Chronic pain (primary and secondary) in over 16s: summary of NICE guidance

Carville, Serena; Constanti, Margaret; Kosky, Nick; Stannard, Cathy; Wilkinson, Colin

doi:10.1136/bmj.n895

Cited by 37 publications

(19 citation statements)

References 2 publications

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“…This is in line with a study by Outram et al, stating that the majority of amateur cyclists reported regular use of NSAIDs in combination with caffeine [40]. However, international clinical practice guidelines (CPGs) recommend avoiding use of NSAIDs in favour of exercise and education as a first-line treatment for chronic pain and that NSAIDs should only be used as a complementary treatment for a short period of time and during the acute phase, in order to reduce the possible side effects of these medications [41][42][43]. Therefore, prioritising the use of NSAIDs over other first-line interventions may jeopardise the success of the therapeutic process.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Characteristics, Association Factors of and Management Strategies for Low Back Pain Among Italian Amateur Cyclists: an Observational Cross-Sectional Study

2021

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Background Low back pain (LBP) is a burdensome problem affecting amateur cyclists. This cross-sectional study analysed Italian amateur cycling cohort’s demographic and sport-specific characteristics, the prevalence and characteristics of LBP among this population, its possible association factors, the management strategies adopted to deal with LBP and the sample’s beliefs among possible LBP triggers. A web-based cross-sectional survey was created. The questionnaire included 56 questions divided into six sections, querying the sample’s demographic, clinical, and cycling characteristics. Binomial logistic regression with a Wald backward method was performed to ascertain the effects of some covariates (“Sex”, “Age”, “Body Mass Index”, “Sleep hours”, “Work type”, “Cycling year”, “Number of training sessions per week”, “Stretching sessions”, “Being supervised by a coach or following a scheduled training”, “Other sports practised regularly”, “Number of cycling competitions per year”, “Past biomechanic visits”, “Specific pedal training”, “LBP before cycling”) on the likelihood of developing LBP in the last 12 months. Results A total of 1274 amateur cyclists answered the survey. The prevalence of LBP appeared to be 55.1%, 26.5% and 10.8% in life, in the last 12 months and the last 4 weeks, respectively. The final model of the logistic regression included the covariates “Sex”, “Work type”, “Cycling year”, “Being supervised by a coach or following a scheduled training”, “Other sports practised regularly”, “Specific pedal training”, “LBP before cycling”, among which “Cycling year” (variable “Between 2 and 5 years” vs. “Less than 2 years”, OR 0.48, 95% CI [0.26–0.89]), “Being supervised by a coach or following a scheduled training” (OR 0.53, 95% CI [0.37–0.74]), “Specific pedal training” (OR 0.69, 95% CI [0.51–0.94]), and “LBP before cycling” (OR 4.2, 95% CI [3.21–5.40]) were found to be significant. Conclusions The prevalence of LBP among Italian amateur cyclists seems to be less frequent compared to the general population. Moreover, undergoing previous specific pedal training and being supervised by a coach or following scheduled training drew a negative association with LBP development. This evidence highlights the importance of being overseen by specific sport figures that could offer a tailored evidence-based training to reach good physical level and to practise sports safely.

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Section: Discussionmentioning

confidence: 99%

Prevalence, Characteristics, Association Factors of and Management Strategies for Low Back Pain Among Italian Amateur Cyclists: an Observational Cross-Sectional Study

2021

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“…Stepped psychosocial care is described for inflammatory bowel disease patients, beginning with lifestyle advice (gentle exercise, sleep hygiene, diet changes), problem solving (debt, housing, etc) then stress reduction measures (mindfulness, cognitive–behavioural therapy), through to antidepressant prescription: interventions which are also likely to benefit these patients 47. Evidence supports antidepressants for treating chronic primary pain, but opioids are harmful without benefit 48. Many psychological symptoms can be secondary to opioids including dysphoria, apathy and night time insomnia as well as the distress of constipation and anergia.…”

Section: Psychopathologymentioning

confidence: 99%

Gastrointestinal symptoms and nutritional issues in patients with hypermobility disorders: assessment, diagnosis and management

Lam

Amarasinghe

Zárate-López

et al. 2022

Frontline Gastroenterol

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Patients diagnosed with hypermobile Ehlers-Danlos syndrome and hypermobile spectrum disorders are increasingly presenting to secondary and tertiary care centres with gastrointestinal (GI) symptoms and nutritional issues. Due to the absence of specific guidance, these patients are investigated, diagnosed and managed heterogeneously, resulting in a growing concern that they are at increased risk of iatrogenic harm. This review aims to collate the evidence for the causes of GI symptoms, nutritional issues and associated conditions as well as the burden of polypharmacy in this group of patients. We also describe evidence-based strategies for management, with an emphasis on reducing the risk of iatrogenic harm and improving multidisciplinary team care.

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“…Clinical guidelines for the management of persistent pain in non-cancer populations endorse non-pharmacological approaches [9][10][11][12]. This reflects in part the evidence against pharmacological approaches and significant concerns of harm [26].…”

Section: Current Approach For Persisting Pain Post-breast Cancer Trea...mentioning

confidence: 99%

“…Management of persisting pain problems in non-cancer populations has moved beyond medication-based approaches. Education, active and psychological therapies and self-management skills are now considered and recommended as frontline interventions and are endorsed as such in clinical guidelines almost wherever they exist [9][10][11][12]. This is in stark contrast to how persisting pain after successful breast cancer treatment is usually approached.…”

Section: Introductionmentioning

confidence: 99%

Treating persistent pain after breast cancer: practice gaps and future directions

et al. 2022

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This paper discusses the growing problem of persisting pain after successful treatment of breast cancer and presents recommendations for improving pain-related outcomes for this group. We discuss the dominant treatment approach for persisting pain post-breast cancer treatment and draw contrasts with contemporary treatment approaches to persistent pain in noncancer-related populations. We discuss modern application of the biopsychosocial model of pain and the notion of variable sensitivity within the pain system, moment by moment and over time. We present the implications of increasing sensitivity over time for treatment selection and implementation. By drawing on transformative changes in treatment approaches to persistent non-cancer-related pain, we describe the potentially powerful role that an intervention called pain science education, which is now recommended in clinical guidelines for musculoskeletal pain, may play in improving pain and disability outcomes after successful breast cancer treatment. Finally, we present several research recommendations that centre around adaptation of the content and delivery models of contemporary pain science education, to the post-breast cancer context.

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Chronic pain (primary and secondary) in over 16s: summary of NICE guidance

Cited by 37 publications

References 2 publications

Prevalence, Characteristics, Association Factors of and Management Strategies for Low Back Pain Among Italian Amateur Cyclists: an Observational Cross-Sectional Study

Prevalence, Characteristics, Association Factors of and Management Strategies for Low Back Pain Among Italian Amateur Cyclists: an Observational Cross-Sectional Study

Gastrointestinal symptoms and nutritional issues in patients with hypermobility disorders: assessment, diagnosis and management

Treating persistent pain after breast cancer: practice gaps and future directions

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