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”
Commentary: Medical management of opioid-induced constipation differs than for other forms of the condition – American Gastroenterological Association (free) AND AGA: New Opioid-Induced Constipation Management Guidelines Available – MPR (free)
Effect of Gabapentin vs Pregabalin on Pain Intensity in Adults WIth Chronic Sciatica: A Randomized Clinical Trial – JAMA Neurology (link to abstract – $ for full-text)
Commentary: Chronic sciatica: gabapentin tops pregabalin as initial treatment – Univadis (free registration required)
“It seems unlikely that cannabinoids are highly effective medicines for chronic noncancer pain conditions.”
Commentaries: Chronic Pain Affects 20% of Americans, CDC Reports – MedPage Today (free registration required) AND CDC: About 1 in 5 US Adults Have Chronic Pain – MPR (free) AND One-fifth of American adults experience chronic pain, CDC estimates – CNBC (free)
Commentaries: New study questions effectiveness of invasive procedures for chronic pain – The Reis Group (free) AND Invasive Procedures For Chronic Pain Have Not Been Proven to Work – MedicalResearch.com (free)
Editorial: Pain, Opioids, and Suicide Mortality in the United States (free)
Commentaries: Chronic pain may contribute to suicide, study warns – Reuters(free) ANDChronic Pain Tied to Increased Suicide Risk – NEJM Physician’s First Watch(free) AND Increasing rates of chronic pain found among those who die by suicide – ACP Internist(free)
Pregabalin and the Risk for Opioid-Related Death: A Nested Case–Control Study – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries: Pregabalin may increase the risk of death when coprescribed with opioids – 2 Minute Medicine (free) AND Pregabalin Linked To Increased Risk for Opioid-Related Deaths – MedicalResearch.com (free) AND Anticonvulsant With Opioids Tied To Higher Mortality – MedPage Today (free registration required)
Opioid prescribing decreases after learning of a patient’s fatal overdose – Science (free for a limited period)
Commentary: Notification of patient overdose deaths reduces clinician opioid prescriptions – NIH News Releases (free) AND Clinicians were told their patient had died of an overdose. Then opioid prescribing dropped – STAT (free)
Commentaries: Low-Dose Ketamine Offers Effective Alternative to Opioids in Treatment of Acute Pain, Meta-Analysis Suggests – Psychiatric News Alert (free) AND Ketamine vs Opioids for Acute Pain in the Emergency Department – MedicalResearch.com (free) AND Low-Dose Ketamine May Be a Safe Opioid Alternative, Review Confirms – Medscape (free registration required) AND Ketamine could help reduce opioid use in the ER – Medical News Today (free)
Related research with similar results: Arthroscopic subacromial decompression for subacromial shoulder pain (free article, editorial and commentaries)
Commentaries: A painful lesson: are we repeating previous mistakes in pain management? – The Lancet Public Health (free) AND Use of illicit cannabis does not reduce chronic pain, according to new Australian study – RACGP (free)
Related: Efficacy and adverse effects of medical marijuana for chronic noncancer pain: Systematic review of randomized controlled trials – Canadian Family Physician (free) AND Benefits and Harms of Cannabis in Chronic Pain or Post-traumatic Stress Disorder: A Systematic Review – VA Evidence-based Synthesis Program (free) AND Cannabis products for adults with chronic neuropathic pain – Cochrane Library (free)
Commentaries: Class of drugs used as alternative to opioids for back pain are ineffective, have potentially serious side effects: report – The Globe and Mail (free) AND Anticonvulsant drugs ineffective for low back pain and can cause harm, despite increased prescribing – CMAJ, via EurekAlert (free)
Related Meta-Analysis: Benefits and safety of gabapentinoids in chronic low back pain (free research and commentaries)
Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists – Regional Anesthesia and Pain Medicine (free)
Commentaries: Johns Hopkins Expert Available to Comment on New Ketamine Guidelines For Chronic and Acute Pain Management – Johns Hopkins Medicine, via NewsWise (free) AND First-Ever Ketamine Guidelines for Acute Pain Management Released – Medscape (free registration required)
