Latest & greatest articles for pain

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Top results for pain

361. Greater trochanteric pain syndrome (trochanteric bursitis): Scenario: Management

Greater trochanteric pain syndrome (trochanteric bursitis): Scenario: Management Scenario: Management | Management | Greater trochanteric pain syndrome (trochanteric bursitis) | CKS | NICE Search CKS… Menu Scenario: Management Greater trochanteric pain syndrome (trochanteric bursitis): Scenario: Management Last revised in August 2016 Scenario: Management From age 16 years onwards. How should I manage a person with greater trochanteric pain syndrome? Reassure the person that greater (...) trochanteric pain syndrome is usually self-limiting. Explain that, although symptoms do persist in a small proportion of people, persistence does not mean that there is a serious underlying condition or that the hip joint is being damaged. Offer written information on greater trochanteric pain syndrome, such as the patient information available on the website. Offer conservative treatment: Advise the person to : Rest the affected hip by avoiding activity that may worsen the pain such as repetitive

2019 NICE Clinical Knowledge Summaries

362. Greater trochanteric pain syndrome (trochanteric bursitis): Differential diagnosis

Greater trochanteric pain syndrome (trochanteric bursitis): Differential diagnosis Differential diagnosis | Diagnosis | Greater trochanteric pain syndrome (trochanteric bursitis) | CKS | NICE Search CKS… Menu Differential diagnosis Greater trochanteric pain syndrome (trochanteric bursitis): Differential diagnosis Last revised in August 2016 Differential diagnosis Conditions which can present similarly to greater trochanteric pain syndrome include: Soft-tissue conditions Iliotibial band (...) /snapping hip syndrome History: lateral hip pain on walking, running, or cycling, with or without snapping; lateral knee pain aggravated by repetitive activity. Examination: symptoms can be reproduced by adducting the hip joint while it is held in extension and external rotation (Ober's test). Iliopsoas bursitis History: reproducible painful snapping sensations in the anterior hip. Examination: tenderness on deep palpation over the femoral triangle (upper inner thigh). Sports hernia/athletic pubalgia

2019 NICE Clinical Knowledge Summaries

363. Radiofrequency denervation for lumbar and cervical facet joint pain ? a systematic review. Decision Support Document 99/ Update 2019.

Radiofrequency denervation for lumbar and cervical facet joint pain ? a systematic review. Decision Support Document 99/ Update 2019. Radiofrequency denervation for lumbar and cervical facet joint pain – a systematic review - Repository of AIHTA GmbH English | Browse - - - Radiofrequency denervation for lumbar and cervical facet joint pain – a systematic review Fuchs , E. and Geiger-Gritsch, S. (2019): Radiofrequency denervation for lumbar and cervical facet joint pain – a systematic review (...) . Decision Support Document 99/ Update 2019. Preview - Sie müssen einen PDF-Viewer auf Ihrem PC installiert haben wie z. B. , oder 1MB Abstract The report represents the 1st update of the evaluation of radiofrequency denervation for the treatment of chronic lumbar or cervical facet joint pain. In addition to the original review, patients suffering from facet joint syndrome due to osteoporosis were considered. In order to evaluate the clinical efficacy and safety of radiofrequency denervation for cervical

2019 Austrian Institute of Health Technology Assessment

364. Back pain - low (without radiculopathy)

Back pain - low (without radiculopathy) Back pain - low (without radiculopathy) | Topics A to Z | CKS | NICE Search CKS… Menu Back pain - low (without radiculopathy) Back pain - low (without radiculopathy) Last revised in November 2018 Low back pain affects the lumbosacral area of the back, between the bottom of the ribs and the top of the legs. Diagnosis Management Prescribing information Background information Back pain - low (without radiculopathy): Summary Low back pain affects (...) the lumbosacral area of the back, between the bottom of the ribs and the top of the legs. It affects around one third of the adult population each month. In most people, low back pain is non-specific and serious specific causes are rare. Complications include: Development of chronicity and depression. Disability and loss of employment. Non-specific low back pain is often a chronic problem in which periods of little pain or disability are interrupted by acute episodes of severe pain. In people with low back

