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Guidelines for management of chronic pain

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https://www.readbyqxmd.com/read/28097532/medication-overuse-in-chronic-pain
#1
REVIEW
Eric S Hsu
PURPOSE OF REVIEW: Chronic pain is usually managed by various pharmacotherapies after exhausting the conservative modalities such as over-the-counter choices. The goal of this review is to investigate current state of opioids and non-opioid medication overuse that includes NSAIDs, skeletal muscle relaxants, antidepressants, membrane stabilization agents, and benzodiazepine. How to minimize medication overuse and achieve better outcome in chronic pain management? RECENT FINDINGS: Although antidepressants and membrane stabilization agents contribute to the crucial components for neuromodulation, opioids were frequently designated as a rescue remedy in chronic pain since adjunct analgesics usually do not provide instantaneous relief...
January 2017: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/28095832/cost-effectiveness-of-using-a-motion-sensor-biofeedback-treatment-approach-for-the-management-of-sub-acute-or-chronic-low-back-pain-economic-evaluation-alongside-a-randomised-trial
#2
Terry Haines, Kelly-Ann Bowles
BACKGROUND: Low back pain is a common and costly condition internationally. There is high need to identify effective and economically efficient means for managing this problem. This study aimed to explore the cost-effectiveness of a novel motion-sensor biofeedback treatment approach in addition to guidelines-based care compared to guidelines-based care alone, from a societal perspective over a 12 month time horizon. METHOD: This was an incremental cost-effectiveness analysis conducted concurrently with a pilot, cluster randomized controlled trial...
January 17, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28075425/management-of-fibromyalgia-practical-guides-from-recent-evidence-based-guidelines
#3
Winfried Häuser, Jacob Ablin, Serge Perrot, Mary-Ann Fitzcharles
Fibromyalgia (FM) is a prevalent and costly condition worldwide, affecting approximately 2% of the general population. Recent evidence- and consensus-based guidelines from Canada, Germany, Israel and the European League Against Rheumatism aim to support physicians in achieving a comprehensive diagnostic work-up of patients with chronic widespread pain (CWP) and to assist patients and physicians in shared decision making on treament options. Every patient with CWP requires at the first medical evaluation a complete history, medical examination and some laboratory tests (complete blood count, C-reactive protein, serum calcium, creatine phosphokinase, thyroid stimulating hormone, 25-OH vitamin D) to screen for metabolic or inflammatory causes of CWP...
January 4, 2017: Polskie Archiwum Medycyny Wewnętrznej
https://www.readbyqxmd.com/read/28065184/long-term-outcomes-in-the-management-of-painful-diabetic-neuropathy
#4
Lauren M Mai, A John Clark, Allan S Gordon, Mary E Lynch, Pat K Morley-Forster, Howard Nathan, Catherine Smyth, Larry W Stitt, Cory Toth, Mark A Ware, Dwight E Moulin
BACKGROUND: Painful diabetic neuropathy (PDN) is a frequent complication of diabetes mellitus. Current treatment recommendations are based on short-term trials, generally of ≤3 months' duration. Limited data are available on the long-term outcomes of this chronic disease. The objective of this study was to determine the long-term clinical effectiveness of the management of chronic PDN at tertiary pain centres. METHODS: From a prospective observational cohort study of patients with chronic neuropathic non-cancer pain recruited from seven Canadian tertiary pain centres, 60 patients diagnosed with PDN were identified for analysis...
January 9, 2017: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/28057027/clinical-practice-guidelines-for-the-management-of-chronic-musculoskeletal-pain-in-primary-healthcare-a-systematic-review
#5
REVIEW
Dawn V Ernstzen, Quinette A Louw, Susan L Hillier
BACKGROUND: Up-to-date, high quality, evidence-based clinical practice guidelines (CPGs) that are applicable for primary healthcare are vital to optimize services for the population with chronic musculoskeletal pain (CMSP). The study aimed to systematically identify and appraise the available evidence-based CPGs for the management of CMSP in adults presenting in primary healthcare settings. METHODS: A systematic review was conducted. Twelve guideline clearinghouses and six electronic databases were searched for eligible CPGs published between the years 2000 and May 2015...
