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CKS topic review: Low back painEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: CKS Area: Evidence > Guidelines This Topic Review from the Clinical Knowledge Service (CKS) covers the management of acute and chronic low back pain. It covers: . the management in primary care of non-specific low back pain without radiculopathy (sciatica) that has lasted less than about 6 weeks, and . the management in primary care of non-specific low back pain without radiculopathy (sciatica) that has lasted more than about 6 weeks. (Source: NeLM - Pain control)
Source: NeLM - Pain control - November 17, 2009 Category: Anesthesiology Source Type: organizations

CKS topic review: Sciatica (lumbar radiculopathy)Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: CKS Area: Evidence > Guidelines This Topic Review from the Clinical Knowledge Service (CKS) covers the symptomatic management of sciatica (lumbar radiculopathy) in primary care. It focuses on the diagnostic and pharmacologic interventions that are available for primary healthcare practitioners in the NHS to recommend or prescribe. (Source: NeLM - Pain control)
Source: NeLM - Pain control - November 17, 2009 Category: Anesthesiology Source Type: organizations

Published evidence for off-label gabapentin uses is incompleteEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: NEJM Area: News A comparison of the published evidence for off-label uses of gabapentin with reports available to the manufacturer found significant discrepancies in outcome reporting and unpublished negative trials. There is substantial evidence that selective and biased outcome reporting in published clinical trials exists - this is one of the reasons that clinical trial databases now available were set up. The authors of this paper report an analysis of the outcomes reported in published papers describing unlicensed (off-label) uses of gabapentin, using internal company documents made available as a ...
Source: NeLM - Pain control - November 12, 2009 Category: Anesthesiology Source Type: organizations

SMC accepts restricted use of fentanyl nasal spray (Instanyl®) in NHSScotlandEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Scottish Medicines Consortium (SMC) Area: Evidence > Drug Specific Reviews The Scottish Medicines Consortium (SMC) has accepted for restricted use within NHSScotland, fentanyl nasal spray (Instanyl®) for the management of breakthrough pain in adults already receiving maintenance opioid therapy for chronic cancer pain. Use should be restricted to patients who are unsuitable for other short-acting oral opioids (e.g. oral morphine) as an alternative to other buccal and sublingual fentanyl preparations. (Source: NeLM - Pain control)
Source: NeLM - Pain control - November 10, 2009 Category: Anesthesiology Source Type: organizations

MTRAC verdict: Oxycodone + naloxone in severe painEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: MTRAC Area: Evidence > Drug Specific Reviews The Midlands Therapeutics Review and Advisory Committee (MTRAC) has reviewed the evidence on oxycodone + naloxone combination prolonged release tablets (Targinact®) for the management of severe pain. The Committee concluded that oxycodone/naloxone prolonged-release tablets were suitable for prescribing in primary care for patients with severe opioid responsive pain who have persistent constipation despite standard laxative treatment. The evidence for efficacy and safety is relatively weak, and it has not been compared to the standard first-line treatment of ...
Source: NeLM - Pain control - November 5, 2009 Category: Anesthesiology Source Type: organizations

MTRAC verdict: Duloxetine in pain due to diabetic peripheral neuropathyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: MTRAC Area: Evidence > Drug Specific Reviews The Midlands Therapeutics Review and Advisory Committee (MTRAC) has reviewed the evidence on duloxetine (Cymbalta®) for diabetic peripheral neuropathic pain in adults. The Committee concluded that duloxetine is suitable for primary care prescribing in this situation. It noted that the evidence for benefit was relatively strong, and that a draft NICE guideline recommends it for first-line use. Duloxetine had been assessed in this indication in three placebo-controlled trials, reducing 24-hour pain scores to a significantly greater degree than...
Source: NeLM - Pain control - November 5, 2009 Category: Anesthesiology Source Type: organizations

