Use of Benzodiazepines in Lower Back Pain Problem Based Learning, Oct 2008.

Slides:

Advertisements

Similar presentations

How to use Clinical Evidence to inform clinical decision making

Advertisements

Department of O UTCOMES R ESEARCH. Daniel I. Sessler, M.D. Professor and Chair Department of O UTCOMES R ESEARCH The Cleveland Clinic Clinical Research.

LOW BACK PAIN The GPs Problem. The GPs Problems Lots of patients Precise diagnosis is difficult Changing guidelines - triage - what helps and what doesn’t?

A systematic review of the analgesic efficacy and adverse effects of epidural morphine versus parenteral morphine after caesarean section Carmen KM Chan.

JNC 8 Guidelines….

QUASI-EXPERIMENTAL STUDY DESIGNS IN EVALUATING MEDICINES USE INTERVENTIONS 1 Lloyd Matowe 2 Craig Ramsay 1 Faculty of Pharmacy, Kuwait University 2 HSRU,

CRITICAL READING Stephen Newell. December Reading a paper – R-E-A-D-ER  Relevant?  Educational? Does it add anything?  Applicable? Primary-care.

The Cochrane Reviews of Acupuncture Doris Hubbs, MD, FACP April 26, 2013.

Are topical NSAIDs a safe and effective treatment for Corneal Abrasions? Department of Emergency Medicine University of Pennsylvania Health System Andrew.

Treatment of Chronic Insomnia: A Literature Search of Practice Guidelines, Meta-Analyses, and Review Articles Praveen Kambam, PGY-2 EBM Seminar 10/27/2005.

Clinical Trials Hanyan Yang

Fibromyalgia: Creating a Claim James Witter MD, PhD Arthritis Advisory Committee June 23, 2003.

E. McLaughlin, P. D. Chakravarty, D. Whittaker, E. Cowan, K. Xu, E. Byrne, D.M. Bruce, J. A. Ford University of Aberdeen.

Dr.Zhila Abedi Asl MD.Fellowship of lnfertility Tehran medical university.

NIMESULIDE DR.B.B.SAHNI SR.SPECIALIST TATA CENTRAL HOSPITAL DHANBAD.

Chronic Pain A Review of the Literature. Meade Study: BMJ 1990 A British ten year study concluded that chiropractic treatment was significantly more effective,

The European Network for Traumatic Stress Training & Practice

Criteria and Standard.

The Growing Knee OA Population

Effects of Pediatric Asthma Education on Hospitalizations and Emergency Department Visits: A Meta-Analysis June 3, 2007 Janet M. Coffman, PhD, Michael.

Medications for Pain: What You Need to Know for Treatment in Workers’ Compensation Suzanne Novak, MD, PhD 5/17/07.

How to Analyze Therapy in the Medical Literature (part 2)

Evidence-Based Practice: Evidence-Based Practice: NUR 126 Denise Filiatrault Adopted from Curry College Division of Nursing Elizabeth Kudzma.

Common Therapies for Back Pain:

The Cochrane Reviews of Acupuncture Doris Hubbs, MD, FACP April 26, 2013.

American College of Chest Physicians (ACCP) Health and Science Policy Committee Orientation Program Part #4 Grading and Wording of Recommendations.

2nd Concertation Meeting Brussels, September 8, 2011 Reinhard Prior, Scientific Coordinator, HIM Evidence in telemedicine: a literature review.

1 Study Design Issues and Considerations in HUS Trials Yan Wang, Ph.D. Statistical Reviewer Division of Biometrics IV OB/OTS/CDER/FDA April 12, 2007.

RELEVANCERELEVANCE Is the objective of the article on harm similar to your clinical dilemma? Yes, the article’s objective is similar to the clinical dilemma.

Community wide interventions for physical activity Clinical

Summary Pattern of Specific COX II Inhibitors Use Physician prescribed appropriate COX II use in high risk was 40.08% and inappropriate COX II use in low.

1 International Society for CNS Clinical Trials and Methodology FDA Advisory Committee Meeting Proposed Requirement for Long-Term Data to Support Initial.

Acupuncture By Katie Hicks.

EVALUATING u After retrieving the literature, you have to evaluate or critically appraise the evidence for its validity and applicability to your patient.

How Empty Are Empty Reviews? The first report on the Empty Reviews Project sponsored by the Cochrane Opportunities Fund and an invitation to participate.

Quality Education for a Healthier Scotland Audit Fiona McMillan Principal Lead, Vocational Training and Leadership Development NHS Education for Scotland.

Multifidus and Paraspinal Muscle Group Cross-Sectional Areas of Patients With Low Back Pain and Control Patients: A Systematic Review With a Focus on Blinding.

Joanne Edwards Medical Information Manager ASCO Tech Assessment Update Commercial Implications & Promotional Guidance.

