Actipatch for management of localised musculoskeletal pain
|
|
- Bernice Walker
- 5 years ago
- Views:
Transcription
1 Northern Treatment Advisory Group Actipatch for management of localised musculoskeletal pain Lead author: Daniel Hill Regional Drug & Therapeutics Centre (Newcastle) November
2 Summary Analgesics are only effective in a small proportion of patients with chronic pain. Nonpharmacological treatment may be effective in reducing long-term pain and disability in some people with chronic pain, and can be used to augment and complement analgesic use. ActiPatch is a wearable pulsed electromagnetic field device for the management of localised musculoskeletal pain. In a small RCT in patients with osteoarthritis of the knee (n=60), one month of treatment with the ActiPatch device was associated with a reduction in pain and WOMAC score compared with placebo. A registry study evaluated efficacy of the device in subjects with chronic musculoskeletal pain due to a variety of aetiologies. After using a trial device for seven days, 65% of subjects reported a benefit from the trial device, with an average pain reduction in these individuals of 57%. A three month follow-up survey showed sustained pain relief; decreased analgesic use and improved QoL. In a second registry study in subjects with chronic back pain, 52% of subjects reported a benefit from the trial device, with a mean pain reduction of 66%. Over the same period, 36% of subjects had a decrease in their medication use, and 14% stopped using pain medications. Due to the limitations of the registry design, the self-selected enrolment and self-reported nature of data collection, and the lack of a control group these findings should be interpreted with caution. No major adverse events associated with the ActiPatch device were reported during the placebo-controlled trial or in the two large registry studies. Minor issues concerning attachment of the device and a reaction to the adhesive medical tape were reported in some instances. In the chronic back pain registry study, increased pain was reported in 1.5% of individuals. Three versions of the ActiPatch device are available, with each product specifically tailored for the treatment of knee pain, back pain or muscle and joint pain. Each device has an on/off function and lasts for 720 hours. All three products can be purchased without prescription online and OTC at a retail cost of 20 to 25 per device. A refill device, supplied without any attachments is available for 20. The device was recently added to the NHS Drug Tariff at a cost of for each of the three products. A healthcare utilisation study assessed the impact of using ActiPatch as a chronic pain therapy on healthcare service use and direct costs to the NHS. This study has not been fully published, and therefore has not been subject to peer-review. Over a three-month assessment period, 61 subjects independently purchased 148 devices. Subjects reported a significant reduction in pain and an improvement in QoL which was associated with reduced utilisation of healthcare services as well as prescription analgesics. As a result, NHS costs were reduced by 8,664 over the three-month treatment period, which equated to 34,656 per year ( 568 per patient). The willingness of patients to purchase the device in the long-term has not been established. Given the data are limited to a small number of self-selected patients, and that the long-term efficacy of the device remains uncertain, consideration must therefore be given to whether the results can be suitably extrapolated to UK practice. The place in therapy remains unclear due to limited evidence base and uncertainty surrounding the clinical importance of unpublished trial findings. Northern Treatment Advisory Group, November
3 Introduction Chronic pain (also known as persistent pain or long-term pain) is a complex and debilitating condition, which has a substantial impact on the lives of those affected. In the absence of other criteria, chronic pain is usually defined as pain that has persisted for more than three months. Chronic pain can be associated with a number of different disease processes, previous trauma or injury. The prevalence of chronic pain is difficult to determine. In a recent systematic review, prevalence estimates ranged from 8.7% to 64.4%, with a pooled mean of 31%. 1 An earlier systematic review suggests that chronic pain in the UK affects between onethird and one-half of the population. 2 It has not been established what proportion of people with chronic pain have debilitating symptoms and seek support form healthcare services. Most patients with chronic pain first contact health services through primary care, and are subsequently managed in this setting, and even when patients are referred for specialist treatment, their ongoing care is likely to primarily remain with their GP. The management of chronic pain can present significant clinical challenges as there is considerable variation in patient responses to analgesia, both in terms of efficacy and side effects. 3 Although analgesics can be used effectively to relieve pain, this is only achieved in a small proportion of patients, and therefore prescribers must expect analgesics to fail for the majority of patients. 4,5 It is unusual for any analgesic, even strong opioids, to completely eliminate pain, so treatment should focus on reducing an individual's pain with a view to improving their overall quality of life (QoL). Non-pharmacological treatment may be effective in reducing long-term pain and disability in some people with chronic pain, and can also be used to augment and complement analgesic use as part of a multimodal therapy. 5,6 Nonpharmacological interventions for chronic pain include physical and psychological therapies and electrotherapies such as transcutaneous electrical nerve stimulation (TENS), and percutaneous electrical nerve simulation (PENS). ActiPatch (BioElectronics Corporation, USA) is a wearable pulsed shortwave therapy (PSWT) device for the management of localised musculoskeletal pain. 7 The CE marked class IIa device consists of a small module that houses the electronics and battery, connected to a wire loop antenna which is placed directly over the source of pain. The antenna is circular, soft and flexible and can be shaped to fit the area being treated as required. The device which weighs eight grams is held in place with wraps, adhesives, bandages or clothing, and can be used for up to 24 hours per day. The PSWT device delivers low energy electromagnetic pulses 1,000 times a second, but unlike a transcutaneous electrical nerve stimulation (TENS) machine; there is no sensation when using the device. In the UK, the ActiPatch device has been sold over-the-counter (OTC) for a number of years, and was added to the NHS Drug Tariff in May NICE guidance The National Institute for Health and Care Excellence (NICE) guidelines on chronic pain: assessment and management are currently in development, with an expected publication date of January This guideline will cover adults and young people (16 years and over) with chronic pain. One part of the guideline will cover specific pharmacological and nonpharmacological interventions for chronic primary pain conditions for which there is no existing NICE guidance. It is not yet known whether this guidance will include specific Northern Treatment Advisory Group, November