Effect of Acupuncture vs Sham Acupuncture on Live Births Among Women Undergoing In Vitro Fertilization: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentaries: Fertility study finds acupuncture ineffective for IVF birth rates – NICM, Western Sydney University, via ScienceDaily (free) AND Acupuncture during IVF doesn’t increase chances of having a baby – The Conversation (free) AND Acupuncture doesn’t improve likelihood of IVF success, study finds – The Guardian (free) AND Does Acupuncture Increase Live Births For Women Undergoing IVF? – MedicalResearch.com (free)
Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial – JAMA Network Open (free)
Commentaries: Innovating to Improve Care for Low Back Pain in the Military: Chiropractic Care Passes Muster – JAMA Network Open (free) AND Chiropractic Care Improves Usual Management for Low Back Pain – Medscape (free registration required) AND Adding chiropractic to back pain care may reduce disability – Reuters (free)
Committee Opinion: Postpartum Pain Management – American College of Obstetricians and Gynecologists (free)
News Release: ACOG Recommends Postpartum Pain Management Approach Tailored to Patients (free)
Editorial: No more vertebroplasty for acute vertebral compression fractures? (free)
Related Systematic Review: Percutaneous vertebroplasty for osteoporotic vertebral compression fracture – Cochrane Library (link to abstract and summary)
Author Interview: Association Between Psychological Interventions and Chronic Pain Outcomes in Older Adults (free)
Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial – The BMJ (free)
Commentaries: Study: Ibuprofen, Acetaminophen More Effective Than Opioids in Treating Dental Pain – Case Western Reserve University, via NewsWise (free) AND NSAIDs and Acetaminophen Preferred Over Opioids for Dental Pain – RheumNow (free)
Source: Medscape (free registration required)
“There is a lack of high-quality evidence to support or refute the effectiveness of non-invasive brain stimulation techniques for chronic pain”
Pain Management in Cancer Center Inpatients: A Cluster Randomized Trial to Evaluate a Systematic Integrated Approach—The Edinburgh Pain Assessment and Management Tool – Journal of Clinical Oncology (free)
Commentaries: Cancer patients’ pain eased by simple bedside chart – University of Edinburgh, via ScienceDaily (free) AND Bedside Assessment Tool Improves Worst Pain in Patients With Cancer – Oncology Nurse Advisor (free) AND Effect of Integrated Assessment and Management Tool on Pain Management in Cancer Center Inpatients – The ASCO Post (free)
Medical News & Perspectives: Robert Kerns, PhD: Researching Nondrug Approaches to Pain Management – JAMA (free for a limited period)
Commentaries: Time to rethink exercise for fibromyalgia care – The BMJ Opinion (free) AND The unintended consequences of tai chi for fibromyalgia – The BMJ Opinion (free) AND Tai chi may be as effective for fibromyalgia as standard exercise – NHS Choices (free) AND Tai chi at least as beneficial as aerobic exercise for fibromyalgia – OnMedica (free)
Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentaries: Opioids Don’t Beat Other Medications For Chronic Pain – NPR (free) AND More Data Opioids No Better for Chronic Back, Arthritis Pain – Medscape (free registration required) AND Opioids no better than NSAIDs for chronic back or arthritis pain – Reuters (free)
Randomized double-blind controlled study of bedtime low dose amitriptyline in chronic neck pain – European Journal of Pain (link to abstract – $ for full-text)
Commentary: Low-dose amitriptyline reduces idiopathic chronic neck pain – Univadis (free registration required)
Benefits and Harms of Cranial Electrical Stimulation for Chronic Painful Conditions, Depression, Anxiety, and Insomnia: A Systematic Review – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries: Mild shock therapy may ease anxiety and depression, but not chronic pain – Reuters (free) AND Jury Still Out on CES for Depression, Anxiety, Pain, Insomnia – Medscape (free registration required)
See Apropriate Use Criteria: Management of Osteoarthritis of the Hip (free)
Related AAOS Guideline: Management of Osteoarthritis of the Hip (free PDF)
Commentary: AAOS: Non-Surgical Tx Best for Hip OA – MedPage Today (free registration required)
Original article: Effectiveness of Exercise Programs in Ankylosing Spondylitis: A Meta-Analysis of Randomized Controlled Trials – Archives of Physical Medicine and Rehabilitation (link to abstract – $ for full-text)
Oral Sex and Condom Use in a U.S. National Sample of Adolescents and Young Adults – Journal of Adolescent Health (link to abstract – $ for full-text)
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”.
