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back pain

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141. Recommendations for good practice in the use of epidural injection for the management of pain of spinal origin in adults

, with a copy to the patient, should be sent to the patient’s GP detailing the procedure and follow up arrangements. Fever, severe back pain or worsening neurological and/ or urinary symptoms are potentially serious and an urgent medical review is required. 11.6 Emergency full spine MRI scanning must be available. Arrangements must be in place for urgent referral for neurosurgical or spinal surgical opinion. 11.7 Follow up arrangements should be made for all patients after a therapeutic epidural. The time (...) Anesthesia and Pain Medicine 2003;28:172-197. Horlocker TT et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy. Regional Anesthesia and Pain Medicine 2010;35 (1):64-101. Fluoroscopy (Section 7) White AH. Injection techniques for the diagnosis and treatment of low back pain. Orthopedic Clinics of North America 1983;14 (3):553-567. el-Khoury GY et al. Epidural steroid injection: a procedure ideally performed with fluoroscopic control. Radiology 1988:168 (2);554-557

2011 Faculty of Pain Medicine

142. Opioid prescription in chronic pain conditions guidelines for South Australian general practitioners

, and treatment. European Journal of Pain, 10:287–333. Maniadakis N and Gray A (2000). The economic burden of back pain in the UK. Pain 84: 95–103. What are the goals of pain management? The goals of pain management are to increase the ability to function, reduce pain and suffering, enhance quality of life, and minimise the risk of adverse effects. These goals are the same for all pain patients regardless of history, including a history of substance misuse. T o accomplish these goals, pain management most (...) physical examination is required on subsequent visits is also a matter of clinical judgment, based on the need to confirm or monitor specific findings, track specific treatment effects, or assess comorbidities. A Structured Pain Questionnaire (you can find a Photocopy Master inside the back cover) can be very useful to provide a consistent basis for the clinical assessment of chronic pain patients. When should a GP refer to a pain management specialist for advice on patient management? T reatment

2008 Clinical Practice Guidelines Portal

143. Management of pain in children

expressions that suggest pain but less than 50% of the time. Score 2 Persistent facial expressions suggesting pain/distress more than 50% of the time. Grimace – open mouth, lips pulled back at corners, furrowed forehead and/or between eyebrows, eyes closed, wrinkled at corners. Posture – This relates to the child’s behaviour towards the affected body area. Score 0 Normal. Score 1 Exhibiting increased awareness of body area e.g. by touching, rubbing, pointing, sparing or limping. Score 2 Affected area (...) Management of pain in children Management of Pain in Children Pain Guidelines October 2006 Page 1 of 8 Pain Guidelines INTRODUCTION All children in pain need analgesia 1 , regardless of age or situation. Pain is one of the commonest symptoms in patients presenting to ambulance services. Control of pain is important not only for humanitarian reasons but also because it may prevent deterioration of the child and allow better assessment. There is no excuse for leaving a child in pain because

2006 Joint Royal Colleges Ambulance Liaison Committee

144. Abdominal pain

pain. A history of PID predisposes to ectopic pregnancy. Ruptured Abdominal Aortic Aneurysms (AAA) were responsible for almost 6,000 deaths in men and 3,500 in women in England and Wales in 1999. Most deaths occur in the elderly. Less than 25% of all AAA patients present with classic signs and symptoms with a consequential risk of misdiagnosis. 1 This diagnosis must be considered in anyone over the age of 50 who presents with sudden severe abdominal pain or back ache, hypotension with bilateral (...) Abdominal pain INTRODUCTION Abdominal pain is the most common complaint seen in Emergency Departments (ED). 1 The elderly account for 15% of these attendances. Mortality rises signi?cantly in the over 50’s as they can have atypical presentations and are more prone to catastrophic events. Ambulance crews attend a variety of acute abdominal conditions e.g. appendicitis, renal colic, peptic ulcer perforation, abdominal ischaemia and peritonitis, plus chronic conditions such as irritable bowel

