significantly impact on a woman’s ability to function. 2 Living with any chronic pain carries (...) treatment group. 52 In a meta-analysis of pain management in a related condition involving over 3000 women, a multidisciplinary approach to chronic back pain has been shown to be effective both in reducing subjective pain measures and in improving work and social functioning. 53 When an interdisciplinary approach is adopted for the management of chronic pelvic pain, improvement is seen only when all components of the programme are in place. 54 In a study of 53 women with chronic pelvic pain undergoing

2012 Royal College of Obstetricians and Gynaecologists

86. Palliative Care for the Patient with Incurable Cancer or Advanced Disease: Part 2: Pain and Symptom Management

Palliative Care for the Patient with Incurable Cancer or Advanced Disease: Part 2: Pain and Symptom Management Guidelines & Protocols Advisory Committee Palliative Care for the Patient with Incurable Cancer or Advanced Disease Part 2: Pain and Symptom Management Effective Date: February 22, 2017 Scope This guideline presents strategies for the assessment and management of cancer pain, and symptoms associated with advanced disease, in patients = 19 years of age. Part 2 is divided into seven (...) sections, providing recommendations for evidence-based symptom management with algorithms to facilitate quick access to the information required. Hyperlinked notes in the algorithm refer back to more detailed information within each symptom section. Key symptom areas addressed are: • Constipation: Guideline | Medication Table • Delirium: Guideline | Medication Table • Depression: Guideline | Medication Table • Dyspnea: Guideline | Medication Table • Fatigue and Weakness: Guideline | Medication Table

2017 Clinical Practice Guidelines and Protocols in British Columbia

87. Persistent Vulvar Pain

biopsies) were noted among 61% (55 of 90 biopsy specimens) of patients with refractory vulvodynia ( ). Thus, although there are no specific histopathologic features of vulvodynia, clinicians should assess the need for biopsy to exclude other etiologies. Vulvar pain also may be referred pain from other parts of the body, such as the back or hips, so a thorough musculoskeletal evaluation should be considered (4) (see Fig. 3, Fig. 4, Fig. 5). A musculoskeletal evaluation would help rule out (...) greater odds of improvement compared with patients with primary dyspareunia; those with constant pain in addition to dyspareunia are less likely to achieve pain reduction after surgery (15). Vestibuloplasty (a procedure that involves incising the distal perimeter of the vulvar vestibule, undermining the vestibule, and securing it back in place after removal of only the underlying submucosal minor vestibular glands) is reported to be ineffective (14). There may, however, be subsets of patients more

2016 American College of Obstetricians and Gynecologists

88. Management of Chronic Pain in Survivors of Adult Cancers Full Text available with Trip Pro

Management of Chronic Pain in Survivors of Adult Cancers Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline | Journal of Clinical Oncology Search in: Menu Article Tools ASCO SPECIAL ARTICLE Article Tools OPTIONS & TOOLS COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2016.68.5206 Journal of Clinical Oncology - published online before print July 25, 2016 PMID: Management of Chronic Pain (...) ; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY. Abstract Section: Purpose To provide evidence-based guidance on the optimum management of chronic pain in adult cancer survivors. Methods An ASCO

2016 American Society of Clinical Oncology Guidelines

89. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

clinical settings, the procedure itself may expose the epidural space to multiple traumatic processes, as there may be multiple needle and lead insertions as well as multiple attempts to steer and redirect the leads. Patients with neck or back pain undergoing ESIs or other spinal interventions may have significant spinal abnormalities including spinal stenosis, ligamentum flavum hypertrophy, spondylolisthesis, or spondylosis which may compact the epidural venous plexus within tight epidural spaces (...) of the anterior tubercles of the cervical vertebral bodies. Inadvertent needle damage to these structures has resulted in retropharyngeal hematomas. | Chronic Pain and Stress as a Hypercoagulable State Population and observational studies clearly demonstrate the coexistence of chronic back pain, stress, and other psychosocial comorbidities. The stress model for chronic pain is well established in humans and animals as evidenced by the high level of stress hormones compared with control subjects. The sustained