Clinical review: Pain management and sedation for children in the emergency departmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: BMJ Area: News The authors of this review article provide an overview of published evidence to help clinicians assess, manage, and minimise pain in children presenting to hospital. The following questions are addressed: . How is acute pain best assessed in children? . What is the role of non-pharmacological methods in paediatric pain relief? . What is the best initial choice of analgesic drug? . How can procedures be carried out without causing further pain? . Which topical anaesthetics are available for cannulation and venepuncture? . What are the topical, local, or ...
Source: NeLM - Pain control - November 2, 2009 Category: Anesthesiology Source Type: organizations

European CHMP confirms previous recommendation on withdrawal of non-parenteral dextropropoxyphene-containing medicinesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: EMEA Area: News Finalising a re-examination procedure for dextropropoxyphene-containing medicines, the European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) has confirmed its previous recommendation to withdraw the marketing authorisation for all non-parenteral formulations of these medicines because their risks, particularly the risk of potentially fatal overdose, are greater than their benefits. However, for the parenteral formulation, the Committee concluded that the marketing authorisations should not be withdrawn but suspended until further clinical data are available which may sup...
Source: NeLM - Pain control - October 22, 2009 Category: Anesthesiology Source Type: organizations

European CHMP begins referral for modified-release oral opioids following overdose concernsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: EMEA Area: News The European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) has started a referral for modified release oral opioids (morphine, fentanyl, oxycodone and hydromorphone) due to concerns on their dissolution and their sensitivity and interaction with alcohol, which may cause dose dumping and potential overdose. (Source: NeLM - Pain control)
Source: NeLM - Pain control - October 22, 2009 Category: Anesthesiology Source Type: organizations

Meta-analysis of two studies of zolmitriptan for acute treatment of cluster headacheEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Reuters Health News Area: News According to the results of a patient level meta-analysis of two randomised, crossover trials, zolmitriptan nasal spray (5 mg or 10 mg) is effective in the acute treatment of episodic and chronic cluster headache. Both studies were double-blind, placebo-controlled, randomised studies with similar patient populations, protocol designs, doses, and clinical endpoints. Both studies (n=121; 100 male; 64.5% with episodic cluster headache ) treated three attacks, at least 24 hours apart, in each patient, one with placebo, one with zolmitriptan 5 mg, and one with zolmi...
Source: NeLM - Pain control - October 21, 2009 Category: Anesthesiology Source Type: organizations

MHRA guidance on new requirements for packaging of OTC medicines containing codeine and dihydrocodeineEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: MHRA Area: News The MHRA has issued guidance outlining the new requirements for all packaging components of OTC solid dose medicines containing codeine or dihydrocodeine. This follows a review in July 2009 by the Commission on Human Medicines which recommended a package of measures to minimise the risk of overuse of-and addiction to such medicines. The measures included changes to pack sizes, indications, the PIL, labelling, advertising and promotional activity. (Source: NeLM - Pain control)
Source: NeLM - Pain control - October 18, 2009 Category: Anesthesiology Source Type: organizations

Single dose oral tenoxicam for acute postoperative pain in adultsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Cochrane Library Area: Evidence > Drug Specific Reviews Background Tenoxicam is a non-steroidal anti-inflammatory drug (NSAID) licensed for use in rheumatic disease and other musculoskeletal disorders in the UK, and is widely available in other countries worldwide. This review sought to evaluate the efficacy and safety of oral tenoxicam in acute postoperative pain, using clinical studies of patients with established pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties. Objective...
Source: NeLM - Pain control - October 14, 2009 Category: Anesthesiology Source Type: organizations

NICE consults on draft guidance on pharmacological management of neuropathic painEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: NICE Area: News NICE has issued for consultation from 14th October 2009 to 11th November 2009, its draft guidance on the pharmacological management of neuropathic pain. (Source: NeLM - Pain control)
Source: NeLM - Pain control - October 14, 2009 Category: Anesthesiology Source Type: organizations

Pregabalin for acute and chronic pain in adultsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Cochrane Library Area: Evidence > Drug Specific Reviews Background Antiepileptic drugs have been used in pain management since the 1960s. Pregabalin is a recently developed antiepileptic drug also used in management of chronic neuropathic pain conditions. Objectives To assess analgesic efficacy and associated adverse events of pregabalin in acute and chronic pain. Search strategy We searched MEDLINE, EMBASE, and CENTRAL to May 2009 for randomised controlled trials (RCTs). Additional studies were identified from the reference lists of retrieved papers and on-line clinical trial databases. &n...
Source: NeLM - Pain control - October 12, 2009 Category: Anesthesiology Source Type: organizations