2006 Joint Royal Colleges Ambulance Liaison Committee

145. Evidence-based guideline for neuropathic pain interventional treatments: Spinal cord stimulation, intravenous infusions, epidural injections and nerve blocks

would undergo the procedure again. This was considered by the task force chairs as clinically relevant and was taken into consideration when formulating the recommendation. Failed back surgery syndrome and complex regional pain syndrome: In patients with failed back surgery syndrome and complex regional pain syndrome (CRPS I or II), who are not candidates for corrective surgery and have failed more conservative evidence-based treatment, clinicians should consider offering a trial of SCS. Evidence (...) CPGs (7–12,) for epidural injections of all types for neuropathic pain. One SR ( ) and one CPG ( ) were excluded due to poor quality. The vast majority of the reviewed studies related to lumbar epidural injections for radicular pain and/or failed back surgery syndrome, and several focused on spinal stenosis. The current recommendations arise from the following studies: one SR ( ); five RCTs ( – ); and three CPGs ( , , ). Only three studies included information on cervical epidurals: one SR ( ), one

2012 CPG Infobase

146. Medical Emergencies - abdominal pain

abdominal pain or back ache, hypotension with bilateral lower limb ischaemia or mottling (a late sign) especially if there is a history of smoking, hypertension and hypercholesterolaemia. 13 Appendicitis is also frequently misdiagnosed 1 and up to one third of women of child bearing age with appendicitis are considered as having pelvic in?ammatory disease or UTI. 7 Immunosuppressed patients, for example, human immunode?ciency virus (HIV) and alcoholic patients can present atypically. 1 Abdominal Pain (...) Medical Emergencies - abdominal pain INTRODUCTION Abdominal pain is the most common complaint seen in Emergency Departments (ED). 1 The elderly account for 15% of these attendances. Mortality rises signi?cantly in the over 50’s as they can have atypical presentations and are more prone to catastrophic events. Ambulance crews attend a variety of acute abdominal conditions e.g. appendicitis, renal colic, peptic ulcer perforation, abdominal ischaemia and peritonitis, plus chronic conditions

2007 Joint Royal Colleges Ambulance Liaison Committee

147. The Use of Gabapentin and Tricyclic Antidepressants in the Treatment of Neuropathic Pain in Cancer Patients

Manage 2003;25:406-11. SYSTEMATIC REVIEW – page 12 21. Hagg O, Fritzell P, Nordwall A. The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 2003;12:12-20. 22. Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain 2004;8:283-91. DEVELOPMENT & METHODS – page 1 Evidence-based Series #13-8: Section 3 The Use (...) The Use of Gabapentin and Tricyclic Antidepressants in the Treatment of Neuropathic Pain in Cancer Patients Evidence-Based Series 13-8 EDUCATION AND INFORMATION 2013 A Quality Initiative of the Program in Evidence-based Care (PEBC), Cancer Care Ontario (CCO) The Use of Gabapentin and Tricyclic Antidepressants in the Treatment of Neuropathic Pain in Cancer Patients L. Librach, N. Lloyd, V. Jarvis, D. Warr, A. R. Jadad, J. Wilson, M. Brouwers, R. Wong, and members of the Supportive Care

2006 Cancer Care Ontario

148. Responsible, Safe, and Effective Use of Antithrombotics and Anticoagulants in Patients Undergoing Interventional Techniques: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Responsible, Safe, and Effective Use of Antithrombotics and Anticoagulants in Patients Undergoing Interventional Techniques: American Society of Interventional Pain Physicians (ASIPP) Guidelines Background: Interventional pain management involves diagnosis and treatment of chronic pain. This specialty utilizes minimally invasive procedures to target therapeutics to the central nervous system and the spinal column. A subset of patients encountered in interventional pain are medicated using (...) receiving anti-clotting therapy during interventional pain procedures. Study Design: Best evidence synthesis. Objective: To provide a current and concise appraisal of the literature regarding an assessment of the bleeding risk during interventional techniques for patients taking anticoagulant and/or antithrombotic medications. Methods: A review of the available literature published on bleeding risk during interventional pain procedures, practice patterns and perioperative management of anticoagulant

