Daily Cannabis Can Cut Illicit Opioid Use For Those With Chronic Pain

For people in chronic pain who are tempted to use illicit opioids, a new study reveals that cannabis can act as an effective and much less dangerous alternative to help manage pain. Click here for PsychCentral article

Online Self-Management Helpful for Anxiety, Depression and Pain

Emerging research suggests that for some individuals, online symptom self-management plus clinician telecare is the best strategy for treating anxiety, depression and pain.  Click here to read further.

UHCW publication: Prevalence of cam hip shape morphology: a systematic review.

Prevalence of cam hip shape morphology: a systematic review.
Osteoarthritis Cartilage. 2016 Jun;24(6):949-61
Dickenson E, Wall PD, Robinson B, Fernandez M, Parsons H, Buchbinder R, Griffin DR


ABSTRACT
OBJECTIVE: Cam hip shape morphology is a recognised cause of femoroacetabular impingement (FAI) and is associated with hip osteoarthritis. Our aim was to systematically review the available epidemiological evidence assessing the prevalence of cam hip shape morphology in the general population and any studied subgroups including subjects with and without hip pain. DESIGN: All studies that reported the prevalence of cam morphology, measured by alpha angles, in subjects aged 18 and over, irrespective of study population or presence of hip symptoms were considered for inclusion. We searched AMED, MEDLINE, EMBASE, CINAHL and CENTRAL in October 2015. Two authors independently identified eligible studies and assessed risk of bias. We planned to pool data of studies considered clinically homogenous. RESULTS: Thirty studies met inclusion criteria. None of the included studies were truly population-based: three included non-representative subgroups of the general population, 19 included differing clinical populations, while eight included professional athletes. All studies were judged to be at high risk of bias. Due to substantial clinical heterogeneity meta analysis was not possible. Across all studies, the prevalence estimates of cam morphology ranged from 5 to 75% of participants affected. We were unable to demonstrate a higher prevalence in selected subgroups such as athletes or those with hip pain. CONCLUSIONS: There is currently insufficient high quality data to determine the true prevalence of cam morphology in the general population or selected subgroups. Well-designed population-based epidemiological studies that use homogenous case definitions are required to determine the prevalence of cam morphology and its relationship to hip pain.


Read full text at: https://www.oarsijournal.com/article/S1063-4584(16)00005-4/fulltext

PPA study day: Physio professor outlines new model of pain

Physiotherapists need a new model of pain that takes account of a ‘predictive’ sensory and cognitive interaction, and the influence of people’s emotions and expectations. T

his was the message from CSP fellow Mick Thacker, associate professor at London South Bank University at the Physiotherapy Pain Association (PPA) event on 26 January.

NIHR Signal A surgical procedure for shoulder pain is less effective than previously thought

An increasingly common surgical procedure for shoulder pain, subacromial decompression, was only slightly more effective than no treatment. In the first trial of this sort, improvements in pain and function following decompression or arthroscopy (a placebo surgery) did not reach a threshold of clinical importance compared with people allocated to no treatment at all.


This NIHR-funded study involved 313 people with shoulder pain that had not responded to physiotherapy and a steroid injection. The main intervention, decompression, involved removing any bony outgrowths that could have been causing the tendons around the shoulder to be “pinched”. This was compared with an arthroscopy used for investigation only; this did not include removing any bone or tissue. Those in the third “no treatment” arm did not receive any physiotherapy or advice.


From the NIHR Dissemination Centre

Faculty of Pain/British Pain Society consensus statement on the use of Corticosteroids for Neuraxial Procedures in the UK

The Faculty of Pain Medicine and the British Pain Society have released a joint statement on this important topic.

A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment

Bone Joint J. 2018 Jan;100-B(1):56-63. doi: 10.1302/0301-620X.100B1.BJJ-2017-0918.R1.

Meniscal allograft transplantation is undertaken to improve pain and function in patients with a symptomatic meniscal deficient knee compartment. While case series have shown improvements in patient reported outcome measures (PROMs), its efficacy has not been rigorously evaluated. This study aimed to compare PROMs in patients having meniscal transplantation with those having personalized physiotherapy at 12 months.

UHCW Research: Smith NA, Wright, D, Spalding, T and Thompson, P

Neridronic Acid (Nerixia) for Complex Regional Pain Syndrome

The cause of CRPS is unknown, but it is generally thought to be the result of the body reacting abnormally to an injury. It is difficult to estimate exactly how common CRPS is, as many cases may go undiagnosed or misdiagnosed. Currently there are no approved treatments for CRPS. Neridronic acid administered by injection is currently being developed to treat CRPS and early results indicate that it has the possibility to control the condition. If approved neridronic acid will be a potential new treatment for CRPS.

From NIHR Innovation Observatory

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

The drugs gabapentin and pregabalin (gabapentinoids) were found not to help lower back pain that had lasted more than three months. Gabapentin gave no benefit compared with placebo, while pregabalin was less effective than other painkillers. Both were associated with several side effects, such as dizziness.

