Pain Medicine

Exercise as a Prescription for Patients with Various Diseases – Journal of Sport and Health Science (free)

This review summarizes the latest exercise prescription treatments for 26 different diseases.


A Clinical Overview of Off-label Use of Gabapentinoid Drugs – JAMA Internal Medicine (free for a limited period)

Related Meta-Analysis: Anticonvulsants in the Treatment of Low Back Pain and Lumbar Radicular Pain (free study and commentaries)

“Clinicians who prescribe gabapentinoids off-label for pain should be aware of the limited evidence and should acknowledge to patients that potential benefits are uncertain for most off-label uses.”


EAN Guideline on Trigeminal Neuralgia

14 Mar, 2019 | 00:50h | UTC

Paracetamol versus placebo for knee and hip osteoarthritis – Cochrane Library (free)

Summary: Paracetamol for treating people with hip or knee osteoarthritis – Cochrane Library (free)

Related: Paracetamol: widely used and largely ineffective (free)


Related Commentary on Twitter

Chronic pain as a symptom or a disease: The IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11) – Pain (free)

Commentary: IASP Updates Classification of Chronic Pain – Clinical Advisor (free)


Related Commentary on Twitter

Subacromial decompression surgery for rotator cuff disease – Cochrane Library (free)

Summary: Surgery for rotator cuff disease (free)

Related Studies: Subacromial Decompression vs Diagnostic Arthroscopy for Shoulder Impingement (free study and commentaries) AND Arthroscopic subacromial decompression for subacromial shoulder pain (free study and commentaries)

“The data in this review do not support the use of subacromial decompression in the treatment of rotator cuff disease manifest as painful shoulder impingement.”


Review: Cannabinoids for Chronic Pain

30 Nov, 2018 | 01:45h | UTC

Cannabinoids for Chronic Pain – Therapeutics Initiative (free)

Related: Meta-Analysis: Cannabinoids for the Treatment of Chronic Noncancer Pain Conditions (free) AND Guideline for Prescribing Medical Cannabinoids in Primary Care (free article and commentary)

“At the present time we lack good evidence that any cannabis-derived product works for chronic pain”


Podcast: Headaches Advanced Class

2 Nov, 2018 | 02:49h | UTC

Non-invasive brain stimulation techniques for chronic pain – Cochrane Library (free)

“There is a lack of high-quality evidence to support or refute the effectiveness of non-invasive brain stimulation techniques for chronic pain”


Medical News & Perspectives: Robert Kerns, PhD: Researching Nondrug Approaches to Pain Management – JAMA (free for a limited period)


When Opioids Make Pain Worse

16 Mar, 2018 | 01:17h | UTC

Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study – The BMJ (free)

“The duration of treatment rather than dose is more strongly associated with opioid misuse after surgery, concludes this study” (via @bmj_latest see Tweet)


Two nerve drugs are not suitable for treating long-term low back pain – NIHR Signal (free)

Original Article: Benefits and safety of gabapentinoids in chronic low back pain: A systematic review and meta-analysis of randomized controlled trials – PLOS One (free)

“Evidence supports NICE guidance not to use two nerve drugs (gabapentin and pregabalin) to treat long-term lower back pain”. (RT @NIHR_DC see Tweet)


Systematic Review and Meta-analysis Comparing the Efficacy of Nonsteroidal Anti-inflammatory Drugs, Opioids, and Paracetamol in the Treatment of Acute Renal Colic – European Urology (free) (via @KariTikkinen and @EUplatinum)

“In kidney stone–related acute pain episodes in patients with adequate renal function, treatment with nonsteroidal anti-inflammatory drugs offers effective and most sustained pain relief, with fewer side effects, when compared with opioids or paracetamol”.


Guideline for treatment of cancer pain

25 Nov, 2017 | 22:48h | UTC

Corticosteroid or Nonsteroidal Antiinflammatory Drugs for the Treatment of Acute Gout: A Systematic Review of Randomized Controlled Trials – The Journal of Rheumatology (free)

Source: EvidenceAlerts

Corticosteroids and NSAIDs did not have different effects on pain scores, but there was a higher risk of indigestion, nausea and vomiting with NSAIDs.


Headache and migraine: interventions for preventing or treating headache and migraine – Cochrane Library (free) (RT @CochraneUK see Tweet)

Migraine awareness week (3-9 September). Latest Cochrane Evidence on interventions for preventing or treating headache and migraine.


