SR | Diagnostic accuracy of tests for disc, sacroiliac, and facet joint origins in low back pain assessment10 May, 2023 | 15:44h | UTC
Pro-Con Debate: Peripheral Nerve Blockade Should Be Provided Routinely in Extremity Trauma, Including in Patients At Risk for Acute Compartment Syndrome – Anesthesia & Analgesia (free for a limited period)
Summary: The objective of this systematic review and network meta-analysis was to assess the effectiveness and safety of various analgesic medicines for treating acute non-specific low back pain. After examining 98 randomized controlled trials with over 15,000 participants, the study found that the quality of evidence for the effectiveness and safety of these medications is low or very low.
Some analgesic medicines showed potential in reducing pain intensity, but the evidence was limited due to trial risk of bias and imprecision in effect estimates. Furthermore, certain medications might increase the risk of adverse events during treatment, with evidence ranging from moderate to very low confidence.
Given the lack of high-quality evidence, clinicians and patients are advised to be cautious when using analgesic medicines for acute non-specific low back pain. More robust head-to-head comparison trials are needed to provide clearer guidance on the best course of treatment.
Commentary from the author on Twitter (thread – click for more)
Out today in @bmj_latest.
We found “considerable uncertainty” around the effectiveness and safety of analgesic medicines for adults with acute non-specific low back pain.
Available at https://t.co/PeOmEOeJyJ
Thread 🧵 pic.twitter.com/T8YDNGhhME
— Michael Wewege (@mawewege) March 22, 2023
Cohort Study | Opioid use for pain relief after birth appears to pose no significant risk to breastfed infants23 Mar, 2023 | 13:08h | UTC
Summary: This large study from Canada found that infants born to mothers prescribed opioids after delivery, mainly following a cesarean, are at no greater risk of harm shortly after birth than infants of mothers not prescribed opioids. This suggests that breastfeeding is likely safe for babies whose mothers are taking opioids for pain relief.
The study included 865,691 mother-infant pairs discharged from Ontario hospitals within seven days of delivery between September 2012 and March 2020. Researchers matched mothers who filled an opioid prescription within seven days of discharge to those who did not.
Among the infants admitted to the hospital within 30 days, 2,962 (3.5%) were born to mothers who filled an opioid prescription compared with 3,038 (3.5%) born to mothers who did not, showing that infants of mothers prescribed opioids were no more likely to be admitted to the hospital for any reason. These children were only marginally more likely to visit the emergency department in the subsequent 30 days, and no differences were found for other serious outcomes, including breathing problems or admission to a neonatal intensive care unit, and no infant deaths occurred.
Although the study has some limitations, the high initial breastfeeding rates in Canada (90%) and the consistency of the findings with the fact that millions of new mothers are prescribed opioids after delivery each year provide confidence in the conclusions.
M-A | Analgesic effect of erector spinae plane block in adults undergoing laparoscopic cholecystectomy21 Mar, 2023 | 13:06h | UTC
Summary: The article describes a randomized, placebo-controlled, double-blind clinical trial to evaluate the efficacy and safety of different doses of intravenous ibuprofen (IVIB) in treating acute postoperative pain. The trial involved patients who underwent abdominal or orthopedic surgery and were randomized to placebo, IVIB 400 mg, or IVIB 800 mg. The first dose was given intravenously 30 minutes before surgery ended, followed by IV administration every 6 hours for a total of 8 doses.
The study found that IV administration of ibuprofen 400 mg or 800 mg significantly reduced morphine consumption and relieved pain without increasing the incidence of adverse events.
The study’s strengths were its multicenter, randomized, controlled, and prospective design. However, the extensive list of exclusion criteria suggests that the study was made in a relatively healthy population, making it difficult to extrapolate the safety results for more fragile patients.
Article: Analgesic Efficacy of Intravenous Ibuprofen in the Treatment of Postoperative Acute Pain: A Phase III Multicenter Randomized Placebo-Controlled, Double-Blind Clinical Trial – Pain Research and Management
Deprescribing strategies for opioids and benzodiazepines with emphasis on concurrent use: a scoping review15 Mar, 2023 | 15:06h | UTC
A National Modified Delphi Consensus Process to Prioritize Experiences and Interventions for Antipsychotic Medication Deprescribing Among Adult Patients With Critical Illness – Critical Care Explorations
Facing the challenge of polypharmacy when prescribing for older people with cardiovascular disease. A review by the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy – European Heart Journal – Cardiovascular Pharmacotherapy
How-to guide for medication reviews in older adults with cancer: A Young International Society of Geriatric Oncology and Nursing & Allied Health Interest Group initiative – Journal of Geriatric Oncology
RCT | Immersive virtual reality intervention reduces pain among pediatric patients undergoing venipuncture15 Mar, 2023 | 14:46h | UTC
Decrease in hospitalizations and liver failure after FDA mandate limiting paracetamol dosage in prescription opioid combinations.13 Mar, 2023 | 14:45h | UTC
Editorial: Moving the Needle to Reduce Acetaminophen (Paracetamol) Hepatotoxicity – JAMA (free for a limited period)
Video Summary: Acetaminophen (Paracetamol) and Acute Liver Failure – JAMA
Commentary on Twitter
The @US_FDA mandate to limit acetaminophen to 325 mg/tablet in prescription combination acetaminophen and opioid medications was associated with a decline in hospitalizations involving acetaminophen and opioid toxicity. https://t.co/6tdqFAI4hG
— JAMA (@JAMA_current) March 7, 2023
Summary: The study evaluated the effect of cannabidiol oil on pain control and opioid usage in patients undergoing ureteroscopy with stent placement for urinary stone disease. Ninety patients were randomized 1:1 to receive either placebo or 20mg of cannabidiol oil daily for 3 days postoperatively.
Results showed no difference between CBD oil and placebo in reducing pain scores, opioid usage, or stent-related symptoms. The study suggests that despite the availability of numerous analgesic agents, stent symptoms continue to be bothersome for most patients, and further research is needed to find effective non-opioid alternatives for pain management in this setting.
SR | Spinal cord stimulation for low back pain provides no sustained clinical benefits compared to placebo9 Mar, 2023 | 14:12h | UTC
Summary: Spinal cord stimulation (SCS) is a surgical procedure used to treat persistent low back pain by sending electrical signals via implanted electrodes into the spinal cord. The review included 13 studies (randomized controlled trials and cross‐over trials) with 699 participants.
Most of the studies were focused on short-term effects (less than one month), but the review found it is uncertain whether spinal cord stimulation can improve outcomes in the immediate term compared with placebo. At six months, SCS probably does not improve back or leg pain, function, or quality of life compared with placebo, with moderate certainty of evidence. Adverse events were also reported, including infections, neurological damage, and lead migration requiring repeated surgery.
The review concluded that the data does not support the use of SCS to manage low back pain outside a clinical trial. Current evidence suggests SCS probably does not have sustained clinical benefits that would outweigh the costs and risks of this surgical intervention.
Commentary from the author on Twitter
Our Cochrane review on spinal cord stimulators for #backpain out today.
-Mod certainty evidence of no benefit vs placebo in medium term
-Uncertain if benefit on pain in immediate term
-Adverse events (infection, re-operation) commonhttps://t.co/lNJQeN96Zs
— Adrian Traeger (@adrian_traeger) March 7, 2023
Pain management and opioid stewardship in adult cardiac surgery: Joint consensus report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society – The Journal of thoracic and cardiovascular surgery
RCT | Addition of preoperative transversus abdominis plane block to multimodal analgesia in open gynecological surgery2 Mar, 2023 | 12:43h | UTC