4 reference to the ActiPatch device. 8 However the manufactures are submitting an application for ActiPatch to be included in this NICE guidance. There is no interventional procedures guidance by NICE specifically for the ActiPatch device. The NICE guidelines on low back pain and sciatica in over 16s (2016) states that patients should not be offered the use of electrotherapies including TENS and PENS for managing low back pain with or without sciatica. 9 The NICE guidelines on osteoarthritis recommend that healthcare professionals should consider the use of TENS as an adjunct to core treatments for pain relief. 10 Clinical evidence Osteoarthritis of the knee The efficacy of ActiPatch in the management of pain in patients with primary osteoarthritis (OA) of the knee was evaluated in a randomised, double-blind placebo-controlled trial. 11 Subjects aged >40 years were included if they had radiographic evidence of knee OA and persistent pain higher than 40 mm on the visual analogue scale (, mm range) for global pain despite receiving the maximal tolerated doses of conventional medical therapy, including paracetamol and/or an NSAID. Exclusion criteria included secondary causes of OA, infection, secondary fibromyalgia, systemic arthritis, diabetes, patients receiving anticoagulant therapy, or previous intra-articular steroid injections. Sixty-six subjects were randomly allocated a wearable PSWT device (ActiPatch) or a placebo device with no electromagnetic properties. Subjects were trained in the use of the device, which was used consecutively with the antenna placed over the knee for a minimum of 12 hours daily treatment for one month. The device was kept in place with a wrap and switched off when not in use. Subjects continued to take prescribed NSAIDs/analgesics as needed. The primary outcome measure was the reduction in pain intensity, assessed through (Visual analogue scale) and WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scores. Secondary outcomes included QoL measured through the SF-36 questionnaire, pressure pain threshold (PPT), and changes in intake of NSAIDs/analgesics. A total of sixty subjects completed the study, as three subjects in each group were lost to follow-up. The baseline demographics and clinical characteristics of the two groups were comparable, and during the study, the rates of compliance with the device were similar. After one month of treatment, there was a significant reduction in pain scores for subjects using the PSWT device compared to those who received the placebo device (25.5% vs. 3.6%; standardised effect size (95% CI to -0.19). Likewise, PSWT treatment was associated with a significant reduction in WOMAC pain scores compared with placebo (23.4% vs. 2.3%; effect size (95% CI to -0.09). Pain tolerance and physical health scores also improved in PSWT-treated patients compared to placebo, but there was no significant difference in mental health scores. In the PSWT group, 26% of subjects stopped previously prescribed NSAID/analgesics, whereas in the placebo group 3% stopped, and 10% started new therapy. General chronic pain A registry study evaluated the efficacy of ActiPatch in a broader population of subjects with chronic musculoskeletal pain in different locations due to a variety of aetiologies. 12 A registry Northern Treatment Advisory Group, November
5 of 44,000 subjects from the UK or Ireland who submitted a request via the ActiPatch website to try a trial device was established between July 2014 and April All subjects paid a small fee for the device which was shipped to their home. The trial device, once activated had a seven-day power supply and is recommended to be used continuously for the seven days. Three-to-four weeks after receiving the trial device subjects were ed a webbased assessment form, with a second reminder six days later. Details of design and content of the assessment form were not reported. The trial device was considered effective or of benefit when there was a reported minimum two-point reduction in the pain scores (0-10 scale). A total of 5,002 responses were received, equating to a response rate of approximately 11%. All responses were included in the analysis, with the exception of 250 responses that included comments that stated the trial device had not been received or used. The majority of responders were over the age of 35, and 74% were female. The most frequently reported causes of pain were OA (31%), rheumatoid arthritis (15%), fibromyalgia (15%), and sports injury (8%). In a number of cases multiple causes of pain were reported, with an overall average of 1.1 per subject. Multiple concurrent locations of pain were reported with an average of 1.7 per subject. The most frequently reported locations of pain were back (58%), knee (34%), and shoulder (26%), which corresponded overall with the most frequent areas of use at 44%, 21% and 14%, respectively. Baseline pain scores for all responders was an average of 8.02, despite the use on average of 1.97 pain treatments per subject. The most frequently used treatments were analgesic tablets (84%), topicals (32%), heat wrap (27%), TENS (20%), and physical therapy (19%). Overall, NSAIDs (48%) and paracetamol (43%) were the most frequently used medications. Using the two-point reduction criteria for determining effectiveness, 65% of all subjects reported a benefit from the trial device, with an average pain reduction in these individuals of 57%. In those subjects experiencing persistent pain for greater than six months (4,308 responses) the percentage reporting benefit was fairly consistent across all major areas of the body and all causes of pain (table 1). The percentage of subjects reporting that the trial device was beneficial was largely matched by those indicating an intention to purchase (49%) or maybe purchase (22%) the retail device. A three month follow-up survey was sent to those subjects who had previously reported an intention to purchase or maybe purchase the retail device. 12 From a total of 658 responses, the indicated purchase rate was 80%, with around half of those not purchasing the device indicated that the reason was financial limitations. Long-term pain control was established with 93% of responders reporting sustained pain relief. Pain levels at the three month time point were on average 3.99 points or 51% lower than the reported baseline. A moderate to great improvement in QoL was reported by 84% of subjects, and medication use was reduced on average by 50%. Northern Treatment Advisory Group, November
6 Table 1. Pain reduction and effectiveness in relation to location of use and by cause of pain in those reporting chronic pain >6 months. Effectiveness and pain reduction in relation to location of use Location Response number Benefit (%) Baseline Trial device difference Pain reduction (%) Back 2, ± ± Knee ± ± Neck ± ± Shoulder ± ± Hip ± ± Other ± ± Effectiveness and pain reduction by cause of pain Aetiology Chronic back pain Response number Benefit (%) Baseline Trial device difference Rheumatoid arthritis ± ± Osteoarthritis 1, ± ± Fibromyalgia ± ± Sports injury ± ± Postsurgery pain ± ± Tendonitis ± ± Neuropathic ± ± Other 1, ± ± Pain reduction (%) A second registry study evaluated the efficacy of ActiPatch in subjects with chronic back pain (CBP). 13 A registry of 31,125 subjects from the UK or Ireland who submitted a request via the ActiPatch website to try a trial device was established between January and May After receiving the trial device subjects were ed an assessment form, with a second reminder four days later. The assessment was designed to collect data on age, gender, pain level, duration of pain, location and cause of pain. In addition, the study collected data on a wider analgesic profile including adverse effects and their impact on QoL, and any change in medication use after using the device. The trial device was considered effective if the pain score was reduced by at least 40%. A total of 3,735 individuals completed the assessment, equating to an overall response rate of approximately 12%. Of this group, 1,394 subjects indicated that they used the device for CBP. The majority of responders were female (75%), over the age of 35 and experiencing long-standing pain of two or more years with a median of 6.1 years. The most frequently reported causes of pain were disc issues (18.0%), OA (13.7%), sciatica and fibromyalgia (both 11.8%). In a number of cases multiple causes of pain were reported, with an overall average of 1.57 per subject, and some of these were therefore not related to CBP. The mean baseline pain reported by the CBP subjects before using the trial device was 8.04 ± The most commonly used analgesics were NSAIDs (46%), paracetamol (52%), weak opioids (30%) and amitriptyline (29%), with subjects using on average 2.5 different pain medications. Many responders indicated that they were also using other treatment modalities such as TENS, heat wraps and physical therapy. Overall, 39.3% of subjects reported good or Northern Treatment Advisory Group, November
