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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
Interstitial cystitis/bladder pain syndrome Interstitial cystitis/bladder pain syndrome - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Interstitial cystitis/bladder pain syndrome Last reviewed: February 2019 Last updated: March 2019 Summary Chronic, often debilitating clinical syndrome of urinary frequency, urgency, and pelvic pain. Symptoms vary with bladder filling. Typified by periods of remission (...) and exacerbations. Diagnosis is one of exclusion, and physicians must carefully consider all patients with chronic pelvic pain as potential candidates. Associated with several other comorbidities, including irritable bowel syndrome and systemic lupus erythematosus. Treatment approach is aimed at symptom relief and pain management, with minimally invasive options tried before progressing to more complex, invasive therapies. On average, a patient experiences symptoms for 5 years prior to diagnosis. Definition
Responsible, Safe, and Effective Use of Antithrombotics and Anticoagulants in Patients Undergoing Interventional Techniques: American Society of Interventional Pain Physicians (ASIPP) Guidelines 30717501 2019 02 05 2150-1149 22 1S 2019 Jan Pain physician Pain Physician Responsible, Safe, and Effective Use of Antithrombotics and Anticoagulants in Patients Undergoing Interventional Techniques: American Society of Interventional Pain Physicians (ASIPP) Guidelines. S1-S74 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 anticoagulant or antithrombotic drugs to mitigate thrombosis risk. Since these drugs target the clotting system, bleeding risk is a consideration accompanying interventional procedures. Importantly, discontinuation of anticoagulant or antithrombotic
Responsible, Safe, and Effective Use of Biologics in the Management of Low Back Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines 30717500 2019 02 05 2150-1149 22 1S 2019 Jan Pain physician Pain Physician Responsible, Safe, and Effective Use of Biologics in the Management of Low Back Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. S1-S74 Regenerative medicine is a medical subspecialty that seeks to recruit and enhance the body's own (...) . Appropriate precautions should be taken into consideration and followed prior to performing biologic therapy. Multiple guidelines from the Food and Drug Administration (FDA), potential limitations in the use of biologic therapy and the appropriate requirements for compliance with the FDA have been detailed in these guidelines. Regenerative medicine, platelet-rich plasma, medicinal signaling cells, mesenchymal stem cells, stromal vascular fraction, bone marrow concentrate, chronic low back pain, discogenic
Effect of ketorolac in intra-articular injection analgesia for postoperative pain in patients undergoing shoulder arthroscopy: a pilot-controlled clinical study 30705607 2019 02 03 1178-7090 12 2019 Journal of pain research J Pain Res Effect of ketorolac in intra-articular injection analgesia for postoperative pain in patients undergoing shoulder arthroscopy: a pilot-controlled clinical study. 417-422 10.2147/JPR.S178413 To date, a regional approach using local anesthetics has become a popular (...) analgesic method for arthroscopy. The optimal postoperative analgesia method for shoulder arthroscopy is still debated. This study was designed to evaluate the effect and safety of using ketorolac in combination with a multimodal drug regime (ropivacaine, morphine, and triamcinolone acetonide) after shoulder arthroscopy. A total of 60 patients were included in a pilot study and patients were randomized into an experimental group (n=30) and a control group (n=30). The following parameters were used
Effectiveness of Slump Stretching on Low Back Pain: A Systematic Review and Meta-analysis 30590849 2018 12 27 1526-4637 2018 Dec 24 Pain medicine (Malden, Mass.) Pain Med Effectiveness of Slump Stretching on Low Back Pain: A Systematic Review and Meta-analysis. 10.1093/pm/pny208 The slump test is a type of neurodynamic test that is believed to evaluate the mechanosensitivity of the neuromeningeal structures within the vertebral canal. The objective of this review was to investigate (...) the effectiveness of slump stretching on back pain and disability in patients with low back pain (LBP). We searched eight electronic databases (PubMed/Medline, Scopus, Ovid, CINAHL, Embase, PEDro, Google Scholar, CENTRAL). The publication language was restricted to English, and we searched the full time period available for each database, up to October 2017. Our primary outcomes were pain and disability, and the secondary outcome was range of motion (ROM). We identified 12 eligible studies with 515 LBP patients