2018 American Society of Regional Anesthesia and Pain Medicine

90. Diagnosis and Treatment Interstitial Cystitis/Bladder Pain Syndrome

such as the lower abdomen and back. 18, 42, 49 Warren and colleagues (2006) found that by using "pelvic pain" as the key descriptor that 100% of his population fit the case definition. 50 It is important that the term "pain" encompass a broad array of descriptors. Many patients use other words to describe symptoms, especially “pressure” and may actually deny pain. 49, 51 Finally, pain that worsened with specific foods or drinks and/or worsened with bladder filling and/or improved with urination contributed (...) Diagnosis and Treatment Interstitial Cystitis/Bladder Pain Syndrome Intertitial Cystitis (IC/BPS) Guideline - American Urological Association advertisement Toggle navigation About Us About the AUA Membership AUA Governance Industry Relations Education AUAUniversity Education Products & Resources Normal Histology and Important Histo-anatomic Structures Urinary Bladder Prostate Kidney Renovascular Diseases Andrenal Gland Testis Paratesticular Tumors Penis Retroperitoneum Cytology Online Learning

2014 American Urological Association

91. Chronic Extremity Joint Pain?Suspected Inflammatory Arthritis

seronegative spondyloarthropathy, evaluation of axial skeleton, see the ACR Appropriateness Criteria ® “Chronic Back Pain: Suspected Sacroiliitis/Spondyloarthropathy” [34]. Variant 3: Chronic extremity joint pain. Suspect gout. Radiography Gout can involve the synovial spaces, showing joint distention due to effusion and synovial hypertrophy. Soft- tissue tophi, if not calcified, may appear nonspecific as focal increased opacity on radiography; however, adjacent characteristic erosions may be identified (...) . ACR Appropriateness Criteria®: Chronic Back Pain: Suspected Sacroiliitis/Spondyloarthropathy. Available at: 35. Ogdie A, Taylor WJ, Weatherall M, et al. Imaging modalities for the classification of gout: systematic literature review and meta-analysis. Ann Rheum Dis. 2014:[E-pub ahead of print]. ACR Appropriateness Criteria ® 11 Chronic Extremity Joint Pain 36. Sivera F, Andres M, Falzon L, van der Heijde DM, Carmona L. Diagnostic value of clinical

2016 American College of Radiology

92. Chronic Hip Pain

+/- corticosteroid injection hip joint or surrounding structures 2 Varies F-18 fluoride PET hip 1 ??? Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level Variant 8: Chronic hip pain and low back, pelvic, or knee pathology. Want to exclude hip as the source. Radiographs negative, equivocal, or showing mild osteoarthritis. Radiologic Procedure Rating Comments RRL* MRI hip without IV contrast 9 O Image-guided anesthetic +/- corticosteroid (...) or bloody aspirate in patients with the diffuse form of pigmented villonodular synovitis [99,100]. CT, MR, or x-ray arthrography can be useful to determine if a body is intra-articular. Variant 8: Chronic hip pain and low back, pelvic, or knee pathology. Want to exclude hip as the source. Radiographs negative, equivocal, or showing mild osteoarthritis. After radiography, MRI is the best next test to screen the hip for significant pathology. As described in variant 2, direct injections can be used

2016 American College of Radiology

93. Chronic Opioid Therapy for Chronic Non-Cancer Pain

prescribing. • Don’t prescribe opioids for non-specific back pain, headaches, or fibromyalgia. • Prescribe the lowest necessary dose for the shortest duration. • Three days or less will often be sufficient; more than seven days will rarely be needed. (CDC 2016) • Opioid use beyond the acute phase is rarely indicated. Subacute phase (6–12 weeks post episode of pain or surgery) • Don’t continue opioids without clinically meaningful improvement in function and pain (CMIF). • Screen for comorbid mental health (...) pain management prescriptions are provided by a single prescriber or multidisciplinary pain clinic and dispensed by a single pharmacy or pharmacy system; (5) The patient's agreement to not abuse alcohol or use other medically unauthorized substances; (6) A written authorization for: (a) The physician to release the agreement for treatment to local emergency departments, urgent care facilities, and pharmacies; and (b) Other practitioners to report violations of the agreement back to the physician