7 adequate pain relief from pain medications. Of the 996 responders asked about the possible adverse effects associated with their pain medication, 66.1% reported experiencing adverse events, with a mean negative impact on their QoL of 5.7 on a 0-10 scale. After using the trial device for seven days, the mean pain score was 4.83 ± 2.66, or a difference of 39.9% (3.21 points) compared to baseline (p<0.001). Using the 40% minimum reduction criteria for determining effectiveness, 52% of CBP subjects reported a benefit from the trial device, with a mean pain decrease of 5.40 points, or 66% reduction in pain. In the prior registry study of general chronic pain sufferers, a two-point reduction on the mean pain score was set as the threshold for effective pain relief. Using this 2-point reduction for the current study, 66% of the CBP subjects meet these criteria and average a 58% reduction in pain. Intent to continue the use of the device was closely associated with the degree of reduction, with only 31.2% of subjects indicating that they would probably- or definitely not continue the therapy. Over the seven day trial period, 36% of CBP subjects reported a distinct decrease in their medication use, and 14% were able to stop using pain medications. Limitations of the evidence There is only one small placebo controlled trial (n=60) evaluating the ActiPatch for use in OA of the knee. Patients were only followed up for one month; this is not a sufficient period of time to evaluate the efficacy of the device for a chronic condition. Furthermore the study is only in comparison to placebo and patients continued to take analgesic medications. However there was no consistency in the other analgesia that was taken. 11 The other trials are registry studies that do not have a control group, are self-selected and self-reported studies. 12,13 Patients who did not respond to the ActiPatch and stopped using it may have been less likely to complete the survey than a patient who did benefit from it. The registry studies did not assess the long term efficacy of the devices despite their use for chronic pain. The length of time the patients used the devices per day was not controlled as in the placebo controlled trial. Patients continued to take analgesia medications throughout the studies. However the dose and frequency was not stated therefore it is unknown if these doses were therapeutic. In addition there was no placebo used in the studies. A comparison was taken between periods with or without the patch. Therefore any benefit from the patch may have been due to a placebo effect that may have been negated if the studies had a longer follow up period. None of the studies had a direct comparison to an equivalent non-pharmacological device such as TENS or PENS devices. Patients were able to use these devices in the registry studies alongside ActiPatch but with no consistency. Therefore the findings of these studies should be interpreted with caution. The place in therapy remains unclear due to limited evidence base and uncertainty surrounding the clinical importance of registry studies and unpublished trial findings. Northern Treatment Advisory Group, November
8 Safety No adverse events associated with the PSWT device were reported during the placebocontrolled trial in patients with primary OA of the knee. 11 In the chronic musculoskeletal pain registry study, no major adverse events associated with the PSWT device were reported. 12 Minor issues concerning attachment of the device and a reaction to the adhesive medical tape were reported in 0.4% of the responses. In the chronic back pain registry study, no significant adverse events associated with the PSWT device were reported. 13 Increased pain was reported in 1.5% of individuals and an adverse reaction to the medical adhesive tape was reported in less than 1% of individuals. Cost analysis The ActiPatch device was added to the NHS Drug Tariff in May 2018 (Part IXA-Appliances) at a cost of each for the knee pain, back pain, or muscle and joint pain products. Prescriptions in primary care will be subject to a single activity fee of 1.29 per prescription, whilst those made in secondary care may be subject to VAT. If worn continuously one device will last for one month. The prices below (Table 2) take into consideration how long the device is worn for. All three ActiPatch products can also be purchased without prescription online and OTC at some local pharmacies at a retail cost of between 20 and 25 per device (720 hours of therapy). A refill device, supplied without any attachments is available for 20. Table 2. ActiPatch device cost per patient. One month (24 hours/day) One month (8 hours/day) Twelve months (24 hours/day) Twelve months (8 hours/day) Primary Care Secondary Care (Inc. VAT) OTC / Online An ActiPatch trial device can be purchased directly from the manufacturer at a cost of 4.95 inclusive of postage. The trial device, once activated has a seven day power supply and cannot be turned off. Only two trials are permitted per household and only one trial permitted per user. In the UK, chronic pain is estimated to affect between one-third and one-half of the population. 2 It has not been established what proportion of people with chronic pain seek support from healthcare services. The treatment of chronic pain is costly to the NHS. In 2016, 537 million was spent on prescribing analgesics, with at least an additional 50% cost incurred from the prescription of other drug classes such as antidepressants and antiepileptic drugs. 8 Additional healthcare costs include visits to primary care, referrals to secondary care, and the costs of investigations and interventions, including surgery. According to the Royal College of General Practitioners (RCGP), people with chronic pain consult their GP around five times more frequently than those without, and chronic pain is a presenting condition in around 22% of consultations. 14 Northern Treatment Advisory Group, November
9 Healthcare utilisation study A healthcare utilisation study assessed the impact of using ActiPatch as a chronic pain therapy on healthcare service use and direct costs to the NHS. This study has not been fully published, but a document presenting the results of the study is freely accessible on the manufacturer s website. 15 The study included 61 adults with severe chronic pain, defined as pain score of at least six out of a maximum possible ten for at least three consecutive months. Data on pain scores, QoL and utilization of healthcare services were measured for each subject during two time periods, each lasting three-months; the first period served as a baseline measure (control), while the second period served as an intervention measure in which ActiPatch was incorporated as a chronic pain therapy. Utilisation of healthcare services was documented using the number of visits to GPs, Pain Specialists and/or other healthcare professionals involved in chronic pain management such as physical therapists. Additionally, the amount of time each subject spent with their GP discussing their pain, and the use of prescription analgesics was also documented. The reference cost of NHS services was calculated from published data, and the cost of analgesics from the NHS formulary. The majority of subjects were female (82%), over the age of 35, with a mean pain duration of 8.9 years. The most frequently reported cause of pain was OA (36%), with a number of subjects reporting multiple causes. The device was predominantly used for treatment of back (45%) and knee pain (45%). The mean baseline pain reported by subjects before using the trial device was 7.93 ± 1.4, which is consistent with aforementioned registry studies. After using the device for three months, the mean pain score was 5.07 ± 2.5, or a difference of 36.6% (2.86 points) compared to baseline (p<0.001). Subjects also reported a statistically significant improvement in QoL as measured by Oswestry Disability Index (p<0.001). Over the three-month baseline period (B-3M), 43 subjects regularly visited their GP which amounted to a total of 135 appointments. During the three-month ActiPatch assessment period (A-3M), 28 subjects had an appointment with their GP, resulting in a total of 58 appointments, which represents a 57% decrease. Of the 43 subjects who visited their GP, both total time (61%) and average time (40%) spent talking about pain were reduced in the A-3M period. During the B-3M period, there were 18 appointments with a pain specialist compared to seven appointments during the A-3M period. The total number of appointments with a physical therapist during the B-3M period was 92 which decreased to 39 during the A- 3M period. At B-3M, 41 subjects were on prescribed analgesic medications compared to 32 in the A-3M period. Subjects were using on average of 1.3 different pain medications at B-3M which was reduced to 0.9 per subject at A-3M. Subjects also reported a distinct reduction in their prescription medication use with an average reported reduction of 38%. The 61 subjects enrolled in this study independently purchased 148 devices over the three-month period, at a retail cost of between 20 and 25 per device. The overall cost to the NHS for healthcare services provided to each subject was calculated by multiplying the number of appointments with the costs for each service (table 3). During the A-3M period, utilisation of healthcare services by the subjects was markedly lower than during the B-3M period, which corresponds to a reduction in NHS costs of 7,540. Over the same period, total analgesic prescription costs were reduced by 1,124. This equates to an overall reduction in Northern Treatment Advisory Group, November
10 NHS healthcare costs of 8,664 during the three-month period, or 34,656 per year ( 568 per patient). If the cost of the ActiPatch devices used in this study was borne by the NHS this would amount to 2,065 (148 x 13.95) over the three-month period. If subjects continued to use the device at the same rate, the projected one-year NHS treatment cost for all 61 subjects would be 8,664. After accounting for the cost of the device the overall reduction in NHS healthcare costs would be 6,599 during the three-month period, or 26,396 per year ( 432 per patient). Table 3. Total NHS healthcare cost comparison between the baseline and ActiPatch threemonth assessment periods in 61 patients - (Self-funded vs. NHS funded). Service/ Resource Use B-3M Cost ( ) Reference cost of appointment: GP 45, Pain Specialist 125, and Physical Therapy 45. *Inclusive of total device cost to NHS for one year of 8,258 A-3M Cost ( ) Cost Difference ( ) GP 6,075 2,610-3,465 Pain Specialist 2, ,375 Physical Therapy 4,140 1,440-2,700 Analgesics 3,189 2,065-1,124 Self-funded device TOTAL (3 month) 15,654 6,990-8,664 TOTAL (1 year) 62,616 27,960-34,656 NHS-funded device Actipatch Device 0 2, ,065 TOTAL (3 month) 15,654 9,055-6,599 TOTAL (1 year) 62,616 36,220-26,396* Points to consider The overall clinical benefit of ActiPatch is difficult to estimate based on the available evidence. There is only one RCT (n=60) that supports the use of ActiPatch. However there are a number of limitations to this study, including the study size and the length of the study. There are no RCTs comparing the efficacy of ActiPatch in comparison to other non-pharmacological interventions for chronic pain. The results from the registry studies and healthcare utilisation studies should be interpreted with caution due to the nature of the study designs. The long term safety and efficacy of the ActiPatch is unknown. NICE will published guidelines regarding non-pharmacological interventions in chronic pain conditions in It is not yet known if the ActiPatch will be included in this guidance. Patients are able to buy the ActiPatch themselves online or via some pharmacies for a cost of between The cost of the ActiPatch in the drug tariff is Northern Treatment Advisory Group, November
11 Author s declaration. The lead author has no relevant interests to declare. References 1. Steingrimsdottir OA et al. Defining chronic pain in epidemiological studies: a systematic review and meta-analysis. Pain 2017;158: Fayaz A et al. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open 2016;6:e Scottish Intercollegiate Guidelines Network SIGN 136 Management of Chronic Pain. december National Institute for Health and Care Excellence. Key therapeutic topic: Medicines optimisation in long-term pain (KTT21). Last updated February British Medical Association. Chronic pain: supporting safer prescribing of analgesics. March Chang KL et al. Chronic pain management: nonpharmacological therapies for chronic pain. FP Essent 2015;432: BioElectronics Corporation. ActiPatch. Accessed 11/06/ National Institute for Health and Care Excellence. Guideline scope. Chronic pain: assessment and management. Accessed 15/06/ National Institute for Health and Care Excellence. Guideline [NG59] - Low back pain and sciatica in over 16s: assessment and management. November National Institute for Health and Care Excellence. Guideline [CG177] - Osteoarthritis: care and management. February Bagnato GL et al. Pulsed electromagnetic fields in knee osteoarthritis: a double blind, placebocontrolled, randomized clinical trial. Rheumatology (Oxford) 2016;55: Rawe IM et al. A UK registry study of the effectiveness of a new over-the-counter chronic pain therapy. Pain Manag 2015;5: Staelin R et al. An over-the-counter central sensitization therapy: a chronic back pain registry study of pain relief, medication use and their adverse effects. Pain Manag 2017;7: Royal College of General Practitioners. Chronic Pain. Accessed 18/06/ BioElectronics Corporation. ActiPatch. Healthcare Utilization Study Northern Treatment Advisory Group, November
6 Months Observational Study
6 Months Observational Study The purpose of this study is to determine the long term (six month) effectiveness of the ActiPatch device for chronic pain. Methods Study Subjects The subjects in this study
More informationGuideline scope Persistent pain: assessment and management
National Institute for Health and Clinical Excellence [document type for example, IFP, QRG] on [topic] Document cover sheet Date Version number Editor 30/08/2017 1 NGC Action 1 2 3 4 5 6 7 8 9 10 11 12
More informationChronic Pain Therapy Pain & Trauma Category Award Winner
Chronic Pain Therapy Pain & Trauma Category Award Winner BioElectronics Corporation ActiPatch Pharmacist Training 11-20-15 Education Kenneth McLeod, Ph.D. PhD in Electrical Engineering, MIT, 1985 Post-Doctoral
More informationEffectiveness of True Acupuncture as an Adjunct to Standard Care or Electro-Physiotherapy in Osteoarthritis of the Knee
Cronicon OPEN ACCESS ORTHOPAEDICS Research article Effectiveness of True Acupuncture as an Adjunct to Standard Care or Electro-Physiotherapy in Osteoarthritis of Dimitar Tonev 1 *, Stoyka Radeva 2 and
More informationA UK registry study of the effectiveness of a new over-the-counter chronic pain therapy
For reprint orders, please contact: reprints@futuremedicine.com A UK registry study of the effectiveness of a new over-the-counter chronic pain therapy Ian M Rawe*,1 & Deepak C Kotak**,1 Practice points
More informationCosting tool: Osteoarthritis Implementing the NICE guideline on osteoarthritis (CG177)
Putting NICE guidance into practice Costing tool: Osteoarthritis Implementing the NICE guideline on osteoarthritis (CG177) Published: February 2014 This costing report accompanies the clinical guideline
More informationCanadian Chiropractic Guideline Initiative (CCGI) Guideline Summary
Canadian Chiropractic Guideline Initiative (CCGI) Guideline Summary Title of guideline Osteoarthritis: care and management Clinical guideline Author of guideline National Institute for Health and Care
More informationEvidence-based Clinical Practice Guidelines on Management of Pain in Older People Aza Abdulla, Margaret Bone, Nicola Adams, Alison M.