January 5, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28034978/discrepancies-between-perceived-benefit-of-opioids-and-self-reported-patient-outcomes
#6
Jenna Goesling, Stephanie E Moser, Lewei A Lin, Afton L Hassett, Ronald A Wasserman, Chad M Brummett
OBJECTIVE : There is little empirical evidence supporting the long-term use of opioid therapy for chronic pain, suggesting the need to reevaluate the role of opioids in chronic pain management. Few studies have considered opioid use and opioid cessation from the perspective of the patient. METHODS : This prospective structured interview study included 150 new patients seeking treatment for chronic pain at an outpatient tertiary care pain clinic. RESULTS : Of the 150 patients, 56% (N = 84) reported current opioid use...
December 29, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28002095/assessing-prescribing-trends-of-adjuvant-medication-therapy-in-outpatients-with-a-diagnosis-of-non-malignant-chronic-pain
#7
Rafia S Rasu, Rachel K Vossen, Maureen Knell
BACKGROUND: Chronic pain affects over 100 million people in the United States, yet continues to be difficult to treat. Concerns continue to mount over the use of opioids to treat nonmalignant chronic pain (NMCP). Guidelines support the use of adjuvant medications as one of the preferred options for treating chronic pain over opioids. OBJECTIVES: To examine reported usage of adjuvants in the treatment of chronic pain via the National Ambulatory Medical Care Survey (NAMCS)...
December 19, 2016: Clinical Journal of Pain
https://www.readbyqxmd.com/read/28001212/pharmacologic-management-of-pain-in-patients-with-chikungunya-a-guideline
#8
Carlos Alexandre Antunes de Brito, Ana Karla Arraes von Sohsten, Clezio Cordeiro de Sá Leitão, Rita de Cássia Coelho Moraes de Brito, Lilian David De Azevedo Valadares, Caroline Araújo Magnata da Fonte, Zelina Barbosa de Mesquita, Rivaldo Venâncio Cunha, Kleber Luz, Helena Maria Carneiro Leão, Cecília Moraes de Brito, Lívia Carla Vinhal Frutuoso
From the arrival of Chikungunya virus in the Americas in 2013 until March 2016, approximately two million cases of the disease have been reported. In Brazil, the virus was identified in 2014 and thousands of people have been affected. The disease has high attack rates, infecting 50% of a population within a few months. Approximately 50% of infected people develop chronic symptoms lasting for months or years. Joint involvement is the main clinical manifestation of Chikungunya. It is characterized by swelling and intense pain that is poorly responsive to analgesics, both in the acute and chronic phase of the disease...
November 2016: Revista da Sociedade Brasileira de Medicina Tropical
https://www.readbyqxmd.com/read/27994797/spinal-cord-stimulation-in-failed-back-surgery-syndrome-review-of-clinical-use-quality-of-life-and-cost-effectiveness
#9
REVIEW
Przemyslaw M Waszak, Marta Modrić, Agnieszka Paturej, Stanislav M Malyshev, Agnieszka Przygocka, Hanna Garnier, Tomasz Szmuda
Failed back surgery syndrome (FBSS) is complex and recurrent chronic pain after spinal surgery. Several important patient and surgery related risk factors play roles in development of FBSS. Inadequate selection of the candidates for the spinal surgeries is one of the most crucial causes. The guidelines suggest that conservative management featuring pharmacologic approaches and rehabilitation should be introduced first. For therapy-refractory FBSS, spinal cord stimulation (SCS) is recommended in selected patients...
December 2016: Asian Spine Journal
https://www.readbyqxmd.com/read/27993899/barriers-to-self-management-of-chronic-pain-in-primary-care-a-qualitative-focus-group-study
#10
Katy Gordon, Helen Rice, Nick Allcock, Pamela Bell, Martin Dunbar, Steve Gilbert, Heather Wallace
BACKGROUND: Supported self-management is a recommended intervention for chronic pain. Effective self-management should enable an individual to reduce the impact of pain on their everyday life. Clinical guidelines suggest primary care services have a role to play in supporting self-management of chronic pain. AIM: To examine the opinions of primary care healthcare professionals (HCPs) and people with chronic pain and their carers, in order to identify possible barriers to the facilitation and adoption of self-management...