Long-Term Effects of Repeated Injections of Local Anesthetic With or Without Corticosteroid for Lumbar Spinal Stenosis: A Randomized Trial – Archives of Physical Medicine and Rehabilitation (free)

Source: ACP Journal Wise ($)

“Epidural injections of corticosteroid plus lidocaine offered no benefits from 6 weeks to 12 months beyond that of injections of lidocaine alone”


Skin-to-skin care: can it reduce procedural pain in neonates? – Evidently Cochrane Blog (free)

Original systematic review: Skin-to-skin care for procedural pain in neonates – Cochrane Library (link to abstract – $ for full-text)

“Skin-to-skin care probably is an effective intervention for pain during procedures for neonates”.


A comprehensive guide to the new science of treating lower back pain – VOX (free)

“Mainstream medicine has failed people with chronic back pain”


New National Guideline Clearinghouse (NGC) Summaries in Low back, Cervical and Thoracic Spine Disorders with focus on occupational health.

Low Back Disorders – American College of Occupational and Environmental Medicine (free summary from NGC – $ see original guideline in ACOEM website)

Cervical and thoracic spine disorders – American College of Occupational and Environmental Medicine (free summary from NGC – $ see original guideline in ACOEM website)


Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis – The Lancet (link to abstract – $ for full-text)

Diclofenac 150 mg/day is the most effective NSAID available at present (are the cardiac and renal risks worth it?) and Paracetamol does not seem to work for this condition.


One year in review 2017: fibromyalgia

27 Jul, 2017 | 16:49h | UTC

Is cyclobenzaprine useful for pain?

25 Jul, 2017 | 00:24h | UTC

Is cyclobenzaprine useful for pain? – Therapeutics Initiative (free)

“…cyclobenzaprine is a long-acting sedative, not a muscle relaxant, and questioning whether any potential benefits are worth the side effects”. (from TI Newsletter). “If prescribed, a dose of 5 mg at bedtime should be tried first.  Evidence suggests titration based on response and tolerability to a maximum dose of 15 mg/day, for no longer than one week”.


Effectiveness of Lateral Decubitus Position for Preventing Post-Dural Puncture Headache: A Meta-Analysis – Pain Physician (free PDF)

Source: Hospital Medicine Virtual Journal Club (free resource to find articles of interest)

Evidence suggests lateral decubitus position is associated with reduced incidence of post-dural puncture headache.


Cochrane Review: Gabapentin for chronic neuropathic pain in adults – Cochrane Library (link to abstract – $ for full-text)

Commentary: Analgesic Effects of Gabapentin Assessed in Chronic Neuropathic Pain – MPR (free)

“Gabapentin at doses of 1800 mg to 3600 mg daily (1200 mg to 3600 mg gabapentin encarbil) can provide good levels of pain relief to some people with postherpetic neuralgia and peripheral diabetic neuropathy”.


Aerobic exercise training for adults with fibromyalgia – Cochrane Library (link to abstract – $ for full-text)

Aerobic exercise probably improves health related quality of life, may slightly decrease pain intensity and may slightly improve physical function.


Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders – JAMA Internal Medicine (link to abstract – $ for full-text)

Commentary: Persistent Pain May Increase Dementia Risk – The New York Times (10 articles per month are free)

Cohort of community-dwelling older adults suggests there might be a link.


The opioid crisis changed how doctors think about pain – VOX (free)

“One of the expectations our patients have is that pain can be completely eliminated. We as a medical community are coming to an understanding that this is not realistic.” (RT @KariTikkinen and @voxdotcom and see Tweet)


After Knee or Hip Replacement, No Place Like Home – The New York Times (10 articles per month are free)

See also: Time to Rethink Inpatient Rehab After Knee Replacement? – The Rheumatologist (free)

Original article abstract ($ for full-text): Effect of Inpatient Rehabilitation vs a Monitored Home-Based Program on Mobility in Patients With Total Knee Arthroplasty: The HIHO Randomized Clinical Trial – JAMA (free)

The NYT commentary talks about the futility of some interventions currently used to postpone surgery and about the benefits of outpatient rehabilitation.


Neuropathic pain in adults

3 Apr, 2017 | 19:23h | UTC

Trial of Pregabalin for Acute and Chronic Sciatica – New England Journal of Medicine (link to abstract – $ required for full-text)

Pregabalin did not reduce pain and was associated with higher incidence of adverse events.


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