Transcutaneous electrical nerve stimulation (TENS) for chronic pain - an overview of Cochrane Reviews. BACKGROUND: Chronic pain, 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 chronic pain (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 chronic pain (excluding headache or migraine).To identify possible sources of inconsistency in the approaches taken to evaluating the evidence related to TENS
Effectiveness of Shortwave Diathermy for Subacromial Impingement Syndrome and Value of Night Pain for Patient Selection: A Double-Blinded, Randomized, Placebo-Controlled Trial. 28885231 2019 02 15 2019 02 15 1537-7385 97 3 2018 03 American journal of physical medicine & rehabilitation Am J Phys Med Rehabil Effectiveness of Shortwave Diathermy for Subacromial Impingement Syndrome and Value of Night Pain for Patient Selection: A Double-Blinded, Randomized, Placebo-Controlled Trial. 178-186 (...) 10.1097/PHM.0000000000000819 The aim of this study was to investigate the effectiveness of short wave diathermy (SWD) in patients with subacromial impingement syndrome. In this double-blinded, randomized, placebo-controlled trial, 57 patients (aged 35-65 yrs) were classified into night pain positive (NP[+]) (n = 28) and night pain negative (NP[-]) (n = 29) groups. Both groups were randomly assigned to SWD (NP[+], n = 14; NP[-], n = 14) and sham (NP[+], n = 15; NP[-], n = 14) subgroups. Visual analog
Does a Rehabilitation Program of Aerobic and Progressive Resisted Exercises Influence HIV-Induced Distal Neuropathic Pain? 29189306 2019 02 15 2019 02 15 1537-7385 97 5 2018 05 American journal of physical medicine & rehabilitation Am J Phys Med Rehabil Does a Rehabilitation Program of Aerobic and Progressive Resisted Exercises Influence HIV-Induced Distal Neuropathic Pain? 364-369 10.1097/PHM.0000000000000866 Distal symmetrical polyneuropathy is a common neurological sequela after HIV, which (...) leads to neuropathic pain and functional limitations. Rehabilitation programs with exercises are used to augment pharmacological therapy to relieve pain but appropriate and effective exercises are unknown. This study explored the safety and effect of moderate-intensity aerobic exercises and progressive resisted exercises for HIV-induced distal symmetrical polyneuropathy neuropathic pain. A randomized pretest, posttest of 12 wks of aerobic exercise or progressive resisted exercise compared
Effectiveness of a Group Physiotherapy Intervention in Nontraumatic, Inoperable Painful Shoulder: A Randomized Clinical Trial. 28857770 2019 02 14 2019 02 15 1537-7385 97 2 2018 02 American journal of physical medicine & rehabilitation Am J Phys Med Rehabil Effectiveness of a Group Physiotherapy Intervention in Nontraumatic, Inoperable Painful Shoulder: A Randomized Clinical Trial. 110-115 10.1097/PHM.0000000000000817 The aim of the study was to assess the effectiveness of a group intervention (...) in painful shoulder. This was a two-arm controlled clinical trial with a 5-wk follow-up and 1:1 allocation ratio with pretreatment and posttreatment assessments in a Spanish hospital in 2015-2016. This study comprised 74 patients with nontraumatic, inoperable painful shoulder. Patients were randomized into two groups: (1) in intervention, patients underwent group rehabilitation exercises supervised by a physical therapist and (2) in control, patients performed the same exercises as the intervention group
Intra-articular Triamcinolone Versus Hyaluronate Injections for Low Back Pain With Symptoms Suggestive of Lumbar Zygapophyseal Joint Arthropathy: A Pragmatic, Double-Blind Randomized Controlled Trial. 29261533 2019 02 13 2019 02 15 1537-7385 97 4 2018 04 American journal of physical medicine & rehabilitation Am J Phys Med Rehabil Intra-articular Triamcinolone Versus Hyaluronate Injections for Low Back Pain With Symptoms Suggestive of Lumbar Zygapophyseal Joint Arthropathy: A Pragmatic, Double (...) -Blind Randomized Controlled Trial. 278-284 10.1097/PHM.0000000000000879 The aim of the study was to compare hyaluronate with triamcinolone injections in treating chronic low back pain suggestive of lumbar zygopophyseal joint arthropathy. This was a prospective, double-blind, randomized controlled trial. Thirty subjects were randomly assigned to receive bilateral L3-S1 lumbar zygopophyseal joint injections with triamcinolone (KA) or Synvisc-One (HA). Pain (visual analog scale) and Pain Disability
