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Latest & greatest articles for chronic pain
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on chronic pain or other clinical topics then use Trip today.
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Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. OBJECTIVE: To assess the benefits and harms of spinal manipulative therapy (SMT) for the treatment of chronic low back pain. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Physiotherapy Evidence (...) Database (PEDro), Index to Chiropractic Literature, and trial registries up to 4 May 2018, including reference lists of eligible trials and related reviews. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials examining the effect of spinal manipulation or mobilisation in adults (≥18 years) with chronic low back pain with or without referred pain. Studies that exclusively examined sciatica were excluded, as was grey literature. No restrictions were applied to language or setting
Transcutaneous electrical nerve stimulation (TENS) for chronicpain - an overview of Cochrane Reviews. BACKGROUND: Chronicpain, considered to be pain lasting more than three months, is a common and often difficult to treat condition that can significantly impact upon function and quality of life. Treatment typically includes pharmacological and non-pharmacological approaches. Transcutaneous electrical nerve stimulation (TENS) is an adjunct non-pharmacological treatment commonly recommended (...) by clinicians and often used by people with pain. OBJECTIVES: To provide an overview of evidence from Cochrane Reviews of the effectiveness of TENS to reduce pain in adults with chronicpain (excluding headache or migraine).To provide an overview of evidence from Cochrane Reviews of the safety of TENS when used to reduce pain in adults with chronicpain (excluding headache or migraine).To identify possible sources of inconsistency in the approaches taken to evaluating the evidence related to TENS
Compounded Topical Pain Creams to Treat Localized ChronicPain: A Randomized Controlled Trial. Background: The use of compounded topical pain creams has increased dramatically, yet their effectiveness has not been well evaluated. Objective: To determine the efficacy of compounded creams for chronicpain. Design: Randomized controlled trials of 3 interventions. (ClinicalTrials.gov: NCT02497066 ). Setting: Military treatment facility. Participants: 399 patients with localized pain classified (...) by each patient's treating physician as neuropathic (n = 133), nociceptive (n = 133), or mixed (n = 133). Interventions: Pain creams compounded for neuropathic pain (ketamine, gabapentin, clonidine, and lidocaine), nociceptive pain (ketoprofen, baclofen, cyclobenzaprine, and lidocaine), or mixed pain (ketamine, gabapentin, diclofenac, baclofen, cyclobenzaprine, and lidocaine), or placebo. Measurements: The primary outcome measure was average pain score 1 month after treatment. A positive categorical
Quick guide: National clinical guideline on opioid treatment of chronic non-malignant pain National clinical guideline on opioid treatment of chronic non-malignant pain. Published by the Danish Health Authority, December 2018 NATIONAL CLINICAL GUIDELINE ON OPIOID TREATMENT OF CHRONIC NON-MALIGNANT PAIN Quick guide 1 Optimise non-pharmacological and pharmacological non-opioid treatment rather a trial of opioids in patients with chronic non-malignant pain conditions. Strong recommendation (...) For some patients with neuropathic pain, the possible pharmacological treatment options apart from opioids are tricyclic antidepressants and anticonvulsants. For patients with nociceptive pain, in specific instances NSAIDs can be used at the lowest possible dose for the shortest possible time and in accordance with the recommendations of the Danish Health Authority’s National Recommendations List for treatment of chronic nociceptive pain with NSAIDs. The evidence profile for paracetamol has not been