Evidence-based Clinical Practice Guidelines on Management of Pain in Older People Aza Abdulla, Margaret Bone, Nicola Adams, Alison M. Elliott, Derek Jones, Roger Knaggs, Denis Martin, Elizabeth L. Sampson,
More informationMedical technologies guidance Published: 23 January 2019 nice.org.uk/guidance/mtg41
Senza spinal cord stimulation system for delivering ering HF10 therapy to treat chronic neuropathic pain Medical technologies guidance Published: 23 January 2019 nice.org.uk/guidance/mtg41 NICE 2019. All
More informationThe NICE revised guidelines for the management of non-specific low back pain and; Implications for Practice
The NICE revised guidelines for the management of non-specific low back pain and; Implications for Practice David Walsh David.walsh@nottingham.ac.uk National Clinical Guideline Centre Commissioned by NICE
More information7 th November % of patients had lidocaine plasters prescribed for the licensed indication of post herpatic neuralgia
Directorate of Integrated Care Health and Social Care Board 12-22 Linenhall Street Belfast BT2 8BS Tel : 028 90553782 Fax : 028 90553622 Web Site: www.hscboard.hscni.net 7 th November 2013 Dear colleague
More informationLow back pain and sciatica in over 16s NICE quality standard
March 2017 Low back pain and sciatica in over 16s NICE quality standard Draft for consultation This quality standard covers the assessment and management of non-specific low back pain and sciatica in young
More informationmain/1103_new 01/11/06
Search date May 2006 Allan Binder QUESTIONS What are the effects of treatments for people with uncomplicated neck pain without severe neurological deficit?...3 What are the effects of treatments for acute
More informationPrevention Diagnosis Assessment Prescription and /or application of wide range of interventions and PRM program management
OA PATHOLOGY Characterized by progressive deterioration and ultimate loss of articular cartilage Reactive changes of joint margins and joint thickening of the capsule When OA symptomatic leads to: Pain
More informationCoverage Guideline. BioniCare System (formerly the BIO-1000 System) DEFINITION COVERAGE CRITERIA MEDICAL BACKGROUND
Coverage Guideline System (formerly the BIO-1000 System) Disclaimer: Please note that Baptist Health Plan updates Coverage Guidelines throughout the year. A printed version may not be most up to date version
More informationActiPatch. Healthcare Utilization Costs Study
ActiPatch Healthcare Utilization Costs Study 1 Contents Executive Summary... 3 Methods... 4 Results... 5 Cost Analysis... 5 Economic Cost Analysis... 14 Statistical Analysis of Direct Healthcare Costs...
More informationCOMPOUNDING PHARMACY SOLUTIONS PRESCRIPTION COMPOUNDING FOR PAIN MANAGEMENT
JANUARY 2012 COMPOUNDING PHARMACY SOLUTIONS PRESCRIPTION COMPOUNDING WWW.CPSRXS. COM We customize individual prescriptions for the specific needs of our patients. INSIDE THIS ISSUE: Osteoarthritis Pain
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of platelet-rich plasma injections for knee osteoarthritis Osteoarthritis can develop
More informationPlacename CCG. Policies for the Commissioning of Healthcare. Policy for Managing Back Pain- Spinal Injections
Placename CCG Policies for the Commissioning of Healthcare Policy for Managing Back Pain- Spinal Injections 1 Introduction 1.1 This document is part of a suite of policies that the CCG uses to drive its
More informationSuffolk PCT Drug & Therapeutics Committee New Medicine Report (Adopted by the CCG until review and further notice)
Suffolk PCT Drug & Therapeutics Committee New Medicine Report (Adopted by the CCG until review and further notice) This drug has been reviewed because it is a product that may be prescribed in primary
More informationBerkshire West Area Prescribing Committee Guidance
Guideline Name Berkshire West Area Prescribing Committee Guidance Date of Issue: September 2015 Review Date: September 2017 Date taken to APC: 2 nd September 2015 Date Ratified by GP MOC: Guidelines for
More informationPRESCRIBING SUPPORT TEAM AUDIT: Etoricoxib hypertension safety evaluation
PRESCRIBING SUPPORT TEAM AUDIT: Etoricoxib hypertension safety evaluation DATE OF AUTHORISATION: AUTHORISING GP: PRESCRIBING SUPPORT TECHNICIAN: SUMMARY This audit has been designed to ensure that patients
More informationCommissioning Policy. The use of Acupuncture in the Management of Musculoskeletal Pain. July 2013
Commissioning Policy The use of Acupuncture in the Management of Musculoskeletal Pain July 2013 This commissioning policy applies to patients within: South Worcestershire Clinical Commissioning Group (CCG)
More informationCosting report: Lipid modification Implementing the NICE guideline on lipid modification (CG181)
Putting NICE guidance into practice Costing report: Lipid modification Implementing the NICE guideline on lipid modification (CG181) Published: July 2014 This costing report accompanies Lipid modification:
More informationCommissioning Policy Individual Funding Request
Commissioning Policy Individual Funding Request Management of Low Back Pain and Sciatica in over 16s Policy Criteria Based Access Policy Date Adopted: August 2017 Version: 1718.1 Individual Funding Request
More informationLOW BACK PAIN AND SCIATICA INTERVENTIONS POLICY IN OVER 16S CRITERIA BASED ACCESS
