Scrotal pain and swelling: Scenario: Epididymal cyst/spermatocele Scenario: Epididymal cyst/spermatocele | Management | Scrotal pain and swelling | CKS | NICE Search CKS… Menu Scenario: Epididymal cyst/spermatocele Scrotal pain and swelling: Scenario: Epididymal cyst/spermatocele Last revised in August 2019 Scenario: Epididymal cyst/spermatocele How should I manage a man with epididymal cysts/spermatoceles? If confident of the diagnosis: Reassure the man that epididymal cysts/spermatoceles

Subacromial decompression surgery for adults with shoulder pain Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline | The BMJ Intended for healthcare professionals Username * Password * Edition: Search form Search Search Subacromial... Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline (Published 06 February 2019) Cite this as: BMJ 2019;364:l294 Visual summary of recommendation or Subacromial decompression (...) surgery Nonoperative management only Arthroscopic subacromial decompression plus nonoperative management Including guided physical therapy, exercise programmes, NSAIDs, and steroid injections Interventions compared Recommendation Population Adults with shoulder pain for more than 3 months Does not apply to patients with: Including: Traumatic shoulder pain Subacromial pain syndrome (SAPS) Rotator cuff disease (RCD) Other differential diagnoses We recommend against subacromial decompression surgery More

Inhaled Methoxyflurane Provides Greater Analgesia and Faster Onset of Action Versus Standard Analgesia in Patients With Trauma Pain: InMEDIATE: A Randomized Controlled Trial in Emergency Departments The objective of the InMEDIATE study was to evaluate the change in intensity of traumatic pain over the first 20 min in adult patients treated with methoxyflurane versus standard analgesic treatment in Spain. This the first randomized, active-controlled, multicenter trial of methoxyflurane (...) in the emergency setting in Europe.This was a randomized, controlled study that enrolled adult patients with acute moderate to severe (score ≥4 on the 11-point Numeric Rating Scale) trauma-associated pain in 14 Spanish emergency departments. Patients were randomized 1:1 to methoxyflurane (up to 2×3 mL) or standard analgesic treatment. Coprimary endpoints were the change from baseline in Numeric Rating Scale pain intensity score during the first 20 minutes of treatment and time to first pain relief.Three

Effects of open-label placebo on pain, functional disability, and spine mobility in patients with chronic back pain: a randomized controlled trial Chronic back pain (CBP) is a major global health problem, while its treatment is hampered by a lack of efficacy and restricted safety profile of common frontline therapies. The present trial aims to determine whether a 3-week open-label placebo treatment reduces pain intensity and subjective and objective functional disability in patients with CBP (...) . This randomized controlled trial, following a pretest-posttest design, enrolled 127 patients with CBP (pain duration >12 weeks) from the Back Pain Center, Neurology, University Hospital Essen, Germany. Patients randomized to the open-label placebo group received a 3-week open-label placebo treatment. Patients in the treatment as usual (TAU) group received no intervention. Both groups continued TAU. Primary outcome was the change in pain intensity. Secondary outcomes included patient-reported functional

Effects of Cervico-Mandibular Manual Therapy in Patients with Temporomandibular Pain Disorders and Associated Somatic Tinnitus: A Randomized Clinical Trial This randomized clinical trial investigated the effects of adding cervico-mandibular manual therapies into an exercise and educational program on clinical outcomes in individuals with tinnitus associated with temporomandibular disorders (TMDs).Sixty-one patients with tinnitus attributed to TMD were randomized into the physiotherapy (...) and manual therapy group or physiotherapy alone group. All patients received six sessions of physiotherapy treatment including cranio-cervical and temporomandibular joint (TMJ) exercises, self-massage, and patient education for a period of one month. Patients allocated to the manual therapy group also received cervico-mandibular manual therapies targeting the TMJ and cervical and masticatory muscles. Primary outcomes included TMD pain intensity and tinnitus severity. Secondary outcomes included tinnitus