Chronic pelvic pain Journal Club 17 th June 2011 Dr Claire Hoxley (GPST1) Dr Harpreet Rayar (GPST2)

Acupuncture in Pain Management Zekeriya AKTÜRK Şifa University Medical Faculty, Department of Family Medicine 17 March 2016

Low back pain (LBP) is one of the most common reasons for a visit to your physician, second only to the common cold. It can be caused by any number of.

/ 42 1 Acupuncture or acupressure for pain management in labour. (review of systematic reviews)

Dr. Rupak Sethuraman. SPECIFIC LEARNING OBJECTIVES Various management techniques of orofacial pain Management of common orofacial pain disorders.

The Use of Acupuncture to Decrease Neuralgia in Patients with Spinal Cord Injuries Joanna Christiansen PA-S Pacific University School of Physician Assistant.

LSU Journal Club Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia A Systematic Review and Meta-analysis Scott Hebert,

Efficacy of Colchicine When Added to Traditional Anti- Inflammatory Therapy in the Treatment of Pericarditis Efficacy of Colchicine When Added to Traditional.

CHEST 2013; 144(3): R3 김유진 / Prof. 장나은. Introduction 2  Cardiovascular diseases  common, serious comorbid conditions in patients with COPD cardiac.

Pharmacological management of delirium

Medications: Overview of Evidence-Based Strategies

Effects of Uric acid- lowering therapy on renal outcomes: a systematic review and meta-analysis Nephrol Dial Transplant (2014) 29: Vaughan Washco.

Mustafa Serinken MD, Cenker Eken MD, Kamil Tunay MD, Yalcin

MONOCLONAL ANTIBODIES AGAINST NERVE GROWTH FACTOR IN PAIN MANAGENT

ACUPUNCTURE A TREATMENT FOR PAINFUL DIABETIC NEUROPATHY

Yoga in therapy for chronic non-specific low back pain (CLBP) – a short term intensive yoga program for in-patients (project) Aleš Kubát MD Department.

Martha Carvour, MD, PhD March 2, 2017

A Recommendation from Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from ACOP and APS By Rhys Dela Cruz, Angela Hickey,

Optimizing Therapy for Osteoarthritis

Continuous Infusion Pumps For Post-Operative Pain Control Oksana Sidorevich, RN State University of New York Institute of Technology Abstract A large.

Program Goals. Treatment-Naive Patients With PAH What Do We Know and What Choices Do We Have?

Section II: Pain Assessment

Low risk of sexual dysfunction versus placebo

Radiofrequency denervation for chronic low back pain

Treatments for Subacute Cough in Primary Care: Systematic Review and Meta-analyses of Randomized Clinical Trials Benjamin Speich, Anja Thomer, Soheila.

Assessing the Burden of Hyperkalemia

Managing Pain in the 21st Century

Low risk of sexual dysfunction versus placebo

Benefit and harm of pregabalin in acute pain treatment: a systematic review with meta- analyses and trial sequential analyses M.L. Fabritius, C. Strøm,

Assessing the Burden of Hyperkalemia

Championing Evidence-Based Care in Patients With Acute Low Back Pain

Yoga treatment for chronic non-specific low back pain

Presentation transcript:

Use of Benzodiazepines in Lower Back Pain Problem Based Learning, Oct 2008

Cochrane Systematic Review Muscle relaxants for non-specific low-back pain: Thirty trials met the inclusion criteria 23 trials (77%) were of high quality 24 trials (80%) were on acute low back pain 4 studied benzodiazepines 11 non-benzodiazepines 2 antispasticity muscle relaxants – in comparison with placebo

Cochrane Systematic Review Results showed that there is strong evidence that any of these muscle relaxants are more effective than placebo for patients with acute LBP on short-term pain relief. The various muscle relaxants were found to be similar in performance.

Cochrane Systematic Review Authors' conclusions “Muscle relaxants are effective in the management of non-specific LBP, but adverse effects require that they be used with caution. Trials are needed that evaluate if muscle relaxants are more effective than analgesics or NSAIDs.”

BestBets Use of muscle relaxants in acute LBP. Also benzodiazepines & non- benzodiazepines. Following comment: – Many cope well with simple analgesics – But many c/o spasmodic pain and stiffness – Therefore logical argument for use of relaxants.

BestBets The systematic review demonstrates that in RCTs and CCTs does appear to be a real benefit from use of muscle relaxants in acute and chronic settings. However, incidence of S/Es is considerable and their blanket use cannot be advocated. Remains up to treating physician to assess need for and potential risks in individual patients

BestBets Clinical bottom line: – Muscle relaxants are effective in management of acute and chronic back pain. – However, the incidence of side effects means that they must be used with caution.”

CKS (formerly PRODIGY) Discuss muscle relaxants in their guideline on lower back pain, this includes the following passage: – “If analgesics fail to provide adequate relief, consider a short course of a muscle relaxant, on its own or together with an NSAID. – Several muscle relaxants have been studied in relation to lower back pain. Diazepam is usually first- line choice. – Due to risk of dependency, recommended only for short courses”