LOW BACK PAIN AND SCIATICA INTERVENTIONS POLICY IN OVER 16S CRITERIA BASED ACCESS Version: Recommendation by: 1718.v2b Somerset CCG Clinical Commissioning Policy Forum (CCPF) Date Ratified: 12 July 2017
More informationAnalgesic Subcommittee of PTAC Meeting held 1 March 2016
Analgesic Subcommittee of PTAC Meeting held 1 March 2016 (minutes for web publishing) The Analgesic Subcommittee minutes are published in accordance with the Terms of Reference for the Pharmacology and
More informationPrescribing drugs of dependence in general practice, Part C
HO O Prescribing drugs of dependence in general practice, Part C Key recommendations and practice points for management of pain with opioid therapy H H HO N CH3 Acute pain Acute pain is an unpleasant sensory
More informationSubject: Pain Management (Page 1 of 7)
Subject: Pain Management (Page 1 of 7) Objectives: Managing pain and restoring function are basic goals in helping a patient with chronic non-cancer pain. Federal and state guidelines require that all
More informationREGIONAL PHARMACY SPECIALIST SMOKING CESSATION SERVICE FEBRUARY A Pharmacist s Guide
REGIONAL PHARMACY SPECIALIST SMOKING CESSATION SERVICE FEBRUARY 2009 A Pharmacist s Guide Aims of the Service The overall aim of the service is to deliver a pharmacy based, one stop specialist smoking
More informationEffective Date: 01/01/2012 Revision Date: Code(s): Application of surface (transcutaneous) neurostimulator
ARBenefits Approval: 10/19/2011 Effective Date: 01/01/2012 Revision Date: Code(s): 64550 Application of surface (transcutaneous) neurostimulator Medical Policy Title: Electrical Stimulation, Transcutaneous
More informationW37 Total prosthetic replacement of hip joint using cement. W38 Total replacement of hip joint not using cement
Bedfordshire and Hertfordshire Priorities Forum statement Number: 32 Subject: Referral criteria for patients from primary care presenting with hip pain due to ostoarthritis, and clinical thresholds for
More informationMedical technologies guidance Published: 2 October 2018 nice.org.uk/guidance/mtg39
ifuse for treating chronic sacroiliac joint pain Medical technologies guidance Published: 2 October 2018 nice.org.uk/guidance/mtg39 NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationChronic Low Back Pain Seminar Patient Engagement. NHS North West London CCGs 6 th February 2017
Chronic Low Back Pain Seminar Patient Engagement NHS North West London CCGs 6 th February 2017 Aims and Objectives Welcome and introductions Why are we here? To hear patient views as CCGs plan to adopt
More informationProsthetic intervertebral disc replacement in the cervical spine: Cost-effectiveness compared with cervical discectomy with or without vertebral
Prosthetic intervertebral disc replacement in the cervical spine: Cost-effectiveness compared with cervical discectomy with or without vertebral fusion Author: William Horsley NHS North East Treatment
More informationCommunity alcohol detoxification in primary care
Community alcohol detoxification in primary care 1. Purpose The purpose of this primary care enhanced service is to improve the health and quality of life of people whose health may be compromised by their
More informationSwitching Tramacet to paracetamol alone or paracetamol and codeine
Bulletin 62 February 2014 Community Interest Company Switching Tramacet to paracetamol alone or paracetamol and codeine This is one of a number of bulletins providing further information on medicines contained
More informationScottish Medicines Consortium
Scottish Medicines Consortium duloxetine 30mg and 60mg capsules (Cymbalta ) No. (285/06) Eli Lilly and Company Limited/Boehringer Ingelheim 4 August 2006 The Scottish Medicines Consortium has completed
More informationPRIMARY CARE BRIEFING GLUSARTEL (GLUCOSAMINE SULPHATE)
Summary This Primary Care Briefing informs healthcare professionals of a new preparation of glucosamine sulphate, Glusartel, licensed for the relief of symptoms in mild to moderate osteoarthritis of the
More informationLiterature Scan: Topical Analgesics
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationDOWNLOAD OR READ : PAIN RELIEF IN LABOUR PDF EBOOK EPUB MOBI
DOWNLOAD OR READ : PAIN RELIEF IN LABOUR PDF EBOOK EPUB MOBI Page 1 Page 2 pain relief in labour pain relief in labour pdf pain relief in labour 1 of 8 Coping methods and options for pain relief in labour
More informationNICE guidelines development Low back pain and sciatica: Management of non-specific low back pain and sciatica
NICE guidelines development Low back pain and sciatica: Management of non-specific low back pain and sciatica Steven Vogel Vice Principal (Research), The British School of Osteopathy Editor-in-Chief, The
More informationArthroscopic knee washout, with or without debridement, for the treatment of osteoarthritis
Arthroscopic knee washout, with or without debridement, for the treatment of osteoarthritis Issued: August 2007 www.nice.org.uk/ipg230 Copyright NICE 2007 Contents 1 Guidance... 3 2 The procedure... 4
More informationSurveillance report Published: 8 June 2017 nice.org.uk. NICE All rights reserved.
Surveillance report 2017 Antenatal and postnatal mental health: clinical management and service guidance (2014) NICE guideline CG192 Surveillance report Published: 8 June 2017 nice.org.uk NICE 2017. All
More informationType of intervention Treatment. Economic study type Cost-effectiveness analysis.