Nycomed launches Instanyl® (intranasal fentanyl spray) for relief of breakthrough cancer painEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Nycomed Area: News Nycomed has launched an intranasal fentanyl spray (Instanyl) for the management of breakthrough pain in adults already receiving maintenance opioid therapy for chronic cancer pain. The Summary of Product Characteristics defines patients receiving maintenance opioid therapy as those who are taking at least 60 mg of oral morphine daily, at least 25 micrograms of transdermal fentanyl per hour, at least 30 mg oxycodone daily, at least 8 mg of oral hydromorphone daily or an equianalgesic dose of another opioid for a week or longer. The product is available as Instanyl® 50, 100 ...
Source: NeLM - Pain control - October 12, 2009 Category: Anesthesiology Source Type: organizations

Small RCT finds that cannabanoid spray Sativex® no more effective than placebo for painful diabetic neuropathyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Diabetes Care Area: News A small RCT has assessed the efficacy of Sativex® spray, a cannabis based medicinal extract, as adjuvant treatment in painful diabetic neuropathy. It involved 30 subjects randomised to receive either daily Sativex or placebo. The primary outcome measure was change in mean daily pain scores and secondary outcome measures included quality of life assessments. There were improvements in pain scores in both groups but the mean change between groups was not significant and there were no significant differences in secondary outcome measures. The authors note that depression was a major confound...
Source: NeLM - Pain control - October 7, 2009 Category: Anesthesiology Source Type: organizations

Gabapentin plus nortriptyline better combined than singly for neuropathic painEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Lancet Area: News A controlled trial shows that combining gabapentin with nortriptyline gives better outcomes in neuropathic pain than either drug individually. Gabapentin and tricyclic antidepressive drugs are both used in the treatment of neuropathic pain, however response rates are still poor even at maximum tolerated doses. Experimental evidence suggests that combinations of the two may have additive or synergistic effects, and this trial was carried out to investigate this possibility. It involved patients from one Canadian university hospital centre with confirmed neuropathic pain due to diabetic ...
Source: NeLM - Pain control - September 29, 2009 Category: Anesthesiology Source Type: organizations

Cyclimorph (morphine / cyclizine) 10 Injection- Revised SPCEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: eMC (electronic Medicines Compendium) Area: Other Library Updates > SPC Changes Section 4.8 (undesirable effects) has been updated and now reads as follows: As Cyclimorph Injection contains morphine and cyclizine, the type and frequency of adverse effects associated with such compounds may be expected. Adverse reactions attributable to morphine include respiratory depression, raised intra-cranial pressure, orthostatic hypotension, drowsiness, confusion, dysphoria, restlessness, miosis, constipation, nausea, vomiting, skin reactions (e.g. urticaria) biliary tract and renal spasm, vertigo and difficulty with mic...
Source: NeLM - Pain control - September 27, 2009 Category: Anesthesiology Source Type: organizations

MST (morphine sulphate) Continus suspensions 20, 30, 60, 100 and 200 mg - Revised SPCEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: eMC (electronic Medicines Compendium) Area: Other Library Updates > SPC Changes Section 4.4 (special warnings and precautions for use) has been updated and now reads as follows: Should paralytic ileus be suspected or occur during use, MST CONTINUS suspension should be discontinued immediately. Patients about to undergo additional pain relieving procedures (e.g. surgery, plexus blockade) should not receive MST CONTINUS suspension for 24 hours prior to the intervention. If further treatment with MST CONTINUS suspension is indicated, then the dosage should be adjusted to the new post-operative requireme...
Source: NeLM - Pain control - September 27, 2009 Category: Anesthesiology Source Type: organizations