Preemptive Oral Compared With Intravenous Acetaminophen for Postoperative Pain After Robotic-Assisted Laparoscopic Hysterectomy: A Randomized Controlled Trial

Moderators of Internet-Delivered Cognitive-Behavioral Therapy for Adolescents With Chronic Pain: Who Benefits From Treatment at Long-Term Follow-Up? Cognitive behavioral therapy (CBT) is effective for pediatric chronic pain, but little is understood about which youth are most likely to benefit. The current study aimed to identify individual characteristics for which CBT yielded the greatest (and least) clinical benefit among adolescents with chronic pain participating in a multicenter (...) randomized controlled trial of Internet-delivered CBT (WebMAP2). A total of 273 adolescents ages 11 to 17 with chronic pain (M age = 14.7; 75.1% female) were randomly assigned to Internet-delivered CBT or Internet-delivered pain education and evaluated at pretreatment, post-treatment, and 2 longer term follow-up periods (6 and 12 months). Multilevel growth models tested several adolescent- and parent-level moderators of change in pain-related disability including 1) adolescent age, sex, pain

Effect of Ubrogepant vs Placebo on Pain and the Most Bothersome Associated Symptom in the Acute Treatment of Migraine: The ACHIEVE II Randomized Clinical Trial. Ubrogepant is an oral calcitonin gene-related peptide receptor antagonist under investigation for acute treatment of migraine.To evaluate the efficacy and tolerability of ubrogepant compared with placebo for acute treatment of a single migraine attack.Phase 3, multicenter, randomized, double-blind, placebo-controlled, single-attack (...) , clinical trial (ACHIEVE II) conducted in the United States (99 primary care and research clinics; August 26, 2016-February 26, 2018). Participants were adults with migraine with or without aura experiencing 2 to 8 migraine attacks per month.Ubrogepant 50 mg (n = 562), ubrogepant 25 mg (n = 561), or placebo (n = 563) for a migraine attack of moderate or severe pain intensity.Co-primary efficacy outcomes were pain freedom and absence of the participant-designated most bothersome migraine-associated

Pentosan polysulfate sodium (Elmiron) - bladder pain syndrome characterised by either glomerulations or Hunner’s lesions 1 Published 11 November 2019 1 SMC2194 pentosan polysulfate sodium 100mg hard capsules (Elmiron®) Consilient Health Ltd 04 October 2019 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHSScotland. The advice is summarised as follows: ADVICE (...) : following a full submission considered under the orphan equivalent process pentosan polysulfate sodium (Elmiron ® ) is accepted for use within NHSScotland. Indication under review: for the treatment of bladder pain syndrome characterised by either glomerulations or Hunner’s lesions in adults with moderate to severe pain, urgency and frequency of micturition. In patients with bladder pain syndrome and glomerulations or Hunner’s lesions, pentosan polysulfate sodium was associated with significantly more

Patellofemoral Pain Clinical Practice Guidelines RICHARD W. WILLY, PT , PhD • LISA T . HOGLUND, PT , PhD • CHRISTIAN J. BARTON, PT , PhD LORI A. BOLGLA, PT , PhD • DAVID A. SCALZITTI, PT , PhD • DAVID S. LOGERSTEDT , PT , PhD ANDREW D. LYNCH, PT , PhD • LYNN SNYDER-MACKLER, PT , ScD, FAPTA • CHRISTINE M. MCDONOUGH, PT , PhD Patellofemoral Pain Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical (...) © 2019 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.cpg2 | september 2019 | volume 49 | number 9 | journal of orthopaedic & sports physical therapy Patellofemoral Pain: Clinical Practice Guidelines DIAGNOSIS A Clinicians should use reproduction of retropatellar or peri- patellar pain during squatting as a diagnostic test for patellofemoral pain (PFP). Clinicians should also use perfor- mance of other functional activities that load the patellofemoral joint (PF J

