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)
Opioid substitution treatment seems to be associated with decreased mortality.
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)
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.