RCT of dietary intervention and quadriceps strengthening exercises on pain and function in overweight people with knee painEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: BMJ Area: News The effect of dietary intervention or knee strengthening exercise, or both on knee pain and knee function in overweight and obese adults in the community has been assessed in a RCT. The study involved 389 men and women aged ?45 years with a BMI ? 28.0 and self reported knee pain from 5 general practices in Nottingham, who were randomised to one of the following interventions: . Dietary intervention plus quadriceps strengthening exercises . Dietary intervention alone . Quadriceps strengthening exercises alone . Advice leaflet only (control group) Dietar...
Source: NeLM - Pain control - September 17, 2009 Category: Anesthesiology Source Type: organizations

Conference report: Study compares fentanyl nasal spray (Instanyl®) to oral transmucosal fentanyl (Actiq®) in breakthrough cancer painEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: EurekAlert Area: News Findings from an open-label crossover trial comparing intranasal fentanyl spray (Instanyl®) and oral transmucosal fentanyl citrate (OTFC; Actiq®) for the treatment of breakthrough pain in patients with cancer have been presented at the 6th congress of the European Federation of Chapters of the International Association for the Study of Pain, and are summarised in a press release (See link below). Only brief details of trial design, methodology and results are available. The trial was multinational and compared the efficacy of the two treatments in patients who were receivin...
Source: NeLM - Pain control - September 13, 2009 Category: Anesthesiology Source Type: organizations

Instanyl (fentanyl) 50, 100 and 200 mcg/dose nasal spray - New productEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: eMC (electronic Medicines Compendium) Area: Other Library Updates > SPC Changes Instanyl is a new product indicated for the management of breakthrough pain in adults already receiving maintenance opioid therapy for chronic cancer pain. Breakthrough pain is a transitory exacerbation of pain that occurs on a background of otherwise controlled persistent pain. Patients receiving maintenance opioid therapy are those who are taking at least 60 mg of oral morphine daily, at least 25 micrograms of transdermal fentanyl per hour, at least 30 mg oxycodone daily, at least 8 mg of oral hydromorphone daily or an equianalgesi...
Source: NeLM - Pain control - September 12, 2009 Category: Anesthesiology Source Type: organizations

Targinact (oxycodone / naloxone) 5mg/2.5mg and 40mg/20mg prolonged release tablets - New ProductEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Manufacturer notification Area: Other Library Updates > SPC Changes Targinact 5mg/2.5mg and 40mg/20mg prolonged release tablets are new strengths of this product launched by Napp. These new strengths will add to the existing range of Targinact prolonged release tablets which are currently available in 10 mg/5 mg and 20 mg/10 mg tablet strengths. Targinact 5 mg/2.5 mg prolonged release tablets are intended for dose titration when initiating opioid therapy and individual dose adjustment. Targinact is indicated for severe pain, which can be adequately managed only with opioid analgesics. The opioid antagon...
Source: NeLM - Pain control - September 9, 2009 Category: Anesthesiology Source Type: organizations

Review: Diagnosis and management of cervicogenic headacheEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Lancet Neurology Area: News The Lancet Neurology has featured a review on the diagnosis, and management of cervicogenic headache, which is characterised by pain referred to the head from the cervical spine. (Source: NeLM - Pain control)
Source: NeLM - Pain control - September 8, 2009 Category: Anesthesiology Source Type: organizations

Dynastat (parecoxib) 20mg & 40mg Powder for Solution for Injection, Dynastat 20mg & 40mg Powder & Solvent for Solution for Injection - Revised SPCEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: eMC (electronic Medicines Compendium) Area: Other Library Updates > SPC Changes Section 4.4 (special warnings and precautions for use) has been updated. Some reports of Stevens-Johnson syndrome have been reported through post marketing surveillance in patients receiving parecoxib, it has been added that some of these were fatal. Again, fatal reports has been added to the statement that toxic epidermal necrolysis has been reported. (Source: NeLM - Pain control)
Source: NeLM - Pain control - September 3, 2009 Category: Anesthesiology Source Type: organizations

Care Quality Commission annual report on the safer management of controlled drugs 2008Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Care Quality Commission (CQC) Area: News The Care Quality Commission has published its second annual report on the regulation of controlled drugs, covering the year ended 31st December 2008. (Source: NeLM - Pain control)
Source: NeLM - Pain control - September 2, 2009 Category: Anesthesiology Source Type: organizations