2019 NICE Clinical Knowledge Summaries

365. Palliative cancer care - pain: Scenario: Managing pain - non-emergency

Palliative cancer care - pain: Scenario: Managing pain - non-emergency Scenario: Managing pain - non-emergency | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Managing pain - non-emergency Palliative cancer care - pain: Scenario: Managing pain - non-emergency Last revised in October 2016 Scenario: Managing pain - non-emergency From age 16 years onwards. How should I treat persistent pain in a non-emergency situation? Prescribe analgesia for continuous pain (...) on a regular basis, in addition to as-required analgesia. Consider a stepwise approach, using the World Health Organization analgesic ladder. Start at the appropriate point of the analgesic ladder, moving up the ladder when the maximum dose at each step is reached until the person is comfortable. The steps are: Step 1: analgesic such as paracetamol and/or nonsteroidal anti-inflammatory drug (mild pain). Step 2: such as codeine, dihydrocodeine or tramadol (controlled drug), with or without a non-opioid

2019 NICE Clinical Knowledge Summaries

366. Palliative cancer care - pain: Scenario: Managing neuropathic pain

Palliative cancer care - pain: Scenario: Managing neuropathic pain Scenario: Managing neuropathic pain | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Managing neuropathic pain Palliative cancer care - pain: Scenario: Managing neuropathic pain Last revised in October 2016 Scenario: Managing neuropathic pain From age 16 years onwards. How should I manage neuropathic pain? Consider whether there is a treatable underlying cause (for example, nerve compression (...) from bone metastases or soft-tissue disease) and seek specialist advice regarding further treatment of the cause (for example, surgical stabilization for bone metastases or radiotherapy for soft-tissue disease). If pain is purely neuropathic and reversible conditions (for example, vitamin B 12 deficiency) have been excluded: Consider offering amitriptyline (off-label use) or pregabalin (or gabapentin if there is a local decision to prefer gabapentin over pregabalin). Titrate the dosage according

2019 NICE Clinical Knowledge Summaries

367. Palliative cancer care - pain: Scenario: Managing muscle spasm pain

Palliative cancer care - pain: Scenario: Managing muscle spasm pain Scenario: Managing muscle spasm pain | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Managing muscle spasm pain Palliative cancer care - pain: Scenario: Managing muscle spasm pain Last revised in October 2016 Scenario: Managing muscle spasm pain From age 16 years onwards. How should I manage muscle spasm? Consider whether there is a treatable underlying cause. Try simple measures (...) (such as heat pad, massage, relaxation). Consider transcutaneous electric nerve stimulation over the trigger point if the pain is myofascial. If trigger points are multiple or the muscle spasm is widespread, consider a muscle relaxant — diazepam or (less preferred) baclofen: Several different doses of diazepam have been suggested by experts. These range from 2–10 mg at night to 2–5 mg three times a day; the higher doses may be helpful if there is co-existing anxiety. The dose may need to be reduced

2019 NICE Clinical Knowledge Summaries

368. Palliative cancer care - pain: Scenario: Managing intracranial pressure pain

Palliative cancer care - pain: Scenario: Managing intracranial pressure pain Scenario: Managing intracranial pressure pain | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Managing intracranial pressure pain Palliative cancer care - pain: Scenario: Managing intracranial pressure pain Last revised in October 2016 Scenario: Managing intracranial pressure pain From age 16 years onwards. How should I manage pain from raised intracranial pressure? Consider

2019 NICE Clinical Knowledge Summaries

369. Palliative cancer care - pain: Scenario: Managing colic

Palliative cancer care - pain: Scenario: Managing colic Scenario: Managing colic | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Managing colic Palliative cancer care - pain: Scenario: Managing colic Last revised in October 2016 Scenario: Managing colic From age 16 years onwards. How should I manage intestinal colic? Consider whether there is a treatable underlying cause: It may be possible to treat certain causes of colicky pain (for example, bowel colic

