Latest & greatest articles for pain

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Top results for pain

1. Discogenic low back pain

Discogenic low back pain Discogenic low back pain - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Discogenic low back pain Last reviewed: December 2018 Last updated: January 2019 Summary Magnetic resonance imaging is the imaging study of choice for degenerative disc disease due to its unique detail on the representation of the disc status. Other tests may include plain radiographs, computed tomography scanning (...) , or provocative discography. Non-surgical treatments include lifestyle measures, followed by the judicious use of medications, physiotherapy, and therapeutic needling procedures. Surgical treatment includes decompression of neural structures and, in selected patients, a fusion of the motion segment. Definition A complex, multi-factorial, clinical condition characterised by low back pain with or without the concurrence of radicular lower limb symptoms in the presence of radiologically-confirmed degenerative

BMJ Best Practice2019

2. Exercise improves intermittent claudication leg pain on walking

Exercise improves intermittent claudication leg pain on walking Exercise improves intermittent claudication leg pain on walking Dissemination Centre Discover Portal NIHR DC Discover Exercise improves intermittent claudication leg pain on walking Published on 10 April 2018 People with intermittent claudication who participate in structured exercise programmes can walk about 80 metres further without experiencing leg pain than those who do not do the programme. They can also walk about 120 metres (...) further overall. Intermittent claudication is a cramp-like pain in the legs caused by narrowing of the arteries, which restricts blood flow to the muscles. There’s increasing evidence that maintaining physical activity can help. This updated systematic review combined data from 32 trials involving 1,835 adults with stable leg pain. The quality of evidence was high for the main outcomes of how far people could walk in total and without pain. Exercises varied (for example, cycling, pole-striding) though

NIHR Dissemination Centre2018

3. Pain on injection of a widely used anaesthetic may be reduced if a common anti-sickness drug is given first

Pain on injection of a widely used anaesthetic may be reduced if a common anti-sickness drug is given first Signal - Pain on injection of a widely used anaesthetic may be reduced if a common anti-sickness drug is given first Dissemination Centre Discover Portal NIHR DC Discover Pain on injection of a widely used anaesthetic may be reduced if a common anti-sickness drug is given first Published on 7 June 2016 This review found that giving an anti-sickness drug, like ondansetron, before propofol (...) , an anaesthetic, helped reduce the frequency and severity of injection pain. The intravenous anaesthetic propofol is used at the start of almost all general anaesthetics in the UK but it does often cause unpleasant pain when it is injected. This review of trials looked for trials of any drug in the group of commonly-used anti-sickness drugs called 5HT3 receptor antagonists. Ondansetron, one of these drugs, is often used during anaesthesia to reduce nausea and vomiting after waking, but is usually given after

NIHR Dissemination Centre2018

4. Two nerve drugs are not suitable for treating long-term low back pain

Two nerve drugs are not suitable for treating long-term low back pain Signal - Two nerve drugs are not suitable for treating long-term low back pain Dissemination Centre Discover Portal NIHR DC Discover Two nerve drugs are not suitable for treating long-term low back pain Published on 5 December 2017 The drugs gabapentin and pregabalin (gabapentinoids) were found not to help lower back pain that had lasted more than three months. Gabapentin gave no benefit compared with placebo, while (...) pregabalin was less effective than other painkillers. Both were associated with several side effects, such as dizziness. Long-term low back pain without clear cause is very common. It causes considerable loss of productivity and places a high demand on the healthcare service. It is difficult to treat, and people often get limited relief from simple painkillers, causing practitioners to consider alternative options. This review gathered eight trials looking at gabapentinoids for adults with long-term

NIHR Dissemination Centre2018

5. A surgical procedure for shoulder pain is less effective than previously thought

A surgical procedure for shoulder pain is less effective than previously thought Signal - A surgical procedure for shoulder pain is less effective than previously thought Dissemination Centre Discover Portal NIHR DC Discover A surgical procedure for shoulder pain is less effective than previously thought Published on 23 January 2018 An increasingly common surgical procedure for shoulder pain, subacromial decompression, was only slightly more effective than no treatment. In the first trial (...) of this sort, improvements in pain and function following decompression or arthroscopy (a placebo surgery) did not reach a threshold of clinical importance compared with people allocated to no treatment at all. This NIHR-funded study involved 313 people with shoulder pain that had not responded to physiotherapy and a steroid injection. The main intervention, decompression, involved removing any bony outgrowths that could have been causing the tendons around the shoulder to be “pinched”. This was compared