Therapeutic Ultrasound for Pain Management in Chronic Low Back Pain and Chronic Neck Pain: A Systematic Review 30649460 2019 01 16 1526-4637 2019 Jan 12 Pain medicine (Malden, Mass.) Pain Med Therapeutic Ultrasound for Pain Management in Chronic Low Back Pain and Chronic Neck Pain: A Systematic Review. 10.1093/pm/pny287 Low back pain (LBP) and neckpain are major causes of pain and disability that are experienced across all ages. The primary goals of treatment are to improve patient function (...) and facilitate a return to the patient's desired level of daily activity. Therapeutic ultrasound is a noninvasive modality widely utilized in the management of musculoskeletal disorders, but there continues to be controversy regarding its use due to insufficient evidence of effectiveness. The objective of this systematic review was to evaluate the effectiveness of therapeutic ultrasound in the management of patients with chronic LBP and neckpain. Using PRISMA guidelines, a search of the PubMed and CENTRAL
Evaluation of the Neuropathic Component of Chronic Low Back Pain 30222611 2018 12 06 1536-5409 35 1 2019 Jan The Clinical journal of pain Clin J Pain Evaluation of the Neuropathic Component of Chronic Low Back Pain. 7-17 10.1097/AJP.0000000000000653 Assessment of neuropathic pain in chronic low back syndromes is important. However, there is currently no gold standard for its diagnosis. The aim of this observational cross-sectional study was to assess the neuropathic component of pain in various (...) chronic low back pain syndromes using a range of diagnostic tests. Included in this study were 63 patients with chronic axial low back pain (ALBP), 48 patients with chronic radicular syndromes (CRS) comprising 23 with discogenic compression (CDRS) and 25 with lumbar spinal stenosis (LSS), and 74 controls. PainDETECT questionnaire (PDQ), quantitative sensory testing (QST), and skin biopsy with evaluation of intraepidermal nerve fiber density (IENFD) were used to assess the neuropathic pain component
Acupuncture shown to have benefits for treatment of some chronicpain Signal - Acupuncture shown to have benefits for treatment of some chronicpain Dissemination Centre Discover Portal NIHR DC Discover Acupuncture shown to have benefits for treatment of some chronicpain Published on 20 June 2017 Acupuncture is not a placebo for treatment of chronicpain. This NIHR-funded systematic review shows that acupuncture is better than usual care and sham acupuncture for pain from musculoskeletal (...) conditions, knee osteoarthritis and chronic headache. This NIHR review was large with over 140 trials overall, and the direct comparison with sham acupuncture helps to address uncertainty around whether acupuncture gives clinical benefit above a “placebo effect.” Acupuncture had a smaller effect on pain when compared with sham acupuncture than when compared with no acupuncture, but both comparisons showed statistically significant differences. Acupuncture also improved quality of life compared
A commonly used treatment does not improve chronic low back pain Signal - A commonly used treatment does not improve chronic low back pain Dissemination Centre Discover Portal NIHR DC Discover A commonly used treatment does not improve chronic low back pain Published on 7 November 2017 This trial found that destroying nerves that take pain signals to the brain using heat (radiofrequency denervation) did not improve pain, function or a sense of “recovery”. The treatment was used alongside (...) was this study needed? Low back pain of no specific source is the single biggest cause of disability worldwide. Exact UK figures are lacking as it is recorded alongside other musculoskeletal conditions. However, an estimated 30.6 million working days were lost in 2013 due to these conditions. In most cases, back pain resolves quickly. However, chronic back pain can interfere with everyday life, lead to time off work or education and affect the quality of life. Chronic back pain can be difficult to treat
Do Regenerative Medicine Therapies Provide Long-Term Relief in Chronic Low Back Pain: A Systematic Review and Metaanalysis 30508983 2018 12 04 2150-1149 21 6 2018 Nov Pain physician Pain Physician Do Regenerative Medicine Therapies Provide Long-Term Relief in Chronic Low Back Pain: A Systematic Review and Metaanalysis. 515-540 Several cell-based therapies have been proposed in recent years the management of low back pain, including the injection of medicinal signaling cells or mesenchymal stem (...) shows that MSCs and PRP may be effective in managing discogenic low back pain, radicular pain, facet joint pain, and sacroiliac joint pain, with variable levels of evidence in favor of these techniques. Chronic low back pain, regenerative therapy, medicinal signaling or mesenchymal stem cells, platelet-rich plasma, disc injection, lumbar facet joint injections, sacroiliac joint injections. Sanapati Jaya J University Pain Medicine and Rehabilitation Center, Newark, NJ. Manchikanti Laxmaiah L Pain