2019 NICE Clinical Knowledge Summaries

370. Palliative cancer care - pain: Scenario: Managing bone pain

Palliative cancer care - pain: Scenario: Managing bone pain Scenario: Managing bone pain | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Managing bone pain Palliative cancer care - pain: Scenario: Managing bone pain Last revised in October 2016 Scenario: Managing bone pain From age 16 years onwards. How should I manage bone pain? Consider whether there is a treatable underlying cause and discuss with an oncologist if this is suspected (for example (...) , regarding radiotherapy for bone metastases). Seek urgent advice from an orthopaedic surgeon if there is evidence or suspicion of an actual or imminent fracture. For symptomatic relief: Apply hot or cold packs. Use standard analgesia in a stepwise approach (see ). If incident pain occurs on movement, encourage the person to take a dose of their breakthrough analgesia 20–30 minutes before anticipated movement. See . If pain is difficult to manage, seek advice from a specialist (such as a palliative care

2019 NICE Clinical Knowledge Summaries

371. Palliative cancer care - pain: Scenario: End of life care

Palliative cancer care - pain: Scenario: End of life care Scenario: End of life care | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: End of life care Palliative cancer care - pain: Scenario: End of life care Last revised in October 2016 Scenario: End of life care End of life care It can often be difficult to be certain that a person is dying, but it is essential to recognize the signs of dying in order to appropriately care for people at the end of life (...) . For more information see the CKS topic on . An individualised care plan including the areas of symptom control and anticipatory prescribing should be created. For more information see the CKS topic on . Follow the principles of pain management used at other times when caring for people in the last days of life, for example, matching the medicine to the severity of pain and, when possible, using the dying person's preferences for how it is given. Consider non-pharmacological management of pain

2019 NICE Clinical Knowledge Summaries

372. Palliative cancer care - pain: Scenario: Assessment of pain

Palliative cancer care - pain: Scenario: Assessment of pain Scenario: Assessment of pain | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Assessment of pain Palliative cancer care - pain: Scenario: Assessment of pain Last revised in October 2016 Scenario: Assessment of pain From age 16 years onwards. How should I approach pain assessment? Discuss pain with the person directly if possible. The person, if competent and able to communicate, is the most reliable (...) source of information about their pain. If it is not possible to ask them (because of cognitive impairment or communication deficits, for example), the family or healthcare professionals may be able to help with the assessment, bearing in mind that family members may overestimate, and healthcare professionals underestimate, the person's pain. Assess each pain a person has with a view to establishing an underlying , bearing in mind that there may be more than one. Seek specialist advice if assessment

2019 NICE Clinical Knowledge Summaries

373. Palliative cancer care - pain: Scenario: Acute severe pain

Palliative cancer care - pain: Scenario: Acute severe pain Scenario: Acute severe pain | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Acute severe pain Palliative cancer care - pain: Scenario: Acute severe pain Last revised in October 2016 Scenario: Acute severe pain From age 16 years onwards. How should I manage acute severe pain? Immediately relieve pain using a subcutaneous or slow intravenous dose of a strong opioid. The dose depends on the person's (...) comorbidities and their existing analgesia: If the person is opioid naive, consider a subcutaneous or slow intravenous dose of 5 mg of morphine (2.5 mg if the person is elderly or frail). If the person is already taking a regular opioid, calculate the 4-hourly dose by taking the total dose given over the previous 24 hours (including doses required for breakthrough pain but excluding those for incident pain) and dividing it by six, and then give the equivalent subcutaneous dose of morphine: The subcutaneous

2019 NICE Clinical Knowledge Summaries

374. Palliative cancer care - pain: Codeine, dihydrocodeine and tramadol

Palliative cancer care - pain: Codeine, dihydrocodeine and tramadol Codeine, dihydrocodeine and tramadol | Prescribing information | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Codeine, dihydrocodeine and tramadol Palliative cancer care - pain: Codeine, dihydrocodeine and tramadol Last revised in October 2016 Codeine, dihydrocodeine and tramadol For a detailed information on prescribing codeine, dihydrocodeine and tramadol, see the CKS topic on . © .