December 19, 2016: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/27974006/safety-and-effectiveness-of-therapeutic-magnetic-resonance-in-diabetic-foot-ulcers-a-prospective-randomised-controlled-trial
#11
A Piaggesi, M Sambataro, C Nicoletti, C Goretti, E Lacopi, A Coppelli
OBJECTIVE: To test the efficacy and safety of therapeutic magnetic resonance (TMR) in the management of diabetic foot ulcers (DFU), the authors designed a prospective randomised controlled trial in three highly specialised diabetic foot clinics. METHOD: All the patients consecutively visited in a period of 18 months were screened according to the inclusion (presence of an ulcer >1 cm(2) in the foot lasting at least 6 weeks; ABPI>0.6; consent to participate in the study) and exclusion (Charcot's foot; local or systemic infections; chronic renal failure; any wearable electrically-driven life-supporting device) criteria...
December 2, 2016: Journal of Wound Care
https://www.readbyqxmd.com/read/27973463/rationale-and-evidences-for-treatment-of-symptomatic-uncomplicated-diverticular-disease
#12
Rosario Cuomo, Martina Cargiolli, Paolo Andreozzi, Francesco P Zito, Giovanni Sarnelli
INTRODUCTION: Symptomatic uncomplicated diverticular disease (SUDD) is one of the possible clinical manifestations of diverticular disease. It is a common disorder characterized by chronic abdominal symptoms ranging from lower left abdominal pain to alteration of bowel habit, that significantly reduce quality of life of subject affected. The present article aims to review the current data for medical management of SUDD. EVIDENCE ACQUISITION: We analyzed the existing literature on the factors involved in the pathogenesis of SUDD and we highlighted the possible target for treatment...
December 14, 2016: Minerva Gastroenterologica e Dietologica
https://www.readbyqxmd.com/read/27931749/-hereditary-epidermolysis-bullosa-french-national-guidelines-pnds-for-diagnosis-and-treatment
#13
C Chiaverini, E Bourrat, J Mazereeuw-Hautier, S Hadj-Rabia, C Bodemer, J-P Lacour
Hereditary epidermolysis bullosa (EB) is a heterogeneous group of rare genetic diseases characterized by fragile skin and/or mucous membrane, and it may be either local or generalized. It is caused by mutations in genes encoding different proteins involved mainly in the structure and function of the dermal-epidermal junction. Nineteen genes have so far been identified. They are classified by level of skin cleavage (from top to bottom) into four groups: EB simplex, junctional EB, dystrophic EB and Kindler syndrome...
December 5, 2016: Annales de Dermatologie et de Vénéréologie
https://www.readbyqxmd.com/read/27928501/patient-prioritization-of-comorbid-chronic-conditions-in-the-veteran-population-implications-for-patient-centered-care
#14
Lorilei M Richardson, Jennifer N Hill, Bridget M Smith, Erica Bauer, Frances M Weaver, Howard S Gordon, Kevin T Stroupe, Timothy P Hogan
OBJECTIVE: Patients with comorbid chronic conditions may prioritize some conditions over others; however, our understanding of factors influencing those prioritizations is limited. In this study, we sought to identify and elaborate a range of factors that influence how and why patients with comorbid chronic conditions prioritize their conditions. METHODS: We conducted semi-structured, one-on-one interviews with 33 patients with comorbidities recruited from a single Veterans Health Administration Medical Center...