The effect of lumbosacral orthosis on the thickness of deep trunk muscles using ultrasound imaging: A randomized controlled trial in patients with chronic low back pain. 30652982 2019 01 17 1537-7385 2019 Jan 15 American journal of physical medicine & rehabilitation Am J Phys Med Rehabil The effect of lumbosacral orthosis on the thickness of deep trunk muscles using ultrasound imaging: A randomized controlled trial in patients with chronic low back pain. 10.1097/PHM.0000000000001135 This study (...) was conducted to evaluate the changes occurring in the thickness of deep trunk muscles, measured using ultrasound imaging, after four weeks of lumbosacral orthosis (LSO) use in conjunction with routine physical therapy. This parallel-group, randomized, controlled trial was conducted on 44 patients with nonspecific chronic low back pain (CLBP), randomly allocated to the experimental and control groups. Both groups received eight sessions of physical therapy twice per week for four weeks. The experimental
Non-pharmacological interventions for chronicpain in multiple sclerosis. BACKGROUND: Chronicpain is common and significantly impacts on the lives of persons with multiple sclerosis (pwMS). Various types of non-pharmacological interventions are widely used, both in hospital and ambulatory/mobility settings to improve pain control in pwMS, but the effectiveness and safety of many non-pharmacological modalities is still unknown. OBJECTIVES: This review aimed to investigate the effectiveness (...) and safety of non-pharmacological therapies for the management of chronicpain in pwMS. Specific questions to be addressed by this review include the following.Are non-pharmacological interventions (unidisciplinary and/or multidisciplinary rehabilitation) effective in reducing chronicpain in pwMS?What type of non-pharmacological interventions (unidisciplinary and/or multidisciplinary rehabilitation) are effective (least and most effective) and in what setting, in reducing chronicpain in pwMS? SEARCH
Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis. Importance: Harms and benefits of opioids for chronic noncancer pain remain unclear. Objective: To systematically review randomized clinical trials (RCTs) of opioids for chronic noncancer pain. Data Sources and Study Selection: The databases of CENTRAL, CINAHL, EMBASE, MEDLINE, AMED, and PsycINFO were searched from inception to April 2018 for RCTs of opioids for chronic noncancer pain vs any nonopioid control. Data (...) , -0.90 cm [95% CI, -1.65 to -0.14 cm]; physical functioning: WMD, 0.45 points [95% CI, -5.77 to 6.66 points]). Conclusions and Relevance: In this meta-analysis of RCTs of patients with chronic noncancer pain, evidence from high-quality studies showed that opioid use was associated with statistically significant but small improvements in pain and physical functioning, and increased risk of vomiting compared with placebo. Comparisons of opioids with nonopioid alternatives suggested that the benefit
Cannabinoids for ChronicPain Cannabinoids for ChronicPain November 2018 Mailing Address: Therapeutics Initiative The University of British Columbia Department of Anesthesiology, Pharmacology & Therapeutics 2176 Health Sciences Mall Vancouver, BC Canada V6T 1Z3 Tel.: 604 822 0700 Fax: 604 822 0701 E-mail: firstname.lastname@example.org www.ti.ubc.ca 115 C anada’s parliament legalized the recreational use of herbal cannabis (marijuana) in October 2018. The well-publicized limitations of clinical re- search (...) and well-recognized side effects such as canna- bis intoxication have not deterred people from seeking out and using herbal cannabis for chronicpain in in- creasing numbers. This is occurring with or without a physician’s authorization. 1 In fact, half of Canadians reporting a medical use of herbal cannabis used it for pain relief. 2 Adult patients in Canada still require a physician’s ‘au- thorization’ to legally access cannabis from a licensed producer of cannabis for medical purposes. Facilitating
