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443. Acute Pain Management: Scientific Evidence

pain management 280 8.1.3 Acute rehabilitation after surgery, “fast-track” surgery and enhanced recovery after surgery 281 8.1.4 Risks of acute postoperative neuropathic pain 282 8.1.5 Acute postamputation pain syndromes 283 8.1.6 Other postoperative pain syndromes 285 8.1.7 Day-stay or short-stay surgery 288 8.1.8 Cranial neurosurgery 294 8.1.9 Spinal surgery 297 8.2 Acute pain following spinal cord injury 298 8.2.1 Treatment of acute neuropathic pain after spinal cord injury 299 8.2.2 Treatment (...) — the International Association for the Study of Pain (IASP), the Royal College of Anaesthetists and its Faculty of Pain Medicine, the Australian Pain Society, the Australasian Faculty of Rehabilitation Medicine, the College of Anaesthesiologists of the Academies of Medicine of Malaysia and Singapore, the College of Intensive Care Medicine of Australia and New Zealand, the Faculty of Pain Medicine of the College of Anaesthetists of Ireland, the Hong Kong College of Anaesthesiologists, the Hong Kong Pain Society

2015 Clinical Practice Guidelines Portal

444. Disorders of Ejaculation: An AUA/SMSNA Guideline

, and more recently humans, has indicated the presence of galaninergic neurons arranged in columns within the central spinal cord. 10 Lesion of these structures is strongly associated with ejaculatory failure; it is likely that these neurons are responsible for integrating stimuli from peripheral and cerebral sources and triggering the ejaculatory reflex. Some experts have described this structure as the “spinal ejaculation generator” (SEG). 10 Ejaculation consists of two distinct phases. The first (...) contributions from the bulbourethral glands and from spermatozoa transported from the epididymis via the vas deferens. 5 The second phase is ejection, a reflex driven by the somatic nervous system, specifically the pudendal nerve. Ejection is characterized by repeated contractions of the bulbospongiosus and ischiocavernous muscles leading to forceful expulsion of seminal fluid from the urethral meatus. 4, 5 A cluster of motor neurons in spinal segments S2-4 (“Onuf’s nucleus”) appears to be of particular

2020 American Urological Association

445. Neuropathic pain - drug treatment

to, or dysfunction of, the somatosensory system. The pain may be constant or intermittent, and it is typically described as shooting, stabbing, burning, tingling, numb, prickling, or itching. The causes of neuropathic pain are complex and diverse and include diabetic neuropathy, trigeminal neuralgia, stroke, spinal cord injury, and multiple sclerosis. In many cases, it is not possible to completely cure the underlying disease or lesion or to reverse the neurological changes. Consequently, neuropathic pain (...) into account any physical or psychological problems, and concurrent medicines. The importance of dosage titrations and the titration process, providing the person with individualized information and advice. Coping strategies for pain and possible adverse effects of treatment. Non-pharmacological treatments, for example, physical and psychological therapies (which may be offered through a rehabilitation service) and surgery (which may be offered through specialist services). An early clinical review should

2016 NICE Clinical Knowledge Summaries

446. Improving the Lives of People with Complex Chronic Pain: How to Commission Effective Pain Management

approach to support patients effectively. Small incremental positive change is made possible through access to a range of enabling treatments including some specialist treatments. This process is difficult to manage in primary care alone. Initial assessments require time, interprofessional integration and specialist rehabilitation. For patients with complex pain, they need specialists with the training and expertise to manage their care holistically. Patients with complex pain benefit from (...) to contribute to dependency on addictive pain medications and the declining potential for functional rehabilitation [26]. A current consequence of this is the well-publicised ‘opioid crisis’, with a consequent rise in prescription addiction. If there is not a full recognition of these risks of fragmenting care, then an attempt to cut costs will likely have the reverse impact. Costs will rise further as quality of life for this group diminishes with the well- recognised consequence of increased heath care

