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British Columbia Medical Journal, December 2010 - WorkSafe BC


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British Columbia Medical Journal, December 2010 issue

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British Columbia Medical Journal, December 2010 - WorkSafe BC

  1. 1. worksafebcEvidence-based treatment of chronic pain he WorkSafeBC Evidence- pain. The systematic literature search The extended summary of the chron-T Based Practice Group (EBPG) conducted a review of system-atic reviews investigating the efficacy of medical databases, including Coch- rane Database of Systematic Reviews, Cochrane Library’s Health Technolo- ic pain report can be viewed at www ers/Assets/PDF/poster-presentations/of treatments for chronic noncancer gy Assessment Database, BIOSIS, ChronicPainTreatmentsEvidence.pdf. Embase, and Medline, was done in No limitation was employed in thisThis article has not been peer reviewed. April 2010. search. The results are summarized below. EvidenceTreatment Comments Positive Negative ConflictingPharmacological management For topical capsaicin, salicylate-based rubefacients, and topicalTopical 1-6 lidocaine For topical ibuprofen for knee pain, especially in the elderly For Carbamazepine, Clonazepam, Phenytoin, Lamotrigine,Anticonvulsants 2,7-12 Sodium Valproate For Lorazepam, Oxcarbazepine, Topiramate, Gabapentin, PregabalinAntidepressants13 In general, for nonspecific low back painTricyclic antidepressants2,9,14 Except for HIV-related neuropathiesSelective serotonin reuptake inhibitors2 — — — No available evidenceSerotonin-norepinephrine For diabetic neuropathy and post-herpetic neuralgia reuptake inhibitors2,9,14,15Antipsychotics (as ADD ON)16 In chronic and resistant pain For acute relief of chronic painKetamine17 For long-term treatment of chronic pain For acute low back pain for short-term pain relief, although adverseMuscle relaxants 18 effects are frequentNon anticonvulsants 19 For trigeminal neuralgiaOpioids2,20-22 For reducing pain, not for quality of life or functional status in chronic low back pain. Adverse effects are common For long-term management of chronic low back painOpioid switching23 In patients with inadequate pain relief or with intolerable opioid- related adverse effectsHydromorphone24 However, analgesic efficacy and tolerability are similar to morphine The effect size is small, side effects are common, and may not beTramadol2,25-28 better than less expensive analgesicsMultimodal Pain Rehabilitation Program29-32 Except for neck and shoulder pain in adults The effect is small, but can be retained up to 6 months in reducing painCognitive behavioral therapy and and disability, altering mood and social function. The best content, du-behavioral therapy30,33,34 ration, intensity, and format of the treatment delivery are still unclearInvasive/surgical management For IV lidocaine; however, the effectiveness is short and may not beSystemic application of local anesthetics35 clinically significantExtracorporeal shock wave therapy36 For low energy in treating lateral epicondylitis For short-term pain relief, but not on function or return to work in complex regional pain syndromeSpinal cord stimulators37,38 For failed back surgery syndrome For all, adverse effects are commonSympathectomy(39) As the sole treatment in patients with chronic head, neck, orTrigger point injection (40,41) shoulder pain, as well as whiplash-associated disorders Continued on page 516 VOL. 52 NO. 10, DECEMBER 2010 BC MEDICAL JOURNAL 515
  2. 2. worksafebc Continued from page 515 Evidence Treatment Comments Positive Negative Conflicting Physical therapy Traction or spinal decompression42,43 As a single treatment for any low back pain, with or without sciatica Photonic stimulation44 Interferential stimulation45 Superficial heat or cold46 Short-term with small effect Electromagnetic fields47 For knee osteoarthritis; however, the effect is not clinically significant Electrotherapy48 In treating neck pain For active or passive treatments in whiplash-associated disorders, Conservative therapy49 Grades 1 or 2 Transcutaneous electrical nerve For knee osteoarthritis or chronic low back pain, or in reducing pain stimulation50-54 among patients with rheumatoid arthritis of the hand Low-level laser therapy55,56 In reducing pain among patients with nonspecific low back or neck pain Complementary and alternative medicine Touch therapy, including healing touch, reiki, therapeutic touch57 In reducing pain; however, the effect is not clinically significant Neuroreflexotherapy58 Short-term effect for nonspecific low back pain For nonspecific neck pain Massage 59,60 Small effect for subacute or chronic nonspecific low back pain Evidence, short-term effect in acute headache or chronic Acupuncture61-63 nonspecific low back pain In treating shoulder pain Herbal64,65 For rheumatoid arthritis and maybe low back pain Vitamin D66 References Available on request by e-mailing or calling 604 232-5883. An extended summary of this review is accessible from the Evidence-based Medicine page on ( —Kukuh Noertjojo, MD, MHSc, MSc; Craig Martin, MD, MHSc; Celina Dunn, MD, CCFP WorkSafeBC Evidence-Based Practice Groupbccdc Continued from page 514 that patients with chronic respiratory Acknowledgments principle in the relationship between conditions such as COPD and asthma Thank you to Population Health Surveil- air pollution and health: a small in- have rescue medication and emer- lance and Epidemiology, BC Ministry of crease in exposure in large populations gency response plans, and know when Healthy Living and Sport, the Office of the (Fraser North, population 597 659) to seek medical help. Public health res- Provincial Health Officer, and Sarah Hen- can affect larger numbers of people ponses include issuing air quality health derson, environmental health scientist, BC than a large increase in exposures in advisories, establishing air shelters, and Centre for Disease Control. small populations (Cariboo-Chilcotin, evacuating those at risk during severe population 26 646). smoke events. Partnerships between References The evidence we present from this physicians and public health practi- 1. Naeher LP, Brauer M, Lipsett M, et al. season serves as a reminder that forest tioners become particularly advanta- Woodsmoke health effects: A review. fire smoke affects people all over the geous when novel scenarios arise, such Inhal Toxicol 2007;19:67-106. province, even those distant from the as how to manage patients in hospitals 2. Brauer M, Hisham-Hashim M. Fires in fires. Physicians and public health prac- when the indoor air becomes smoky. Indonesia. Environment Science Technol titioners across BC can (and did) work Forest fires are the norm in British 1998;32S:404S-407S. together to reduce the health effects of Columbia, and we can anticipate that 3. Moore D, Copes R, Fisk R, et al. Popula- exposure to forest fires, particularly they will increase with global climate tion health effects of air quality changes among those most at risk: firefight- change. Physicians and public health due to forest fires in British Columbia in ers, young children, the elderly, and practitioners must continue to work 2003: Estimates from physician-visit those with chronic respiratory disease. together to reduce the health impacts billing data. Can J Pub Health 2006; Physicians play a key role in ensuring of forest fires. 97:105-108.516 BC MEDICAL JOURNAL VOL. 52 NO. 10, DECEMBER 2010