NIHR Dissemination Centre2018

6. Online education, pain coaching and advice by video conference can reduce knee pain

Online education, pain coaching and advice by video conference can reduce knee pain Signal - Online education, pain coaching and advice by video conference can reduce knee pain Dissemination Centre Discover Portal NIHR DC Discover Online education, pain coaching and advice by video conference can reduce knee pain Published on 18 July 2017 For people with chronic knee pain from osteoarthritis, a programme including online education, interactive pain coaching and physiotherapy advice from (...) a professional by skype gave greater improvement in pain and function at nine months than online education alone. The small randomised control trial included 148 adults aged 50 or over in Australia. Clinically meaningful improvements in pain and physical function were achieved by around three-quarters of the comprehensive intervention group compared with just under half receiving education alone. Internet-delivered treatment could increase access, reduce clinician face-to-face time, and in the long-term

NIHR Dissemination Centre2018

7. Acupuncture shown to have benefits for treatment of some chronic pain

Acupuncture shown to have benefits for treatment of some chronic pain Signal - Acupuncture shown to have benefits for treatment of some chronic pain Dissemination Centre Discover Portal NIHR DC Discover Acupuncture shown to have benefits for treatment of some chronic pain Published on 20 June 2017 Acupuncture is not a placebo for treatment of chronic pain. 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

NIHR Dissemination Centre2018

8. A commonly used treatment does not improve chronic low back pain

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 (...) exercise and was a variation of the technique commonly used in the UK. In this large study, it was compared to exercise alone. Low back pain is usually short-lived, but some people develop long-term back pain which can negatively impact their lives. NICE recommends exercise, pain relief and self-management to cope with pain. If these treatments are not effective and pain is severe, then more intensive options, such as radiofrequency denervation can be considered. These findings suggest

NIHR Dissemination Centre2018

9. Acupuncture may improve neck pain in the short-term

Acupuncture may improve neck pain in the short-term Signal - Acupuncture may improve neck pain in the short-term Dissemination Centre Discover Portal NIHR DC Discover Acupuncture may improve neck pain in the short-term Published on 6 September 2016 Acupuncture provided slightly greater improvement in neck pain in the short-term than sham treatments or being on a waiting list. There were too few studies available to determine its long-term effectiveness and the evidence around disability (...) or quality of life was inconsistent. Most of the 27 trials included in this review were too varied for their results to be combined statistically and issues with the methodological quality of some studies limits the confidence that we can have in the findings. This review indicates that acupuncture delivered by a qualified acupuncturist may provide short-term pain relief from neck pain with minimal side effects or harms. Effects do not seem to be sustainable over the long term. Acupuncture for neck pain

NIHR Dissemination Centre2018

10. Potential alternative to painful blood tests in people with flare-ups of COPD

Potential alternative to painful blood tests in people with flare-ups of COPD Signal - Potential alternative to painful blood tests in people with flare-ups of COPD Dissemination Centre Discover Portal NIHR DC Discover Potential alternative to painful blood tests in people with flare-ups of COPD Published on 27 September 2016 It may be possible to use venous blood and pulse oximeters to initially assess the severity of a flare up of chronic obstructive pulmonary disease (COPD). Blood gas levels (...) dioxide and oxygen. Taking an arterial blood sample is painful and technically challenging. So this study looked at whether analysing blood from a vein and pulse oximeter measures could be an alternative, less invasive and simpler test. Although promising, we still need to understand and define cut-offs in the various measurements, to indicate when arterial blood samples are required to confirm or clarify the findings of alternative blood gas analyses. Share your views on the research. Why was this study needed