2020 Faculty of Pain Medicine

447. Medical Cannabinoids

, chemotherapy-induced nausea and vomiting, and spasticity due to multiple sclerosis or spinal cord injury. MANAGEMENT OF PAIN ACUTE PAIN X DO NOT prescribe medical cannabinoids for acute pain management, due to evidence of no benefit and known harms. [Strong recommendation] HEADACHE X DO NOT prescribe medical cannabinoids for headache, due to the lack of evidence and known harms. a [Strong recommendation] RHEUMATOLOGIC PAIN X DO NOT prescribe medical cannabinoids for pain associated with rheumatologic (...) )/SPINAL CORD INJURY X DO NOT prescribe medical cannabinoids as first- or second-line therapy for spasticity in MS/Spinal Cord Injury due to limited evidence and known harms. [Strong recommendation] ? Consider medical cannabinoids for refractory spasticity in MS/Spinal Cord Injury, with the following caveats: [Weak recommendation] o Discuss the benefits and risks of medical cannabinoids for spasticity with the patient. o Patients have had a reasonable therapeutic trial of standard therapies (including

2019 Accelerating Change Transformation Team

448. Low Back Pain

three months. Adverse effects are infrequent and include headache, fever, and subdural penetration; rare but catastrophic events, including epidural abscess and paralysis, can occur. See Appendix G and the companion document Radiological Diagnostic and Therapeutic Interventions Directed to Lumbar Spine Pathology for further information. SR (G4) + EO (GUC) Multidisciplinary Treatment programs ? No evidence was found to recommend interdisciplinary rehabilitation for acute low back pain (pain less than (...) to standing AP and lateral in order to achieve better assessment of stability and stenosis. CT scans are best limited to suspected fractures or contraindication to MRI. X-rays of the lumbar spine are very poor indicators of serious pathology. Hence, in the absence of clinical red flags spinal x-rays are not encouraged. More specific and appropriate diagnostic imaging should be performed on the basis of the pathology being sought (e.g., DEXA scan for bone density and bone scan for tumours and inflammatory

2017 Accelerating Change Transformation Team

449. Headache

, and no focal neurological signs may have benign intracranial hypertension (pseudotumour cerebri). They should have urgent specialist referral and will need urgent neuroimaging. An intracranial space-occupying lesion should be ruled out prior to lumbar puncture to measure cerebral spinal fluid (CSF) pressure. Further investigation may be required as the differential diagnosis would include cerebral venous sinus thrombosis. EO (GDG) 4. Elderly patient with new headache and subacute cognitive change: Elderly (...) from onset to peak intensity). EO (GDG) Patients presenting with severe headache of sudden onset (thunderclap headache) should be sent to an emergency department with urgent computerized tomography (CT) capability for immediate investigation to exclude subarachnoid hemorrhage. If subarachnoid hemorrhage is not present on head CT scanning, other investigations (e.g., lumbar puncture) may be necessary. Specialist involvement and further neuroimaging may also be necessary, as the differential

2016 Accelerating Change Transformation Team

451. The Primary Care Management of Headache

for the Management of Concussion-mild Traumatic Brain Injury. Available at: VA/DoD Clinical Practice Guideline for the Primary Care Management of Headache July 2020 Page 9 of 150 Medication overuse headache, which has previously been called medication-misuse headache, rebound headache, or drug-induced headache, is an exceedingly common type of headache seen in primary and specialty care settings resulting from the excessive and inappropriate use of non (...) that is of particular interest to VA/DoD providers is a persistent headache attributed to a traumatic injury to the d See the VA/DoD Clinical Practice Guideline for the Management of Concussion-mild Traumatic Brain Injury. Available at: VA/DoD Clinical Practice Guideline for the Primary Care Management of Headache July 2020 Page 11 of 150 head, also known as a PTH. According to ICHD-3, to be defined as a PTH, the onset of the headache must be within seven days

2020 VA/DoD Clinical Practice Guidelines

452. The Non-Surgical Management of Hip & Knee Osteoarthritis (OA)

to the management of OA, from which Work Group members were recruited. The specialties and clinical areas of interest included: primary care, nursing, physical therapy, clinical pharmacology, internal medicine, dietetics, orthopedic surgery, rheumatology, family medicine, sports medicine, physical medicine and rehabilitation, and pain management. The guideline development process for the 2020 CPG update consisted of: 1. Formulating and prioritizing KQs and defining critical outcomes 2. Convening a patient focus

2020 VA/DoD Clinical Practice Guidelines

453. Standards for Neurologic Critical Care Units

safe and rapid transfer of patients between these areas when required. Level I and Level II units should possess the ability to transfer and accept patients via a designated ambulance bay and/ Table 1 Common neurocritical care diagnoses Ischemic stroke Intracerebral hemorrhage Subarachnoid hemorrhage Acute nontraumatic weakness Traumatic brain and spine injury including epidural and subdural hematoma, diffuse axonal injury Anoxic brain injury Coma Intracranial hypertension Meningitis (...) and encephalitis Spinal cord compression Status epilepticus147 Table 2 Neurocritical care unit recommendations Standards Level I Level II Level III Organization Neuroscience critical care (NCC) Service oversight by physician, nursing and hospital executive leadership R R R Delineation of physician and non-physician privileges R R R Distinct administrative unit R R O Leadership meet regularly to evaluate service needs R R R Leadership meet regularly to evaluate service needs R R R NCC Committee R R O Standing