Costs and effectiveness of pre- and post-operative home physiotherapy for total knee replacement: randomized controlled trial Mitchell C, Walker J, Walters S, Morgan A B, Binns T, Mathers N Record Status
More informationPeripheral Subcutaneous Field Stimulation. Description
Subject: Peripheral Subcutaneous Field Stimulation Page: 1 of 6 Last Review Status/Date: June 2016 Peripheral Subcutaneous Field Stimulation Description Peripheral subcutaneous field stimulation (PSFS,
More informationA. Service Specification
A. Service Specification Service Specification No: 1767 Service Adult Highly Specialist Pain Management Services Commissioner Lead For local completion Lead For local completion 1. Scope 1.1 Prescribed
More informationCosting Report: atrial fibrillation Implementing the NICE guideline on atrial fibrillation (CG180)
Putting NICE guidance into practice Costing Report: atrial fibrillation Implementing the NICE guideline on atrial fibrillation (CG180) Published: June 2014 This costing report accompanies the clinical
More informationIs Tanezumab More Effective than a Placebo in Reducing Pain in Patients with Osteoarthritis?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2018 Is Tanezumab More Effective than a Placebo
More informationGateshead Pain Guidelines for Chronic Conditions
Gateshead Pain Guidelines for Chronic Conditions Effective Date: 13.2.2013 Review Date: 13.2.2015 Gateshead Pain Guidelines: Contents PAIN GUIDELINES Chronic Non-Malignant Pain 5 Musculoskeletal Pain 6
More informationOsteoporosis: fragility fracture risk. Costing report. Implementing NICE guidance
Osteoporosis: fragility fracture risk Costing report Implementing NICE guidance August 2012 NICE clinical guideline 146 1 of 15 This costing report accompanies the clinical guideline: Osteoporosis: assessing
More information1. Effectiveness, Volume of Evidence, Applicability / Generalisability and Consistency / Clinical impact
Meeting Date: 21 June 2017 Topic: The effectiveness of injection of steroid into the hip as a form of interventional pain management Purpose This purchasing guidance (considered judgement) document accompanies
More informationPeripheral Subcutaneous Field Stimulation
Peripheral Subcutaneous Field Stimulation Policy Number: 7.01.139 Last Review: 3/2018 Origination: 7/2013 Next Review: 9/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will not provide
More informationTechnology appraisal guidance Published: 28 November 2018 nice.org.uk/guidance/ta547
Tofacitinib for moderately to severelyerely active ulcerative colitis Technology appraisal guidance Published: 28 November 2018 nice.org.uk/guidance/ta547 NICE 2019. All rights reserved. Subject to Notice
More informationdiclofenac, 75mg/2ml of solution for intravenous injection (Dyloject ) No. (446/08) Javelin Pharmaceuticals UK Ltd
Scottish Medicines Consortium diclofenac, 75mg/2ml of solution for intravenous injection (Dyloject ) No. (446/08) Javelin Pharmaceuticals UK Ltd 11 February 2008 The Scottish Medicines Consortium has completed
More informationSIMPLE Targets of OA Therapy
SIMPLE Targets of OA Therapy Helping your patient with their osteoarthritis symptoms is SIMPLE. Remember these steps to prevent and treat osteoarthritis. Symptom management (e.g. reduce pain and stiffness)
More informationNICE guideline Published: 30 November 2016 nice.org.uk/guidance/ng59
Low back pain and sciatica in over 16s: assessment and management NICE guideline Published: 30 November 2016 nice.org.uk/guidance/ng59 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationGuidelines for the Management of Chronic Non-Malignant Pain (CNMP) in Primary Care (not including neuropathic pain (NeP).
Surrey (East Surrey CCG, Guildford & Waverley CCG, North West Surrey CCG, Surrey Downs CCG & Surrey Heath CCG) North East Hampshire & Farnham CCG and Crawley, Horsham & Mid-Sussex CCG Guidelines for the
More informationMEDICAL POLICY. 1 Proprietary Information of YourCare Health Plan
MEDICAL POLICY INTERFERENTIAL STIMULATORS Clinical criteria used to make utilization review decisions are based on credible scientific evidence published in peer reviewed medical literature generally recognized
More informationtens_(transcutaneous_electrical_nerve_stimulator) 7/ / / /2014 This policy is NOT effective until January 13, 2015
Corporate Medical Policy TENS (Transcutaneous Electrical Nerve Stimulator) File Name: Origination: Last CAP Review: Next CAP Review: Last Review: tens_(transcutaneous_electrical_nerve_stimulator) 7/1982
More informationIs Phlogenzym Effective in Reducing Moderate to Severe Osteoarthritis Pain in Adults?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2013 Is Phlogenzym Effective in Reducing Moderate
More informationIs Ginger Effective in Reducing Knee Pain in Adults With Osteoarthritis?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2015 Is Ginger Effective in Reducing Knee
More informationClinical guideline Published: 12 February 2014 nice.org.uk/guidance/cg177
Osteoarthritis: care and management Clinical guideline Published: 12 February 2014 nice.org.uk/guidance/cg177 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationCorporate Medical Policy
Corporate Medical Policy TENS (Transcutaneous Electrical Nerve Stimulator) File Name: Origination: Last CAP Review: Next CAP Review: Last Review: tens_(transcutaneous_electrical_nerve_stimulator) 7/1982
More informationThe prevalence and history of knee osteoarthritis in general practice: a case control study
The Author (2005). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org doi:10.1093/fampra/cmh700 Family Practice Advance Access
More informationTechnology appraisal guidance Published: 26 November 2014 nice.org.uk/guidance/ta325
Nalmefene for reducing alcohol consumption in people with alcohol dependence Technology appraisal guidance Published: 26 November 2014 nice.org.uk/guidance/ta325 NICE 2018. All rights reserved. Subject
More informationNHS West Cheshire Clinical Commissioning Group does not fund the prescribing for dental conditions on FP10.
PRESCRIBING COMMISSIONING POLICY: DENTAL CONDITIONS NHS West Cheshire Clinical Commissioning Group does not fund the prescribing for dental conditions on FP10. Note: Patients who are not eligible for treatment
More informationpat hways Key therapeutic topic Published: 26 February 2016 nice.org.uk/guidance/ktt16
pat hways Anticoagulants, including non-vitamin K antagonist oral anticoagulants (NOACs) Key therapeutic topic Published: 26 February 2016 nice.org.uk/guidance/ktt16 Options for local implementation NICE
More informationThey are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:
bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest
More informationPersistent pain: scope workshop discussions Date: 04/10/2017. How do we distinguish non-specific pain from discrete pain conditions?
Persistent pain: scope workshop discussions Date: 04/10/2017 Opening question: How do we distinguish non-specific pain from discrete pain conditions? What would the definition of nonspecific pain be? For
More informationPeripheral Subcutaneous Field Stimulation
Peripheral Subcutaneous Field Stimulation Policy Number: 7.01.139 Last Review: 9/2014 Origination: 7/2013 Next Review: 1/2015 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will not provide
More informationEffective Health Care Program
Comparative Effectiveness Review Number 77 Effective Health Care Program Physical Therapy Interventions for Knee Pain Secondary to Osteoarthritis Executive Summary Background Osteoarthritis (OA), the most
More informationExclude referred pain from the neck, diaphragm, heart, lungs, & polymyalgia rheumatica YES. NSAIDs/analgesics as required
Shoulder Pain Clinical Presentation info for GPs who refer into PAH more info History and Examination Exclude referred pain from the neck, diaphragm, heart, lungs, & polymyalgia rheumatica more info for
More informationQ&A: Opioid Prescribing for Chronic Non-Malignant Pain
NHS Hastings and Rother Clinical Commissioning Group Chair Dr David Warden Chief Officer Amanda Philpott NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group Chair Dr Martin Writer Chief Officer
More informationOpioid Prescribing for Acute Pain. Care for People 15 Years of Age and Older
Opioid Prescribing for Acute Pain Care for People 15 Years of Age and Older Summary This quality standard provides guidance on the appropriate prescribing, monitoring, and tapering of opioids to treat
More informationMUSCULOSKELETAL CONDITIONS
1. Medical Condition MUSCULOSKELETAL CONDITIONS Musculoskeletal conditions including those arising from injuries are common in sport. In this setting of sport, we traditionally classify injury according
More informationFlash Glucose Monitoring (Flash GM) Frequently asked questions (November 2018)
Flash Glucose Monitoring (Flash GM) Frequently asked questions (November 2018) What is Flash Glucose Monitoring (Flash GM)? Flash glucose monitoring is a small sensor that you wear on your skin (usually
More informationNational Horizon Scanning Centre. Pregabalin (Lyrica) for fibromyalgia. September 2007
Pregabalin (Lyrica) for fibromyalgia September 2007 This technology summary is based on information available at the time of research and a limited literature search. It is not intended to be a definitive
More informationPeripheral Subcutaneous Field Stimulation
Peripheral Subcutaneous Field Stimulation Policy Number: 7.01.139 Last Review: 9/2018 Origination: 7/2013 Next Review: 3/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will not provide
More informationCertolizumab pegol (Cimzia) for psoriatic arthritis second line
Certolizumab pegol (Cimzia) for psoriatic arthritis second line This technology summary is based on information available at the time of research and a limited literature search. It is not intended to
More informationTier 2 MSK Clinic GP Message of the Month March Osteoarthritis in Adults.