Gliptins: joint pain and exposure to NSAIDs Prescrire IN ENGLISH - Spotlight ''Gliptins: joint pain and exposure to NSAIDs'', 1 November 2019 {1} {1} {1} | | > > > Gliptins: joint pain and exposure to NSAIDs Spotlight Every month, the subjects in Prescrire’s Spotlight. 100 most recent :  |   |   |   |   |   |   |   |   |  Spotlight In the November issue of Prescrire International - Gliptins: joint pain and exposure (...) to NSAIDs FREE DOWNLOAD In the Adverse Effects section of the November issue, the results of a study by the independent French medical journal Prescrire, based on data from France's national health insurance system. Full text available for free download. Summary Joint and muscle pain are part of the adverse effect profile of gliptins. In France, Prescrire carried out a study, using data from the mandatory national health insurance system, showing that patients taking gliptins are more frequently exposed

Managing Acute Pain in Patients Taking Medications for Opioid Use Disorder Management Briefs eBrief-no160 -- Managing Acute Pain in Patients Taking Medications for Opioid Use Disorder Enter search terms Button to search HSRD ® Inside VA Budget and Performance Inside the News Room National Observances Special Events » » » » » Management Briefs eBrief-no160 -- Managing Acute Pain in Patients Taking Medications for Opioid Use Disorder Health Services Research & Development Management eBrief (...) no. 160 » Issue 160 October 2019 The report is a product of the VA/HSR&D Evidence Synthesis Program. Evidence Brief: Managing Acute Pain in Patients Taking Medications for Opioid Use Disorder Acute pain management in patients with opioid use disorder (OUD) can be challenging due to several factors including increased pain sensitivity and higher opioid tolerance. Use of medications for OUD (MOUD) including methadone, buprenorphine/naloxone, or naltrexone adds to the complexity of acute pain management

Vertebroplasty for severely painful osteoporotic vertebral fractures of less than 6 weeks duration 1 Public Summary Document Application No. 1466 – Vertebroplasty for severely painful osteoporotic vertebral fractures of less than 6 weeks duration Applicant: The Interventional Radiology Society of Australasia (IRSA) Date of MSAC consideration: MSAC 75 th Meeting, 28-29 March 2019 MSAC 74 th Meeting, 22-23 November 2018 Context for decision: MSAC makes its advice in accordance with its Terms (...) , MSAC deferred its advice regarding public funding of vertebroplasty for severely painful osteoporotic vertebral fractures of less than either 3 or 6 weeks duration. MSAC considered that a stakeholder meeting, to provide a broader clinical perspective and patient input, could inform the uncertainties in the application. MSAC also considered that an independent meta-analysis of the individual patient data (IPD) from all relevant randomised trials would be informative to further address uncertainties

Tourniquet Use Does Not Affect Functional Outcomes or Pain After Total Knee Arthroplasty: A Prospective, Double-Blinded, Randomized Controlled Trial The use of a tourniquet during total knee arthroplasty (TKA) is controversial. Pain and return to function are believed, by some, to be influenced by the use of a tourniquet. The hypothesis of this study was that use of a tourniquet would delay postoperative functional recovery and increase pain as compared with no tourniquet use.Two hundred (...) patients were recruited for this prospective, double-blinded, randomized controlled trial. Patients were randomized to undergo TKA either with a tourniquet (100 patients) or without one (100 patients) and blinded to group allocation. Primary outcome measures were functional assessment testing using the Timed Up & Go (TUG) test and visual analog scale (VAS) pain scores. Secondary outcome measures included the stair-climb test, blood loss, surgical field visualization, and range of motion. Outcome

Low Back Pain in the Emergency Department: Prevalence of Serious Spinal Pathologies and Diagnostic Accuracy of Red Flags - A Systematic Review Very little evidence is available on the prevalence of serious spinal pathologies and the diagnostic accuracy of red flags in patients presenting to the emergency department (ED). This systematic review aims to investigate the prevalence of serious spinal pathologies and the diagnostic accuracy of red flags in patients presenting with low back pain