2020 Neurocritical Care Society

454. Perineal care

and pelvic floor muscles. Pelvic floor muscle training A program of exercises used to rehabilitate the function of the pelvic floor muscles. Perineal injury Includes perineal soft tissue damage, tearing and episiotomy. Perineal tears Includes perineal tearing but not injury such as bruising, swelling, surgical incision (episiotomy). Reinfibulation Procedure to narrow the vaginal opening in a woman after she has been deinfibulated; also known as re-suturing. 1 Restrictive use episiotomy Where episiotomy (...) and repair 5,88 : o 16% of women report severe pain during perineal procedures 90 · For repair: o Infiltrate perineum with local anaesthetic and/or top up epidural or insert spinal anaesthetic as appropriate 5 o Seek confirmation that analgesia is effective and sufficient before commencing repair 5 · If woman reports inadequate pain relief, pause repair and address immediately 5 Timing · Assessment may be done immediately after birth 5 · Recommend repair is undertaken as soon as practicable after birth

2020 Queensland Health

455. The Management of adult patients with severe chronic small intestinal dysmotility

– Infant colic (developmental) ? Autoimmune – Antineuronal antibodies – Ganglionosis ? Infective – Chagas' disease, – Herpes viruses (eg, EBV, CMV, VZV) or – Polyoma viruses (JC virus) Secondary (extrinsic) ? Generalised neurological disorders – Brainstem lesions – Spinal cord injury – Multiple sclerosis – Parkinson’s disease – Neurological effects of diabetes mellitus – Autonomic system degeneration ? Paraneoplastic syndromes (often with antineuronal antibodies (especially anti Hu)) – Small cell lung (...) that innervate the gut (including autonomic system degeneration and the neurological effects of diabetes mellitus (most common) and other endocrine or metabolic disorders) can indirectly cause gut dysmotility. Brainstem lesions, spinal cord injury, multiple scle- rosis, Parkinson’s disease (basal ganglia calcification) and leuko- encephalopathy can all affect gut motility. 74 75 A lymphocytic leiomyositis and myenteric ganglionitis have been described in the ileum of children with cystic fibrosis and distal

2020 British Society of Gastroenterology

456. Clinical Performance Measures for Neurocritical Care

for performance measure development Acute ischemic stroke Acute non-traumatic weakness Coma Intracerebral hemorrhage Aneurysmal subarachnoid hemorrhage Intracranial hypertension and herniation Meningitis and encephalitis Hypoxic-ischemic encephalopathy and targeted temperature manage - ment Spinal cord compression Status epilepticus Traumatic brain injury Traumatic spinal cord injury Brain death8 The search identified 50,257 citations (Fig. 2). Each document underwent title and abstract review by two writing (...) significant care in other locations such as the pre-hospital or post-acute care rehabilitation set- ting. However, these care periods were not included because of the focus of this initial PM Set. Likewise, children (age less than 18 years) were excluded as were patients who developed neurocritical conditions sub- sequent to an admission for another primary disease condition (e.g., in-hospital stroke following admission for myocardial infarction, or status epilepticus occur- ring after admission

2020 Neurocritical Care Society

457. 2020 Acute Coronary Syndromes (ACS) in Patients Presenting without Persistent ST-Segment Elevation (Management of) Guidelines Full Text available with Trip Pro

-ST-segment elevation acute coronary syndrome (Supplementary Data) 47 9.1 Lifestyle management (Supplementary Data) 47 9.1.1 Smoking (Supplementary Data) 47 9.1.2 Diet and alcohol (Supplementary Data) 47 9.1.3 Weight management (Supplementary Data) 47 9.1.3 Physical activity (Supplementary Data) 47 9.1.4 Cardiac rehabilitation (Supplementary Data) 47 9.1.5 Psychosocial factors (Supplementary Data) 47 9.1.6 Environmental factors (Supplementary Data) 47 9.1.7 Sexual activity (Supplementary Data) 47

2020 European Society of Cardiology


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