Tier 2 MSK Clinic GP Message of the Month March 2014 Osteoarthritis in Adults. This month s MoM provides a brief review of the revised guidance for the care and management of osteoarthritis (OA) in adults
More informationPatient Outcomes in Pain Management
Patient Outcomes in Pain Management Specialist pain services aggregated data Report for period ending 3 June 214 About the electronic Persistent Pain Outcomes Collaboration (eppoc) eppoc is a new program
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE QUALITY AND OUTCOMES FRAMEWORK (QOF) INDICATOR DEVELOPMENT PROGRAMME Briefing paper QOF indicator area: Diabetes dietary review Potential output: Recommendations
More informationThe Royal College of. Chiropractors. Chiropractic Quality Standard. Chronic Pain
The Royal College of Chiropractors Chiropractic Quality Standard Chronic Pain About the Royal College of Chiropractor s Quality Standards Quality Standards are tools designed to help deliver the best possible
More informationPreScribing- another tool in the Amputee Rehabilitation Physiotherapist s toolbox?
PreScribing- another tool in the Amputee Rehabilitation Physiotherapist s toolbox? Louise Tisdale Clinical Specialist Physiotherapist Amputee Rehabilitation Royal Wolverhampton NHS Trust November 2015
More informationKnee Replacement Surgery Criteria Based Access Protocol Supporting people in Dorset to lead healthier lives
NHS Dorset Clinical Commissioning Group Knee Replacement Surgery Criteria Based Access Protocol Supporting people in Dorset to lead healthier lives NHS DORSET CLINICAL COMMISSIONING GROUP KNEE REPLACEMENT
More informationGetting Evidence into Clinical Practice: Musculoskeletal Research Facilitation Group (CAT Group) Date: June 2017
Specific Question: In adults with chronic shoulder pain is a nerve ablation procedure (for the suprascapular nerve) as effective in reducing pain, in the long term compared with usual care? Clinical bottom
More informationACUPUNCTURE AND OSTEOARTHRITIS
ACUPUNCTURE AND OSTEOARTHRITIS About osteoarthritis Osteoarthritis involves damage to articular cartilage and other structures in and around joints, with variable levels of inflammation.(hunter 2006) The
More informationAbout BNM.
About BNM The BNM was created with a focus on manufacturing and developing high-quality health care and medical products that embody the company's attitude in the area of health promotion and disease prevention.
More informationTechnology appraisal guidance Published: 28 March 2018 nice.org.uk/guidance/ta516
Cabozantinib for treating medullary thyroid cancer Technology appraisal guidance Published: 28 March 2018 nice.org.uk/guidance/ta516 NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationT.E.N.S (Transcutaneous Electrical Nerve Stimulation)
You have been prescribed a T.E.N.S machine to help in the management of your pain. You should use it only for the condition for which it is prescribed. Not all pain will respond to the use of T.E.N.S and
More informationThe Berkshire Independent Hospital Back Pain & Spinal Care. The Berkshire Independent Hospital
The Berkshire Independent Hospital Back Pain & Spinal Care The Berkshire Independent Hospital Are you experiencing back pain or sciatica? More than four out of five of us will suffer from back pain at
More informationGlucosamine May Reduce Pain in Individuals with Knee Osteoarthritis
1 Glucosamine May Reduce Pain in Individuals with Knee Osteoarthritis Prepared by: Jacqueline Pierce, MSc (PT) candidate, Queen's University Date: April 2005 (planned review date April 2007) Clinical Scenario:
More informationPhysiotherapy information for Achilles Tendinopathy
Physiotherapy information for Achilles Tendinopathy What is Achilles Tendinopathy? Achilles Tendinopathy is a condition that can cause pain, swelling and weakness of the Achilles Tendon. This joins your
More informationTechnology appraisal guidance Published: 4 June 2015 nice.org.uk/guidance/ta340
Ustekinumab for treating active psoriatic arthritis Technology appraisal guidance Published: 4 June 2015 nice.org.uk/guidance/ta340 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationCost-effectiveness of brief intervention and referral for smoking cessation
Cost-effectiveness of brief intervention and referral for smoking cessation Revised Draft 20 th January 2006. Steve Parrott Christine Godfrey Paul Kind Centre for Health Economics on behalf of PHRC 1 Contents
More informationGUIDELINES AND AUDIT IMPLEMENTATION NETWORK
GUIDELINES AND AUDIT IMPLEMENTATION NETWORK General Palliative Care Guidelines The Management of Pain at the End Of Life November 2010 Aim To provide a user friendly, evidence based guide for the management
More informationSmoking cessation interventions and services
National Institute for Health and Care Excellence Guideline version (Final) Smoking cessation interventions and services [E] Evidence reviews for advice NICE guideline NG92 Evidence reviews FINAL These
More informationTechnology appraisal guidance Published: 22 October 2008 nice.org.uk/guidance/ta159
Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin Technology appraisal guidance Published: 22 October 2008 nice.org.uk/guidance/ta159 NICE 2018. All rights reserved. Subject to
More informationIn the Treatment of Patients With Knee Joint Osteoarthritis, Are Platelet Rich Plasma Injections More Effective Than Hyaluronic Acid Injections?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2015 In the Treatment of Patients With Knee
More information