Editorial: No benefit of arthroscopy in subacromial shoulder pain (free)
Commentaries: Common shoulder surgery may offer little pain relief – OnMedica (free) AND Is a common shoulder surgery useless? – MedicalXpress (free) AND Popular Surgery To Ease Chronic Shoulder Pain Called Into Question – NPR (free)
Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials – American Journal of Epidemiology (link to abstract – $ for full-text)
Commentary: Exercise may help prevent low back pain or make it less severe – Reuters (free)
Related meta-analysis: Prevention of Low Back Pain: A Systematic Review and Meta-analysis – JAMA Internal Medicine (free)
Commentaries: No Significant Difference in Pain Relief for Opioids vs Non-Opioid Analgesics for Treating Arm or Leg Pain – The JAMA Network (free) AND Acetaminophen plus Ibuprofen Noninferior to Low-Dose Oral Opioids for Acute Extremity Pain – Journal Watch (free)
Commentaries: Ibuprofen Better Than Morphine After Minor Surgery in Kids – Medscape (free registration required) AND Ibuprofen better choice over oral morphine for pain relief in children after minor surgery – MedicalXpress (free)
Effects of sleep changes on pain-related health outcomes in the general population: A systematic review of longitudinal studies with exploratory meta-analysis – Sleep Medicine Reviews (link to abstract – $ for full-text)
Commentary: Poor sleep associated with higher risk of chronic pain – Reuters (free)
Commentaries: New guidelines discourage use of brain imaging as a ‘lie detector’ for chronic pain – EurekAlert (free) AND Pain Group: Don’t Use Neuroimaging to Confirm Chronic Pain – Physician’s First Watch (free)
Commentary: Non-Pharmacological Self-Management Effective for People With Migraine or Tension-Type Headache – PracticeUpdate (free registration required)
Corticosteroids and NSAIDs did not have different effects on pain scores, but there was a higher risk of indigestion, nausea and vomiting with NSAIDs.
Effect of vitamin D supplementation in chronic widespread pain: a systematic review and meta-analysis – Clinical Rheumatology (link to abstract – $ for full-text)
Commentary: Vitamin D Supplementation Reduces Pain Scores in Chronic Widespread Pain – Practice Update (free registration required)
Migraine awareness week (3-9 September). Latest Cochrane Evidence on interventions for preventing or treating headache and migraine.
Commentaries: Acupuncture, Electrotherapy after Knee Replacement Associated with Reduced and Delayed Opioid Use – The JAMA Network (free) AND Electrotherapy, Acupuncture Tied to Less Opioid Use After Knee Arthroscopy – Medscape (free registration required) AND Meta-Analysis: Electrotherapy, Acupuncture May Help Reduce Opioid Use After Knee Arthroplasty – Physician’s First Watch (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”
See also: Summary
Related: Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes: Executive Summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Maternal-Fetal Medicine, Centers for Disease Control and Prevention, and the March of Dimes Foundation (free)
Commentaries: Gabapentinoids Seem to Offer Little Benefit, Substantial Risks in Low Back Pain – Physician’s First Watch (free) AND Evidence does not support the use of gabapentinoids for chronic low back pain – PLOS, via Science Daily (free) AND Gabapentinoids for Chronic Low Back Pain? Not So Fast – Practical Pain Management (free)
Pregabalin and gabapentin have significant risk of adverse effects without any demonstrated benefit in chronic low back pain.
Commentaries: Evidence on cannabis for chronic pain and PTSD – American College of Physician’s, via EurekAlert (free) AND Evidence Lacking on Benefits of Cannabis for Treating Chronic Pain, PTSD – Physician’s First Watch (free) AND Limited evidence available to determine effectiveness and safety of cannabis to treat chronic pain – 2 Minute Medicine (free) AND Little evidence that marijuana helps chronic pain, PTSD, studies find – CNN (free text and video)
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”.