A single dose of tramadol in continuous wound analgesia with levobupivacaine does not reduce post-sternotomy pain: a randomized controlled trial Medial sternotomy is commonly used in cardiac surgery, although it results in intense post-operative pain. The placement of a sternal wound catheter for the administration of local anesthetic represents an effective technique. An initial bolus of tramadol in the sternal wound catheter could potentiate the effect of the local anesthetic and decrease (...) both the post-operative pain and the morphine consumption.We conducted a prospective, randomized, double-blind study at the University Hospital Center, Dijon, France. Patients requiring scheduled or non-extreme emergency surgery for valve disease, aorta disease, atrial myxoma, or coronary artery bypass graft via sternotomy were included. A sternal wound catheter was inserted at the end of the surgery. The patients were randomized to receive either a 2 mg/kg bolus of tramadol (n=80) or a placebo (n

Intravenous Dexamethasone Injection Reduces Pain From 12 to 21 Hours After Total Knee Arthroplasty: A Double-Blind, Randomized, Placebo-Controlled Trial Pain after total knee arthroplasty (TKA) affects postoperative recovery and patient satisfaction. The analgesic benefits of corticosteroids have not been well studied. We, therefore, investigated the analgesic effects of intravenous (IV) dexamethasone (DEX) in patients undergoing a TKA.This was a randomized, double-blind, placebo-controlled (...) trial of 0.15 mg/kg of IV DEX vs saline placebo in unilateral TKA. Fifty patients/arm were recruited. Primary outcomes were pain level, determined by a visual analog scale, and the amount of morphine consumption (mg) ≤48 hours post-TKA. Secondary outcomes were rates of nausea and vomiting, C-reactive protein concentrations, and functional outcomes.The DEX group had a significantly lower mean visual analog scale score both at rest and during motion at 12, 15, 18, and 21 hours (P < .05). At 21 hours

The Effect of Dexmedetomidine Added to Preemptive Ropivacaine Infiltration on Postoperative Pain After Lumbar Fusion Surgery: A Randomized Controlled Trial A prospective and controlled study of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery.Assessment of dexmedetomidine added to preemptive ropivacaine infiltration for the relief of postoperative pain after lumbar fusion surgery.Single local anesthetic preemptive wound infiltration for the relief (...) of postoperative pain does not translate into major or consistent clinical benefits after lumbar fusion surgery. Dexmedetomidine added to local anesthetics prolonged the duration of blockade and enhanced the analgesic in peripheral nerve block. The effect of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery for the relief of postoperative pain has yet not been studied.Fifty-seven patients with elective posterior lumbar fusion were randomly divided into two groups. Five

Pentosan polysulfate sodium for treating bladder pain syndrome Pentosan polysulfate sodium for treating bladder pain syndrome T echnology appraisal guidance Published: 13 November 2019 www.nice.org.uk/guidance/ta610 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guidance represent the view of NICE, arrived at after careful consideration (...) to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Pentosan polysulfate sodium for treating bladder pain syndrome (TA610) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 25Contents Contents 1 Recommendations 4 2 Information about pentosan polysulfate sodium 6 3 Committee discussion 7

Efficacy of Systemic Steroid Use Given One Day After Total Knee Arthroplasty for Pain and Nausea: A Randomized Controlled Study Systemic steroid has been used to control pain and nausea in total knee arthroplasty (TKA), but most studies recommend a single dose administration prior to, or during, surgery. This study aimed to determine the efficacy of administration on 1 day postoperatively.Patients who were scheduled to undergo TKA were randomly assigned to the following groups: control group (...) , receiving normal saline injection; group 1, receiving 10 mg dexamethasone intravenously (IV) 1 hour before surgery; group 2, receiving 0.1 mg/kg dexamethasone (IV) 24 hours after surgery; or group 3, receiving 0.2 mg/kg dexamethasone (IV) 24 hours after surgery (n = 44-46 per group). Primary outcomes were pain and nausea visual analogue scale (VAS). Secondary outcomes were analgesic administration, rescue antiemetic administration, C-reactive protein, range of motion, and complications.Postoperative