2016 Kaiser Permanente Clinical Guidelines

94. Shoulder Pain and Mobility Deficits: Adhesive Capsulitis

is determined from the history and physical examination. Patients typically present with a gradual and progressive onset of pain, likely sleep-disturbing night pain and pain at end ranges of movements. Patients also present with painful and restricted active and passive ROM in both elevation and rotation that occurs for at least 1 month and has either reached a plateau or worsened. 11 Functional ac- tivities such as reaching overhead, behind the back, or out to the side become increasingly difficult due (...) Shoulder Pain and Mobility Deficits: Adhesive Capsulitis Clinical Practice Guidelines MARTIN J. KELLEY, DPT • MICHAEL A. SHAFFER, MSPT • JOHN E. KUHN, MD • LORI A. MICHENER, PT , PhD AMEE L. SEITZ, PT , PhD • TIMOTHY L. UHL, PT , PhD • JOSEPH J. GODGES, DPT , MA • PHILIP W. MCCLURE, PT , PhD Shoulder Pain and Mobility Deficits: Adhesive Capsulitis Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section

2013 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

95. An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain - Part 2 - Guidance and Recommendations

injections. • For sacr oiliac joint interventions, the evidence for cooled radiofrequency neurotomy is fair; limited for intraarticular injections and periarticular injections; and limited for both pulsed radiofrequency and conventional radiofrequency neurotomy. • For lumbar percutaneous adhesiolysis, the evidence is fair in managing chronic low back and lower extremity pain secondary to post surgery syndrome and spinal stenosis. • For intradiscal pr ocedur es, the evidence for intradiscal electrothermal (...) TECHNIQUES V. MANAGEMENT OF LOW BACK PAIN 1.0 Disc-Related Pathology, Spinal Stenosis, And Radiculitis 1.1 Diagnosis Of Disc-Related Lumbar Pathology 1.1.1 Diagnostic Interventional Techniques 1.2 Therapeutic Interventions Of Lumbar Discogenic Pathology 1.2.1 Epidural Injections 1.2.2 Lumbar Epidural Adhesiolysis 1.2.3 Thermal Annular Procedures 1.2.4 Percutaneous Disc Decompression 2.0 Lumbar Facet Joint Pain 2.1 Diagnosis of Lumbar Facet Joint Pain 2.1.1 Diagnostic Lumbar Facet Joint Blocks 2.2

2013 American Society of Interventional Pain Physicians

96. Acute Onset Flank Pain-Suspicion of Stone Disease (Urolithiasis)

Acute Onset Flank Pain-Suspicion of Stone Disease (Urolithiasis) Date of origin: 1995 Last review date: 2015 ACR Appropriateness Criteria ® 1 Acute Onset Flank Pain—Suspicion of Stone Disease American College of Radiology ACR Appropriateness Criteria ® Clinical Condition: Acute Onset Flank Pain—Suspicion of Stone Disease (Urolithiasis) Variant 1: Suspicion of stone disease. Radiologic Procedure Rating Comments RRL* CT abdomen and pelvis without IV contrast 8 Reduced-dose techniques (...) are preferred. ??? CT abdomen and pelvis without and with IV contrast 6 This procedure is indicated if CT without contrast does not explain pain or reveals an abnormality that should be further assessed with contrast (eg, stone versus phleboliths). ???? US color Doppler kidneys and bladder retroperitoneal 6 O X-ray intravenous urography 4 ??? MRI abdomen and pelvis without IV contrast 4 MR urography. O MRI abdomen and pelvis without and with IV contrast 4 MR urography. O X-ray abdomen and pelvis (KUB) 3