NIHR Dissemination Centre2018

11. Cement injections to treat spinal compression fractures from osteoporosis can reduce short term pain

Cement injections to treat spinal compression fractures from osteoporosis can reduce short term pain Signal - Cement injections to treat spinal compression fractures from osteoporosis can reduce short term pain Dissemination Centre Discover Portal NIHR DC Discover Cement injections to treat spinal compression fractures from osteoporosis can reduce short term pain Published on 13 December 2016 Injecting cement into osteoporotic spinal fractures within six weeks reduces pain in the first few (...) months and disability six months later. The trial was undertaken in people aged over 60 years and compared the one-off injection to a simulated dummy procedure. The procedure, called vertebroplasty, aims to stabilise the collapsed vertebra and prevent further collapse. This trial of 120 older people, average age of 80 years, found that vertebroplasty reduced disability and improved quality of life compared with placebo. Initially, at two weeks, pain scores were better with vertebroplasty

NIHR Dissemination Centre2018

12. Opioid drugs are no better than standard painkillers for long-term back and joint pain

Opioid drugs are no better than standard painkillers for long-term back and joint pain Opioid drugs are no better than standard painkillers for long-term back and joint pain Dissemination Centre Discover Portal NIHR DC Discover Opioid drugs are no better than standard painkillers for long-term back and joint pain Published on 3 July 2018 doi: People with long-term back pain, or osteoarthritis of their hips or knees, do not get better pain relief from opioid drugs and are more likely to get side (...) effects than those who take paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), like naproxen or ibuprofen. A US study assigned 240 patients to either opioid or non-opioid pain relief drugs and measured their pain over 12 months. Those who were assigned opioid drugs had less relief of their pain and also were more likely to have side-effects related to their medication. The findings may surprise some doctors and patients with long-term pain, because of the widely held belief that opioids

NIHR Dissemination Centre2018

13. Music can reduce pain and anxiety following surgery

Music can reduce pain and anxiety following surgery Music can reduce anxiety and pain following surgery Dissemination Centre Discover Portal NIHR DC Discover Music can reduce pain and anxiety following surgery Published on 7 August 2018 doi: Recorded music played before, during or after surgery in adults reduces self-reported post-operative pain and anxiety, compared with usual care. The average effect is equivalent to a reduction in anxiety of 21 percentage points and a 10 percentage point (...) reduction in pain within a few days of surgery. It is thought that placebo and distraction effects probably play a role, but in this review music still improved pain when used for patients under a general anaesthetic. Nearly two-thirds of patients experience severe pain after surgery. Anxiety can amplify perceptions of pain and lead to slower recovery. This systematic review included over 90 small-scale trials with a small effect, and it was not possible to blind conscious patients to which intervention

NIHR Dissemination Centre2018

14. MRI scan does not help to find the cause of pelvic pain in women

MRI scan does not help to find the cause of pelvic pain in women MRI scan does not help to find the cause of pelvic pain in women Dissemination Centre Discover Portal NIHR DC Discover MRI scan does not help to find the cause of pelvic pain in women Published on 16 October 2018 doi: MRI scans are not sufficiently accurate to find the cause of chronic pelvic pain in women and should not replace laparoscopy (keyhole surgery), which can be used for diagnosis and often treatment. MRI only correctly (...) ruled out a gynaecological condition in half of women judged to have no obvious cause and missed half of women who did have a treatable gynaecological condition. Pinpointing the origin of chronic pelvic pain is often difficult due to the number of possible causes. If initial tests and examinations, including ultrasound, don’t identify the cause, a laparoscopy under anaesthesia is often the next step. This NIHR-funded study aimed to see whether MRI could reliably rule out disease and thereby avoid