2019 American Society of Interventional Pain Physicians

149. Acute Pain Management in Trauma Patients

Acute Pain Management in Trauma Patients ACS TRAUMA QUALITY PROGRAMS BEST PRACTICES GUIDELINES FOR ACUTE PAIN MANAGEMENT IN TRAUMA PATIENTS Released November 2020 Supported by the American Society of Anesthesiologists (ASA) Administrative Council*Table of Contents Introduction 4 Pain Physiology 6 Pain Assessment 10 Unidimensional Assessment Tools for Cognitively Intact Adults 11 Assessment Tools for Adult Patients with Cognitive Impairment 12 Functional Pain Assessment Tools 14 Pain Assessment (...) in Older Adults 16 Pediatric Pain Assessment Tools 16 Pain Reassessment 18 Nonpharmacologic Pain Management 21 Cognitive Strategies 22 Physical Strategies 25 Pharmacologic Analgesia 31 Acetaminophen 32 N-methyl-D-aspartate (NMDA) Antagonists 35 Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) 36 Opioids 36 Adjuvant Analgesics 38 Regional Analgesia 43 Neuraxial Techniques: Epidural and Paravertebral Blocks 44 Ultrasound-Guided Fascial Plane Blocks 45 Extremity Blocks: Brachial Plexus, Femoral, and Sciatic

2020 American College of Surgeons

150. Occupational therapy for people with Parkinson's disease

to other causes may be related to Parkinson’s in itself. Pain may be intense and prolonged, related to muscle rigidity, and may include dystonic muscle cramp (dystonia), affecting a part of the body such as a foot, the lower back, or one side of the neck (cervical dystonia). Parkinson’s pain in any part of the body, especially during the later part of the night, may be closely associated with ‘off phases’ of the anti- Parkinson’s medication cycle, and hence anti- Parkinson’s medication adjustments may (...) the majority of urine at night instead of during the day), are all commonly experienced. Sexual health issues: • for example, erectile dysfunction or reduced libido. Hyper- sexuality may also develop as a side effect of some anti- Parkinson’s medications. Fatigue • of rapid onset following relatively short periods of activity or sustained use of a particular muscle group or limb/s. Some people with Parkinson’s also report feelings of general and mental fatigability. Pain • that cannot be attributed

2010 Publication 1554

151. A controlled comparison study to evaluate different management strategies for workplace trauma

significantly higher scores than non- attendees on three important aspects of post trauma management: ¦ reassurance that the symptoms they might be experiencing were normal ¦ knowledge about sources of further information about traumatic reactions ¦ knowledge about where in the organisation to access further support. xv Those who attended SPoT meetings were also far more positive in their views of RMG and the role of support in enabling them to get back to normal, in some cases this extended to more (...) back to normal. xvi In relation to the SPoT meetings, the most important aspects of ‘good’ support were found to be in relation to the educational aspects of meeting ie information about where to go to obtain further support within the organisation, identification of symptoms individuals might have been experiencing since the incident and information about the normal reactions to trauma and coping-mechanisms. Conclusions These results highlight the importance of the organisation’s response

2006 Publication 1430

152. Destructive interpersonal workplace conflict ? bullying: effectiveness of management interventions

and the answer he gave me back was that you’ll just have to do the best you can. He said it’s what we all have to do, we have to do the best we can and I said to him but I don’t think that’s good enough because to me that is bullying, this is the Trust bullying me! I don’t have 37 ½ hours written in my contract, it just says hours as needed I forget the phrase but it says you know to do the job.” 19 Other items: o Existing work pressure makes it difficult to take time off work o Vacant positions are filled

2006 Publication 1430

153. Managing attendance at work

out a specific action will be directly linked to other elements of the wider policy. For example, in one organisation the objective of recording and monitoring absence data may be to gather information about the amount of absence associated with a specific workplace hazard. For another the purpose may be to assess the effectiveness of a particular intervention such as the introduction of a back pain management programme, while for a third it may be aimed at changing a negative absence culture (...) POINTS CASE REVIEWS PRE-EMPLOYMENT SELECTION CRITERIA PROACTIVE AND TREATMENT POLICIES HEALTH PROMOTION BACK PAIN MANAGEMENT STRESS MANAGEMENT RISK MANAGEMENT REHABILITATION ‘FAMILY FRIENDLY’ POLICIES ORGANISATION BASED HEALTH & SAFETY JOB SATISFACTION “CULTURE” 7 Section II - Method Given the framework and scope described above the following questions were defined as those to be addressed. ? are the objectives of policies clear? ? how feasible is the implementation of policies? ? how effective