2016: SAGE Open Medicine
https://www.readbyqxmd.com/read/27920810/hyaluronic-acid-in-the-management-of-osteoarthritis-injection-therapies-innovations
#15
Valter Santilli, Marco Paoloni, Massimiliano Mangone, Federica Alviti, Andrea Bernetti
Osteoarthritis (OA) is a chronic degenerative joint disease characterized by pain and progressive functional limitation. Viscosupplementation with intra-articular (IA) hyaluronic acid (HA) could be a treatment option in OA, however recommendations made in different international guidelines for the non-surgical management of OA are not always concordant with regard to the role of IA injection therapies. Results from a recent Italian Consensus Conference underline how IA-HA to treat OA represents a widely used therapy in Italy...
May 2016: Clinical Cases in Mineral and Bone Metabolism
https://www.readbyqxmd.com/read/27919605/not-all-patients-with-critical-limb-ischaemia-require-revascularisation
#16
T B Santema, R M Stoekenbroek, J van Loon, M J W Koelemay, D T Ubbink
OBJECTIVES: International guidelines recommend revascularisation as the preferred treatment for patients with critical limb ischaemia (CLI). Most contemporary research focuses on the outcome of invasive procedures for CLI, but little is known about the outcome of conservative management. Amputation free survival (AFS) and overall survival (OS) was investigated in patients with CLI who did or did not receive revascularisation, and characteristics associated with clinical outcomes were explored...
December 2, 2016: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/27902848/topiramate-in-migraine-prevention-a-2016-perspective
#17
Stephen D Silberstein
BACKGROUND: In evidence-based guidelines published in 2000, topiramate was a third-tier migraine preventive with no scientific evidence of efficacy; recommendation for its use reflected consensus opinion and clinical experience. Its neurostabilizing activity, coupled with its favorable weight profile, made topiramate an attractive alternative to other migraine preventives that caused weight gain. When guidelines for migraine prevention in episodic migraine were published in 2012, topiramate was included as a first-line option based on double-blind, randomized controlled trials involving nearly 3000 patients...
January 2017: Headache
https://www.readbyqxmd.com/read/27889288/quiet-dissent-the-attitudes-beliefs-and-behaviours-of-uk-osteopaths-who-reject-low-back-pain-guidance-a-qualitative-study
#18
Joanna Figg-Latham, Dévan Rajendran
INTRODUCTION: Clinical guidelines are derived from best research evidence and aim to: improve quality of non-specific low back pain (nsLBP) management and identify patients at risk of suffering chronic pain. However, guideline discordant attitudes and beliefs have been identified in healthcare students and practitioners, including osteopaths. DESIGN: A qualitative approach with elements of grounded theory was used to explore underlying attitudes and beliefs of practitioners/students working in a British osteopathic education institution...
October 18, 2016: Manual Therapy
https://www.readbyqxmd.com/read/27866120/evidence-based-guidelines-on-the-therapeutic-use-of-transcranial-direct-current-stimulation-tdcs
#19
REVIEW
Jean-Pascal Lefaucheur, Andrea Antal, Samar S Ayache, David H Benninger, Jérôme Brunelin, Filippo Cogiamanian, Maria Cotelli, Dirk De Ridder, Roberta Ferrucci, Berthold Langguth, Paola Marangolo, Veit Mylius, Michael A Nitsche, Frank Padberg, Ulrich Palm, Emmanuel Poulet, Alberto Priori, Simone Rossi, Martin Schecklmann, Sven Vanneste, Ulf Ziemann, Luis Garcia-Larrea, Walter Paulus
A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction...
January 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/27807396/laparoscopic-management-of-mobile-cecum
#20
Carlos Augusto Gomes, Cleber Soares, Fausto Catena, Salomone Di Saverio, Massimo Sartelli, Camila Couto Gomes, Felipe Couto Gomes
BACKGROUND AND OBJECTIVES: The mobile cecum is an embryologic abnormality and has been associated with functional colon disease (chronic constipation and irritable bowel syndrome). However, unlike functional disease, the primary treatment is operative, using laparoscopic cecopexy. We compare the epidemiology and pathophysiology of mobile cecum syndrome and functional colon disease and propose diagnostic and treatment guidelines. METHOD: This study was a case-control series of 15 patients who underwent laparoscopic cecopexy...
October 2016: JSLS: Journal of the Society of Laparoendoscopic Surgeons
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