NIHR Dissemination Centre2018

15. Better pain relief for women in labour

Better pain relief for women in labour Better pain relief for women in labour Dissemination Centre Discover Portal NIHR DC Discover Better pain relief for women in labour Published on 9 October 2018 doi: Women in labour, who had the short acting strong painkiller remifentanil, rather than pethidine, had less need for further pain relief. Only 19% of women given remifentanil received a subsequent epidural compared with 41% given pethidine. Remifentanil was given intravenously, using a patient (...) -controlled delivery device, and pethidine given by intramuscular injection. This NIHR-funded study is the first large trial to compare intravenous remifentanil (administered via a patient-controlled delivery device) with intramuscular pethidine for women requesting opioid pain relief in labour. Opioid drugs can cause maternal sedation and depression of the baby's breathing but this trial found no difference in adverse maternal or neonatal outcomes between drugs. One caution is the potential

NIHR Dissemination Centre2018

16. Association of Pharmacological Treatments With Long-term Pain Control in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis.

Association of Pharmacological Treatments With Long-term Pain Control in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. Importance: Even though osteoarthritis is a chronic and progressive disease, pharmacological agents are mainly studied over short-term periods, resulting in unclear recommendations for long-term disease management. Objective: To search, review, and analyze long-term (≥12 months) outcomes (symptoms, joint structure) from randomized clinical trials (...) or longer (or the change from baseline) were extracted. A Bayesian random-effects network meta-analysis was performed. Main Outcomes and Measures: The primary outcome was the mean change from baseline in knee pain. Secondary outcomes were physical function and joint structure (the latter was measured radiologically as joint space narrowing). Standardized mean differences (SMDs) and mean differences with 95% credibility intervals (95% CrIs) were calculated. Findings were interpreted as associations when

JAMA2018

17. Perioperative intravenous ketamine for acute postoperative pain in adults.

Perioperative intravenous ketamine for acute postoperative pain in adults. BACKGROUND: Inadequate pain management after surgery increases the risk of postoperative complications and may predispose for chronic postsurgical pain. Perioperative ketamine may enhance conventional analgesics in the acute postoperative setting. OBJECTIVES: To evaluate the efficacy and safety of perioperative intravenous ketamine in adult patients when used for the treatment or prevention of acute pain following (...) anaesthesia and being treated with perioperative intravenous ketamine. Studies compared ketamine with placebo, or compared ketamine plus a basic analgesic, such as morphine or non-steroidal anti-inflammatory drug (NSAID), with a basic analgesic alone. DATA COLLECTION AND ANALYSIS: Two review authors searched for studies, extracted efficacy and adverse event data, examined issues of study quality and potential bias, and performed analyses. Primary outcomes were opioid consumption and pain intensity at rest

Cochrane2018

18. Non-pharmacological interventions for chronic pain in multiple sclerosis.

Non-pharmacological interventions for chronic pain in multiple sclerosis. BACKGROUND: Chronic pain 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 chronic pain 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 chronic pain 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 chronic pain in pwMS? SEARCH

Cochrane2018

19. Assessment of chest pain

Assessment of chest pain Assessment of chest pain - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Assessment of chest pain Last reviewed: November 2018 Last updated: December 2018 Summary Chest pain is a common chief complaint, accounting for approximately 5% of all emergency department visits in the US per year. Rui P, Kang K; Centers for Disease Control and Prevention, National Center for Health Statistics (...) . National hospital ambulatory medical care survey: 2015 emergency department summary tables. 2015 [internet publication]. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2015_ed_web_tables.pdf It is the presenting complaint in 1% of clinic-based visits. McConaghy JR, Oza RS. Outpatient diagnosis of acute chest pain in adults. Am Fam Physician. 2013 Feb 1;87(3):177-82. https://www.aafp.org/afp/2013/0201/p177.html http://www.ncbi.nlm.nih.gov/pubmed/23418761?tool=bestpractice.com In the UK, 1% to 2

BMJ Best Practice2018

20. Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis.

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 (...) Extraction and Synthesis: Paired reviewers independently extracted data. The analyses used random-effects models and the Grading of Recommendations Assessment, Development and Evaluation to rate the quality of the evidence. Main Outcomes and Measures: The primary outcomes were pain intensity (score range, 0-10 cm on a visual analog scale for pain; lower is better and the minimally important difference [MID] is 1 cm), physical functioning (score range, 0-100 points on the 36-item Short Form physical

JAMA2018