2002 Publication 1430

156. Occupational Therapy for Adults Undergoing Total Hip Replacement

. It is recommended that service users are given advice on effective pain management strategies, to decrease pre- operative pain experience and sleep disturbance, and enhance post- operative physical function. (Berge et al 2004, B; Montin et al 2007, C; Parsons et al 2009, C) 1 B 8. It is suggested that standardised assessment and outcome measures are used, where appropriate, to determine functional outcome and occupational performance in rehabilitation settings, either inpatient or community based. (Gillen et al (...) are identified, the occupational therapist refers the service user on to community rehabilitation, reablement or intermediate care services to enhance community reintegration. (de Groot et al 2008, D; Gillen et al 2007, C) 2 C HIP REPLACEMENT.indd 4 21/02/2013 11:08 5 College of Occupational Therapists 1 Introduction Total hip replacement has been identi?ed as an effective treatment for the hip joint that causes pain and is no longer functioning properly, and when conservative management is no longer

2012 Publication 1554

157. Immunoglobulin infusions: intravenous and subcutaneous

is responsible for all aspects of homecare: obtaining funding for homecare if relevant prescribing treatment monitoring treatment look-back in the event of any transmissible infections. The child/young person must be reviewed at least every six months by the prescribing team. During these reviews, an annual follow-up form must be completed as per the Department of Health's Demand Management Programme ( ): For non-primary immunodeficiency patients at GOSH, this should be returned to Pharmacy. For primary (...) of an acute infection, the infusion may need to be postponed until antibiotic treatment is started and / or pyrexia settles. Infusing when patient has acute infection can lead to adverse events. Rationale 20: To calculate the appropriate dose. Any significant change may indicate a need for dose increase or (less likely) reduction. Rationale 21: To monitor the effectiveness of treatment Rationale 22: To enable look-back in the event of an outbreak of infection. Rationale 23: To avoid medication errors

2017 Publication 1593

158. Specimen collection – microbiology and virology

to pathogens. It is therefore essential that appropriate PPE including respiratory protection (FFP2 respirator and a visor) is worn when performing this procedure. Fast the child for at least six hours overnight. Perform hand hygiene and put on PPE Pass a nasogastric tube (refer to GOSH clinical guideline ‘ ’). Aspirate the stomach contents and place in a sterile container. Instil at least 30ml of sterile water down the tube to obtain as much stomach content as possible. Aspirate the contents back (...) . Gently rotate and withdraw the swab and place back in the tube. Remove PPE and perform hand hygiene. Dispatch specimen to the laboratory immediately to ensure maximum chance of growth of the organism. Good quality sputum samples are essential for accurate microbiological diagnosis of pneumonia, but also acute tracheitis and bronchitis. Sputum cultures are routinely used for patients with chronic and often progressive suppurative lung diseases such as Cystic Fibrosis and Primary Ciliary Dyskinesia

2017 Publication 1593

159. Peripheral venous cannulation of children

into a peripheral vein ( ). While the insertion of a cannula is a routine event for health care professionals (HCP), many children and families associate it with dramatic events and serious illness. Cannulation can be both traumatic and painful for the child and stressful for the family. They will require support and encouragement to deal with the procedure ( ). The implications of cannulation should not be underestimated. The introduction of a foreign body into the vein is an extraordinary intervention (...) procedure to the child and family including the reason for the cannulation, avoiding medical jargon and language. Information must be given according to the child’s age and developmental understanding ( )( ). Previous experience needs to be considered, together with preferred methods of coping, timing of the preparation and readiness of parent/carer(s) to take an active role ( ). There is evidence that tolerance to pain increases with age and maturity when the child no longer perceives medical

2017 Publication 1593

160. Epidermolysis bullosa (EB): management of the newborn infant with EB

-uterine and/or birth damage has been healed ( ) ( ). For removal of tape without damaging skin Use a Silicone Medical Adhesive Remover (SMAR) ( ) such as Appeel® (Clinimed), Niltac® (Trio healthcare) or Peeleasy® (m&a pharmachem ltd). If SMAR not available, cover with 50% liquid/50% white soft paraffin, which will dissolve the adhesive and enable safe removal ( ). When removing the tape, roll the tape back on itself rather than lifting it from the skin ( ). Do not attempt to remove tape whilst (...) a validated neonatal pain assessment tool to ensure adequate analgesia (opioid analgesia is usually required) given prior to wound care (avoid the administration of rectal medication if possible as this can blister the anal margin). ( ). Prepare a clean trolley with clinical waste bag, hypodermic needles, all dressings (cut to shape using supplied template) and tape cut into short lengths ( ). See below for template. Wash hands using 7 step technique using liquid soap (plain or antimicrobial) for at least

2017 Publication 1593

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