From the NIHR Dissemination Centre

Rexmyelocel-T for critical limb ischaemia in patients with diabetes mellitus

The treatment, rexmyelocel-T, is being developed to relieve leg pain at rest and heal leg ulcers. The treatment uses cells from bone marrow which are injected into the damaged blood vessel, where they restore existing blood vessels and create new blood vessels. By improving the blood flow in the limb, this treatment aims to improve the patient’s condition so that they do not require amputation.

From the NIHR Innovation Observatory

NIHR Signal A commonly used treatment does not improve chronic low back pain

This trial found that destroying nerves that take pain signals to the brain using heat (radiofrequency denervation) did not improve pain, function or a sense of “recovery”. The treatment was used alongside exercise and was a variation of the technique commonly used in the UK. In this large study, it was compared to exercise alone.

Low back pain is usually short-lived, but some people develop long-term back pain which can negatively impact their lives. NICE recommends exercise, pain relief and self-management to cope with pain. If these treatments are not effective and pain is severe, then more intensive options, such as radiofrequency denervation can be considered.

From the NIHR Dissemination Centre

Learning from others: good practice when prescribing opioids in chronic pain

Long-term opioid prescribing for chronic non-cancer pain is becoming an increasing issue in England.

Faye's story puts these potential dangers into reality by describing, from her parents' perspective, the sequence of events that ultimately led to her untimely death from respiratory depression. They also outline the lessons learned by the GP practice involved in the case that they want to share with all healthcare professionals.

Please share these resources with those in your team involved in managing patients with long term pain, and encourage them to reflect on their own, and their teams, practice.

Greater pre-operative anxiety, pain and poorer function predict a worse outcome of a total knee arthroplasty

Knee Surg Sports Traumatol Arthrosc (2017) 25: 3403. https://doi.org/10.1007/s00167-016-4314-8

Around 10–30 % of patients are dissatisfied with the results of their total knee arthroplasty (TKA). This review aimed to identify and evaluate the predictors of outcome measured by the three domains of health-related quality of life (pain, stiffness and function). The focus was on pre-operative psychological factors as related to other patient-related variables.

UHCW Research: Daniel Wilson-Nunn

Study suggests epidural does not slow second stage of labour

A study published in the journal Obstetrics & Gynaecology, showed that the use of epidural analgesia in the second stage of labour made no difference to duration of labour, and suggests that the practise of minimising pain management in labour may be outdated.

The results show epidural also had no effect on normal vaginal delivery rate, incidence of episiotomy, the position of the fetus at birth or any other measures of fetal well-being. The study compared the effects of catheter-infused, low-concentration epidural anesthetic to a catheter-infused saline placebo in this double-blinded, randomized trial of 400 women.

London NHS trusts launch ‘back school’ as new care pathway

Two London trusts are launching a 90-minute education session for people with low back pain, as part of a new care pathway to meet the latest clinical guidelines.

Heart of England launches back pain video to promote self-help

Heart of England NHS Trust has launched a video animation with the twin aims of helping people with back pain and reducing the need for hospital treatment.

The animation conveys the message ‘you are the best person to make your back better’. If the back pain is new, you do not need to seek advice from your GP or a therapist, and x-rays and scans are not normally needed because most people recover over time, it says.

It illustrates NHS-approved advice for easing back pain, including keep moving, find a comfortable position, take simple painkillers and anti-inflammatory tablets.

Most common ear infections should not be treated with antibiotics, says NICE

The draft guidance advises GPs and healthcare professionals how they should treat acute otitis media, a middle ear infection that is common in children and young people.

Estimates suggest one in four children experience a middle ear infection before they are 10 years old, and that 60% show signs of improvement (for example being in less pain) within 24 hours, even if they are not given antibiotics.

In light of this, NICE says children and young people should be cared for with pain relief rather than antibiotics.

Persistent pain in neonates: challenges in assessment without the aid of a clinical tool

Acta Paediatr. Accepted Author Manuscript. doi:10.1111/apa.14081

Evaluation of comfort and pain in neonates is important for management. Specific signs of persistent pain in neonates remain undefined; few validated clinical tools assess persistent pain. We sought to determine (i) difficulty perceived by staff and parents in assessing comfort/persistent pain in babies, (ii) strategies employed when no clinical tool is used (iii) variation between clinicians’ assessments.

Pain assessment is challenging for staff. Most parents feel confident in assessing their babies’ comfort, but may overestimate the ease with which staff can do so. Indicators of persistent pain/comfort are poorly defined; staff use differing, subjective assessments, which may complicate communication between carers.

UHCW Research: Joanna Bradshaw and Kathryn I Blake

Back pain pilot slashed number of onward referrals

A pilot primary care service in Hertfordshire has managed to discharge 80 per cent of people with low back pain after their first appointment.

Three advanced practice physiotherapists (APPs) delivered the 12-month pilot at the Fairbrook Medical Centre in Borehamwood. It received £75,000 from the Health Foundation to improve patient experience and save money.

Other outcomes from the pilot, which ended in August, included a reduction in waiting times for spinal injections from an average of 31 weeks to just nine weeks.

Lidocaine with propofol to reduce pain on injection

New from BestBETs:

Lidnocaine pre-treatment or mixed with propofol reduced pain at the injection site. Further research is however required to see how much of this effect is that of lidocaine alone or the change in propofol formulation.