2019 NICE Clinical Knowledge Summaries

375. Palliative cancer care - pain: What issues should I consider before prescribing baclofen?

Palliative cancer care - pain: What issues should I consider before prescribing baclofen? Baclofen | Prescribing information | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Baclofen Palliative cancer care - pain: What issues should I consider before prescribing baclofen? Last revised in October 2016 What issues should I consider before prescribing baclofen? Sedation, drowsiness and nausea are commonly reported adverse effects. Do not stop baclofen abruptly; sudden withdrawal can

2019 NICE Clinical Knowledge Summaries

376. Palliative cancer care - pain: What issues should I consider before prescribing a tricyclic antidepressant drug?

Palliative cancer care - pain: What issues should I consider before prescribing a tricyclic antidepressant drug? Tricyclic antidepressants | Prescribing information | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Tricyclic antidepressants Palliative cancer care - pain: What issues should I consider before prescribing a tricyclic antidepressant drug? Last revised in October 2016 What issues should I consider before prescribing a tricyclic antidepressant drug? For prescribing

2019 NICE Clinical Knowledge Summaries

377. Palliative cancer care - pain: What issues should I consider before prescribing a nonsteroidal anti-inflammatory drug?

Palliative cancer care - pain: What issues should I consider before prescribing a nonsteroidal anti-inflammatory drug? NSAIDs | Prescribing information | Palliative cancer care - pain | CKS | NICE Search CKS… Menu NSAIDs Palliative cancer care - pain: What issues should I consider before prescribing a nonsteroidal anti-inflammatory drug? Last revised in October 2016 What issues should I consider before prescribing a nonsteroidal anti-inflammatory drug? For detailed information on prescribing

2019 NICE Clinical Knowledge Summaries

378. Palliative cancer care - pain: Strong opioids

Palliative cancer care - pain: Strong opioids Strong opioids | Prescribing information | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Strong opioids Palliative cancer care - pain: Strong opioids Last revised in October 2016 Strong opioids Initiation of oral morphine Initially prescribe either immediate-release or modified-release oral morphine: Immediate-release oral morphine has a rapid onset of action (about 20 minutes) but it requires administration every 4 hours to maintain (...) a continuous analgesic effect. Consequently, it is difficult to cover pain throughout 24 hours, unless the person is being closely monitored. Immediate-release morphine is useful for titration if the person's pain is severe and rapid titration is required, usually on an inpatient basis. Oramorph ® solution and Sevredol ® tablets are both immediate-release morphine products. Modified-release morphine preparations have a slower onset of action (1–2 hours) and later peak levels (4 hours) than immediate

2019 NICE Clinical Knowledge Summaries

379. Palliative cancer care - pain: Scenario: Spinal cord compression

Palliative cancer care - pain: Scenario: Spinal cord compression Scenario: Spinal cord compression | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Spinal cord compression Palliative cancer care - pain: Scenario: Spinal cord compression Last revised in October 2016 Scenario: Spinal cord compression From age 16 years onwards. When should I suspect spinal cord compression? Suspect spinal metastases if any of the following features are present: Pain (...) in the middle (thoracic) or upper (cervical) spine. Progressive lower (lumbar) spinal pain. Severe unremitting lower spinal pain. Spinal pain aggravated by straining (for example, when passing stool or when coughing or sneezing). Localized spinal tenderness. Nocturnal spinal pain preventing sleep. Suspect spinal cord compression if any of the following features are present: Neurological symptoms (including radicular pain, any limb weakness, difficulty in walking, sensory loss, or bladder or bowel

2019 NICE Clinical Knowledge Summaries

380. Developmental rheumatology in children: Scenario: Heel pain in children

Developmental rheumatology in children: Scenario: Heel pain in children Scenario: Heel pain in children | Management | Developmental rheumatology in children | CKS | NICE Search CKS… Menu Scenario: Heel pain in children Developmental rheumatology in children: Scenario: Heel pain in children Last revised in April 2019 Scenario: Heel pain in children From birth to 16 years. When should I consider referring a child with heel pain? Management in the community (for example by a podiatrist (...) with paediatric expertise) is usually appropriate for a child with heel pain if all of the following are present: The child is well and there are no features. Milestones are normal with no delay or regression. There is no limp or interference with daily activities. Consider referring children with heel pain for specialist assessment, using clinical judgement to determine the urgency, if any of the following are present: features. Visible swelling or abnormality on inspection (such as skin changes). Unilateral

2019 NICE Clinical Knowledge Summaries