MHRA issues new advice on OTC analgesics containing codeineEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: MHRA Area: News The MHRA has issued new advice on over-the-counter (OTC) medicines containing codeine and dihydrocodeine (DHC) to minimise the risk of overuse and addiction following recent advice from the Commission on Human Medicines (CHM). The package of measures are: . All indications related to colds, flu, coughs and sore throats, and references to minor painful conditions will be removed. . The remaining list of indications will be for the short term treatment of acute, moderate pain which is not relieved by paracetamol, ibuprofen or aspirin alone. . Patient in...
Source: NeLM - Pain control - September 2, 2009 Category: Anesthesiology Source Type: organizations

CKS topic review: HeadacheEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: CKS Area: Evidence > Guidelines This Topic Minibite from the Clinical Knowledge Service (CKS) covers the assessment of children and adults with undiagnosed headache. It provides diagnostic criteria for the common headache disorders and for some of the less common headache disorders. Separate Topic Minibites cover the management of cluster headaches, medication overuse headaches, and tension-type headache (see links below). (Source: NeLM - Pain control)
Source: NeLM - Pain control - August 24, 2009 Category: Anesthesiology Source Type: organizations

Adverse effects of medical cannabinoids: a systematic reviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: DARE Area: Evidence > Patient Safety CRD Summary: This systematic review aimed to assess the safety of medical cannabinoids. The authors concluded that short-term use of medical cannabinoids appears to increase the risk of non-serious adverse events, but that risks associated with long-term use were poorly reported. Overall this was a well conducted systematic review and the authors' conclusions are likely to be reliable. [The cannabinoid preparations investigated were oral ?-9-tetrahydrocannabinol, oral ?-9-tetrahydrocannabinol-cannabidiol or oromucosal ?-9-tetrahydrocannabinol-cannabidiol. ] ...
Source: NeLM - Pain control - August 23, 2009 Category: Anesthesiology Source Type: organizations

Efficacy of complementary and alternative medicine therapies in relieving cancer pain: a systematic reviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: DARE Area: Evidence > Complementary Medicine CRD Summary: The review concluded there was some evidence of short term benefit for the relief of cancer pain with hypnosis, imagery, support groups, acupuncture and healing touch but, due to the paucity of rigorous trials, no interventions can be recommended. The reliability of the authors' cautious conclusions is uncertain due to lack of reporting of review methods and poor quality evidence. [The CAM therapies in the included studies included acupuncture, music, psychological support, cognitive behavioural therapy (CBT), hypnosis, relaxation and guided imag...
Source: NeLM - Pain control - August 20, 2009 Category: Anesthesiology Source Type: organizations

Review: Diagnosis and management of neuropathic painEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: BMJ Area: News This BMJ review on the recognition and management of neuropathic pain addresses the following questions: . What is neuropathic pain and who gets it? . How common is neuropathic pain? . How does neuropathic pain present in clinical practice? . How is neuropathic pain diagnosed? . What are the personal and societal costs of neuropathic pain? . What is a sensible therapeutic approach for patients with neuropathic pain? . What are the recommendations from clinical guidelines and algorithms? . Is there a role for non-pharmacological treatme...
Source: NeLM - Pain control - August 13, 2009 Category: Anesthesiology Source Type: organizations

Central post-stroke pain: clinical characteristics, pathophysiology, and managementEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Lancet Neurology Area: News The Lancet Neurology has featured a review on the clinical characteristics and management of central post-stroke pain (CPSP), a neuropathic pain syndrome that can occur after a cerebrovascular accident. This syndrome is characterised by pain and sensory abnormalities in the body parts that correspond to the brain territory that has been injured by the cerebrovascular lesion. The following topics are discussed: . Epidemiology of CPSP . Clinical characteristics of CPSP . Diagnostic measures . Pathophysiology: possible mechanisms . Management of CPSP usi...
Source: NeLM - Pain control - August 10, 2009 Category: Anesthesiology Source Type: organizations