2015 American College of Radiology

97. Chronic Neck Pain

radicular symptoms from a herniated disc or osteophyte. Additional etiologies include tumor, infection, inflammation, and vascular causes; therefore, consideration of the patient’s medical history is critical to accurately guide imaging. In low back pain, a system of “red flags” was adopted to aid clinicians in triaging patients seeking nonemergent care (see the ACR Appropriateness Criteria ® topic on “Low Back Pain” [16]). Although the diagnostic accuracy of red flag symptoms is not validated (...) by Variant Variant 1: New or increasing nontraumatic cervical or neck pain. No “red flags.” Initial imaging. Similar to low back pain, many cases of acute ( 30 years of age and correlate poorly with the presence of neck pain [20-23]. Although the diagnostic accuracy of red flag symptoms is not validated for the cervical spine, the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders [1] recommended the adoption of a similar system for cervical and neck pain, with red flags

2013 American College of Radiology

98. Practice Guidelines for Chronic Pain Management

. Peripheral blocks may be considered to assist in the diagnosis of pain in a specific peripheral nerve distribution. Provocative discography may be considered for the evaluation of selected patients with suspected discogenic pain; it should not be used for routine evaluation of a patient with chronic nonspecific back pain. Findings from patient history, physical examination, and diagnostic evaluation should be combined to provide the foundation for an individualized treatment plan focused (...) or cryoablation should be performed for postthoracotomy pain syndrome, neuralgia, and low back pain (medial branch). Consultants, ASA members, and ASRA members are equivocal as to whether cryoneurolysis or cryoablation should be performed for facial pain of nonherpetic origin. Thermal intradiscal procedures : Two randomized controlled trials comparing IDET with sham IDET indicate no significant differences ( P > 0.01) for either pain or functional outcomes ( Category C2 evidence ). However, studies

2010 American Society of Anesthesiologists

99. Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders

compared to sham TENS in the treatment of chronic low back pain, with 2 Class II studies showing benefit, but 2 Class I studies and another Class II study not showing benefit. Because the Class I studies are stronger evidence, TENS is established as ineffective for the treatment of chronic low back pain (2 Class I studies). TENS is probably effective in treating painful diabetic neuropathy (2 Class II studies). Recommendations: Transcutaneous electric nerve stimulation (TENS) is not recommended (...) for the treatment of chronic low back pain (Level A). TENS should be considered in the treatment of painful diabetic neuropathy (Level B). Further research into the mechanism of action of TENS is needed, as well as more rigorous studies for determination of efficacy. Glossary CI = confidence interval ; TENS = transcutaneous electric nerve stimulation ; TENS-burst = burst-pattern TENS ; TENS-FM = frequency-modulated TENS ; VAS = visual analog scale. Transcutaneous electric nerve stimulation (TENS) has been used

2010 American Academy of Neurology

100. Botulinum neurotoxin in the treatment of autonomic disorders and pain

of botulinum neurotoxin (BoNT) in the treatment of autonomic and urologic disorders and low back and head pain. Methods: A literature search was performed including MEDLINE and Current Contents for therapeutic articles relevant to BoNT and the selected indications. Authors reviewed, abstracted, and classified articles based on the quality of the study (Class I–IV). Conclusions and recommendations were developed based on the highest level of evidence and put into current clinical context. Results (...) : The highest quality literature available for the respective indications was as follows: axillary hyperhidrosis (two Class I studies); palmar hyperhidrosis (two Class II studies); drooling (four Class II studies); gustatory sweating (five Class III studies); neurogenic detrusor overactivity (two Class I studies); sphincter detrusor dyssynergia in spinal cord injury (two Class II studies); chronic low back pain (one Class II study); episodic migraine (two Class I and two Class II studies); chronic daily

2008 American Academy of Neurology


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