NIHR Signal Blood test and ECG may safely rule out heart attack

A high sensitivity troponin test accurately ruled out a heart attack amongst a third of patients presenting to the emergency department with chest pain. A patient with no detectable troponin and normal electrocardiogram was almost certain not to have had a heart attack.

Off-Label Use of Antidepressants May Provide Pain Relief

A new study suggests some of the most effective medications for chronic pain are the same medications that are used for depression.

At doses lower than those needed to treat depression, antidepressants can relieve chronic pain in conditions ranging from diabetic neuropathy, migraine and tension headaches, to osteoarthritis and fibromyalgia.

Low-dose Ketamine for Acute Pain in the Emergency Department

New from BestBETs:

[In ED patients with acute pain who do not respond to conventional therapies], is the [low-dose ketamine better than morphine] at [safely and effectively reducing pain scores]?

Ketamine can be an effective alternative or adjunct to intravenous opioid pain medications and in some instances may provide more effective pain relief when compared with opioids. However, further trials need to be performed to establish more robust data.

Chest pain of recent onset: assessment and diagnosis

New recommendations have been added to NICE guidance on Chest pain of recent onset: assessment and diagnosis for the assessment and diagnosis of acute chest pain and the assessment and diagnosis of stable chest pain.

Perfect painkiller? Safe alternative to opiates may have been found

The Independent has claimed: "Scientists discover what could be a 'perfect' painkiller without side effects".

New research suggests that a newly identified compound, PZM21, could be more effective at longer-lasting pain relief than morphine, without any of the attendant drawbacks.

- NHS Choices - 

The National Back Pain Pathway – Prof Charles Greenough

Back pain is the largest single cause of disability in the UK, with lower back pain alone accounting for 11% of the total disability of the UK population.
Referrals for spinal surgery are increasing year on year and a growing number of patients are waiting longer than 18 weeks from referral to treatment. Wide variations exist in surgical rates between centres, and there are a significant number of treatments with a poor evidence base.
From a review of the service it was clear that that there were three main issues impacting on this area of work:...

Acute Pain Management: Scientific Evidence (4th Edition)

Acute Pain Management: Scientific Evidence is published every five years by ANZCA and FPM ANZCA and covers a wide range of clinical topics, combining a review of the best available evidence for acute pain management with current clinical and expert practice.

Moderate to severe acute post-operative pain: fentanyl transdermal system (ESNM77)

New NICE advice:

The fentanyl transdermal system, Ionsys, is a patient‑controlled analgesia (PCA) system that delivers  fentanyl in a non‑invasive way across the skin using iontophoresis. It is licensed for the management of acute moderate to severe post‑operative pain in adults.

The fentanyl transdermal system has comparable efficacy to IV morphine PCA. Its adverse event profile is as expected for an opioid used in post‑operative pain, and is similar to that of IV morphine PCA. In randomised controlled trials, the fentanyl transdermal system had better user satisfaction than IV morphine PCA, mainly because of improved mobilisation, and more favourable ease of care scores reported by nurses and physiotherapists. However, the clinical significance of these differences is unclear.