Related guidelines: United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (free) AND Guidelines for the understanding and management of pain in chronic pancreatitis – Pancreatology (free)
State of the Art Review: Advances in the diagnosis and management of neck pain – The BMJ (free)
Related guideline: Neck Pain: Revision 2017 – Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health from the Orthopaedic Section of the American Physical Therapy Association (free)
Related guideline: Low back pain and sciatica in over 16s: assessment and management – NICE (free)
Functional Gain and Pain Relief After Total Joint Replacement According to Obesity Status – The Journal of Bone & Joint Surgery (link to abstract – $ for full-text)
Commentaries: Joint Replacement Weight Loss Requirements Challenged – Medscape (free registration required) AND Pain relief, functional outcomes after joint replacement similar in obese and normal-weight patients – News Medical (free)
“Mainstream medicine has failed people with chronic back pain”
Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic review and individual patient data meta-analysis from the OA trail bank – Annals of Rheumatic Diseases (link to abstract – $ for full-text) (RT @PhysioMeScience see Tweet)
“Currently, there is no good evidence to support the use of glucosamine for hip or knee OA”
Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes: Executive Summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Maternal-Fetal Medicine, Centers for Disease Control and Prevention, and the March of Dimes Foundation (free)
New National Guideline Clearinghouse (NGC) Summaries in Low back, Cervical and Thoracic Spine Disorders with focus on occupational health.
Systematic Review: Treatment Outcomes for Patients with Failed Back Surgery – Pain Physician (free PDF)
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.
“…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”.
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.
Effect of Electroacupuncture on Urinary Leakage Among Women With Stress Urinary Incontinence: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentaries: Electroacupuncture linked to improvements for stress urinary incontinence – 2 Minute Medicine (free) AND Electroacupuncture May Decrease Stress Urinary Incontinence – Medscape (free registration required) AND Mixed Results on Effectiveness of Acupuncture to Treat Stress Urinary Incontinence, Infertility – The JAMA Network (free)
Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy: A Systematic Review – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries: Tapering long-term opioid therapy may improve outcomes in chronic pain, review finds – ACP Internist (free) AND Opioid Reduction Therapy Offers Some Benefits to Patients with Chronic Pain – Physician’s First Watch (free) AND How tapering off opioids can help people with chronic pain – CNN (free)
– less pain: 8 of 8 studies
– Improved function: 5 of 5 studies
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.
Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial – Medical Journal of Australia (link to abstract – Free PDF here) (RT @theMJA see Tweet)
Positive commentaries: Acupuncture Found to Be an Effective Analgesia Option in ER – PracticeUpdate (free registration required) AND Acupuncture relieves pain in emergency patients: Study – RMIT University, via ScienceDaily (free)
“Not so fast” commentaries: Acupuncture in the ER: No, study did not prove it was ‘safe and effective’ – HealthNewsReview (free)AND A skeptical look at a study of acupuncture delivered in emergency rooms, by James C Coyne (free)
Commentary: Chronic Pain Opioid Guidelines Updated for State Medical Boards – Medscape (free registration required)
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.
“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)
Commentaries: Long-Term Opioid Treatment Seems Only to Add Complications to Polyneuropathy – Physician’s First Watch (free) AND Long-Term Opioids May Not Help in Polyneuropathy – MedPage Today (free registration required)
“Patients had worse functional outcomes than controls; some became dependent” (from MedPage Today)
Original article: Non-steroidal anti-inflammatory drug use is associated with increased risk of out-of-hospital cardiac arrest: a nationwide case–time–control study – European Heart Journal – Cardiovascular Pharmacotherapy (free)
Opioid substitution treatment seems to be associated with decreased mortality.
After Knee or Hip Replacement, No Place Like Home – The New York Times (10 articles per month are 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.
FDA Statement: New warnings about the use of codeine and tramadol in children & nursing mothers (free)
Commentaries on the statement: FDA: Codeine Now Contraindicated for Pain and Cough in Kids – Physician’s First Watch (free) AND Codeine cough syrup should not be given to kids, FDA warns – STAT News (free)
These drugs should not be used at all for children younger than 12 years, and their use should also be limited in some older children.
Source: EULAR Revised Recommendations for the Management of Fibromyalgia – Medscape (free registration required)
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.