Effects of Platelet-Rich Plasma on Pain and Muscle Strength in Patients With Knee Osteoarthritis. 29210705 2019 02 13 2019 02 15 1537-7385 97 4 2018 04 American journal of physical medicine & rehabilitation Am J Phys Med Rehabil Effects of Platelet-Rich Plasma on Pain and Muscle Strength in Patients With Knee Osteoarthritis. 248-254 10.1097/PHM.0000000000000874 No studies comparing the effects of platelet-rich plasma (PRP) injection and placebo injection in bilateral knee osteoarthritis in the (...) Universities Osteoarthritis Index and the secondary included isokinetic test results. The evaluation was at baseline and at 2 wks, 1, 3, and 6 mos after injection. The PRP group showed a significant reduction in the Western Ontario and McMaster's Universities Osteoarthritis Index pain and total scores compared with normal saline group (P < 0.05). Although a significantly greater percentage of knee strength (extensor > flexor) was found in the PRP group during a longer follow-up period, PRP treatment
Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline. CLINICAL QUESTION: Do adults with atraumatic shoulder pain for more than 3 months diagnosed as subacromial pain syndrome (SAPS), also labelled as rotator cuff disease, benefit from subacromial decompression surgery? This guideline builds on to two recent high quality trials of shoulder surgery. CURRENT PRACTICE: SAPS is the common diagnosis for shoulder pain with several first line treatment options (...) , including analgesia, exercises, and injections. Surgeons frequently perform arthroscopic subacromial decompression for prolonged symptoms, with guidelines providing conflicting recommendations. RECOMMENDATION: The guideline panel makes a strong recommendation against surgery. HOW THIS GUIDELINE WAS CREATED: A guideline panel including patients, clinicians, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines and the GRADE system. The recommendation
Compounded Topical Pain Creams to Treat Localized Chronic Pain: 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 chronic pain. 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
Interventions for intra-operative pain relief during postpartum mini-laparotomy tubal ligation. BACKGROUND: Postpartum mini-laparotomy tubal ligation (PPTL) is a contraceptive method that works by interrupting the patency of the fallopian tubes. Several methods are used for intraoperative pain relief, such as systemic administration of opioids or intraperitoneal instillation of lidocaine. OBJECTIVES: To evaluate the effectiveness of and adverse effects associated with interventions for pain (...) relief in women undergoing PPTL. SEARCH METHODS: We searched for eligible studies published on or before 31 July 2017 in the CENTRAL Register of Studies Online, MEDLINE, Embase, PsycINFO, and CINAHL. We examined review articles and searched registers of ongoing clinical trials, citation lists of included studies, key textbooks, grey literature, and previous systematic reviews for potentially relevant studies. SELECTION CRITERIA: We included randomised controlled trials (RCT) that compared perioperative pain
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
Efficacy and Safety of EMLA Cream for Pain Control Due to Venipuncture in Infants: A Meta-analysis 30587535 2019 01 02 1098-4275 143 1 2019 Jan Pediatrics Pediatrics Efficacy and Safety of EMLA Cream for Pain Control Due to Venipuncture in Infants: A Meta-analysis. e20181173 10.1542/peds.2018-1173 : media-1vid110.1542/5852339542001PEDS-VA_2018-1173 Video Abstract CONTEXT: The eutectic mixture of lidocaine (EMLA) cream has been used to reduce the pain during venipuncture in infants. To determine (...) the efficacy and safety of EMLA in infants <3 months of age requiring venipuncture in comparison with nonpharmacological interventions in terms of pain reduction, change in physiologic variables, and methemoglobinemia. Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and gray literature were searched from inception to August 2017, without language restrictions. We selected randomized controlled trials in which
Combination Drug Therapy for the Management of Low Back Pain and Sciatica: Systematic Review and Meta-Analysis 30585164 2019 01 29 1528-8447 20 1 2019 Jan The journal of pain : official journal of the American Pain Society J Pain Combination Drug Therapy for the Management of Low Back Pain and Sciatica: Systematic Review and Meta-Analysis. 1-15 S1526-5900(18)30319-5 10.1016/j.jpain.2018.06.005 Combining medicines may give greater pain relief and/or improved tolerability. We conducted (...) a systematic review to investigate the effects of combination drug therapy in patients with low back pain and/or sciatica on pain, disability, and adverse events. Databases and trial registers were searched from inception to July 27, 2017, for randomized trials of (sub)acute or chronic back pain or sciatica participants that were administered combination drug therapy compared with monotherapy or placebo. Of the 27 studies included, most combinations (21 of 23) consisted of single trials. Most combinations