Identifying and Engaging Neuronal Oscillations by Transcranial Alternating Current Stimulation in Patients With Chronic Low Back Pain: A Randomized, Crossover, Double-Blind, Sham-Controlled Pilot Study 30268803 2018 11 25 1528-8447 2018 Sep 27 The journal of pain : official journal of the American Pain Society J Pain Identifying and Engaging Neuronal Oscillations by Transcranial Alternating Current Stimulation in Patients With Chronic Low Back Pain: A Randomized, Crossover, Double-Blind, Sham (...) -Controlled Pilot Study. S1526-5900(18)30642-4 10.1016/j.jpain.2018.09.004 Chronicpain is associated with maladaptive reorganization of the central nervous system. Recent studies have suggested that disorganization of large-scale electrical brain activity patterns, such as neuronal network oscillations in the thalamocortical system, plays a key role in the pathophysiology of chronicpain. Yet, little is known about whether and how such network pathologies can be targeted with noninvasive brain
Effects of an anteroposterior mobilization of the glenohumeral joint in overhead athletes with chronic shoulder pain: A randomized controlled trial. 30359870 2018 11 29 2468-7812 38 2018 12 Musculoskeletal science & practice Musculoskelet Sci Pract Effects of an anteroposterior mobilization of the glenohumeral joint in overhead athletes with chronic shoulder pain: A randomized controlled trial. 91-98 S2468-7812(18)30100-0 10.1016/j.msksp.2018.09.009 Passive oscillatory mobilizations are often (...) employed by physiotherapists to reduce shoulder pain and increase function. However, there is little data about the neurophysiological effects of these mobilizations. To investigate the initial effects of an anteroposterior (AP) shoulder joint mobilization on measures of pain and function in overhead athletes with chronic shoulder pain. Double-blind, controlled, within-subject, repeated-measures design. Thirty-one overhead athletes with chronic shoulder pain participated. The effects of a 9-min, AP
Postmenopausal Subacute or Chronic Pelvic Pain New 2018 ACR Appropriateness Criteria ® 1 Postmenopausal Subacute or Chronic Pelvic Pain American College of Radiology ACR Appropriateness Criteria ® Postmenopausal Subacute or Chronic Pelvic Pain Variant 1: Postmenopausal subacute or chronic pelvic pain, localized to the deep pelvis. Initial imaging. Procedure Appropriateness Category Relative Radiation Level US pelvis transvaginal Usually Appropriate O US duplex Doppler pelvis Usually Appropriate (...) Not Appropriate ???? CT pelvis without IV contrast Usually Not Appropriate ??? Radiography abdomen and pelvis Usually Not Appropriate ??? Variant 2: Postmenopausal subacute or chronic pelvic pain, clinically suspected pathologies in perineum, vulva, or vagina. Initial imaging. Procedure Appropriateness Category Relative Radiation Level US duplex Doppler pelvis Usually Appropriate O US pelvis transabdominal Usually Appropriate O US pelvis transvaginal Usually Appropriate O MRI pelvis without and with IV
Chronic Knee Pain Revised 2018 ACR Appropriateness Criteria ® 1 Chronic Knee Pain American College of Radiology ACR Appropriateness Criteria ® Chronic Knee Pain Variant 1: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial imaging. Procedure Appropriateness Category Relative Radiation Level Radiography knee Usually Appropriate ? Aspiration knee Usually Not Appropriate Varies CT arthrography knee Usually Not Appropriate ? CT knee with IV contrast Usually (...) . Chronic knee pain. Initial knee radiograph negative or demonstrates joint effusion. Next imaging procedure. Procedure Appropriateness Category Relative Radiation Level MRI knee without IV contrast Usually Appropriate O Aspiration knee May Be Appropriate Varies CT arthrography knee May Be Appropriate ? CT knee without IV contrast May Be Appropriate ? US knee May Be Appropriate (Disagreement) O Radiography hip ipsilateral May Be Appropriate ??? Radiography lumbar spine May Be Appropriate ??? MR
Chronic Chest Pain-Noncardiac Etiology Unlikely: Low to Intermediate Probability of Coronary Artery Disease Revised 2018 ACR Appropriateness Criteria ® 1 Chronic Chest Pain–Noncardiac Etiology Unlikely American College of Radiology ACR Appropriateness Criteria ® Chronic Chest Pain-Noncardiac Etiology Unlikely: Low to Intermediate Probability of Coronary Artery Disease Variant 1: Chronic chest pain, noncardiac etiology unlikely: low to intermediate probability of coronary artery disease. Initial (...) chest without and with IV contrast Usually Not Appropriate ??? CT chest without IV contrast Usually Not Appropriate ??? Tc-99m SPECT/CT MPI rest only Usually Not Appropriate ??? ACR Appropriateness Criteria ® 2 Chronic Chest Pain–Noncardiac Etiology Unlikely CHRONIC CHEST PAIN-NONCARDIAC ETIOLOGY UNLIKELY: LOW TO INTERMEDIATE PROBABILITY OF CORONARY ARTERY DISEASE Expert Panel on Cardiac Imaging: Amar B. Shah, MD a ; Jacobo Kirsch, MD b ; Michael A. Bolen, MD c ; Juan C. Batlle, MD d ; Richard K. J