pain management

Importance Shoulder pain is a common and disabling condition most often managed in primary care. This review provides an evidence-based update on the diagnosis and management of shoulder pain to support clinical decision-making and improve patient outcomes.

Observations Shoulder pain arises from benign, self-limiting soft-tissue disorders or rare but serious causes. In primary care, most cases are nontraumatic and involve periarticular soft tissues. The subacromial region is the most frequent source of pain, and the term subacromial pain is preferred over overlapping and inconsistently defined labels such as rotator cuff tendinopathy or tear, impingement syndrome, or subacromial bursitis. Less commonly, pain originates from the glenohumeral joint, as in glenohumeral osteoarthritis or adhesive capsulitis. Assessment should focus on a detailed history and physical examination to assess pain patterns and movement limitation and to exclude serious causes, such as infection, malignant neoplasm, or nonshoulder referred pain. Once these are excluded, first-line treatment is similar for most patients and aligns with recommended care for other regional musculoskeletal concerns: education about the favorable natural history, symptom relief and activity modification if needed, and watchful waiting. Early imaging is not indicated in the absence of significant trauma or suspicious features, such as fever, unexplained weight loss, or history of malignant neoplasm, as structural abnormalities often do not correlate with symptoms, rarely alter management, and may lead to overdiagnosis and overtreatment. Specialist referral should be reserved for suspected serious pathology, such as infection, malignant neoplasm, fracture, or dislocation; significant functional or neurologic deficit; features suggestive of systemic inflammatory disease; or persistent or worsening pain and debility. High-certainty evidence indicates that subacromial pain does not benefit from surgical intervention.

Conclusions and Relevance Shoulder pain is the third most common musculoskeletal presentation in primary care. Although causes vary, the initial management is largely the same once serious conditions have been excluded. Most patients with subacromial pain will fully recover with minimal intervention and can be safely treated with supportive care. Imaging and referral to surgical subspecialists should be reserved for rare and carefully selected cases to avoid unnecessary intervention.

Author/s:

Romi Haas, Thomas Ibounig, MD, Buchbinder, Rachelle

Management of Shoulder Pain in Primary Care

Mary Cervantes — Wed, 19 Aug 2026 17:36:50 +0000

Date Added:

August 19, 2026

Journal/Publication:

JAMA Internal Medicine

Publisher:

JAMA, JAMA Network, JN Learning, AMA Ed Hub

Publication Date:

August 17, 2026

URL:

Management of Shoulder Pain in Primary Care

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Video

Keywords

MeSH

Physical Therapy Modalities

primary health care

A 15-minute audio-review of the management of shoulder pain in primary care. James W. Mold, MD, MPH

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From the JAMA Network, this is JAMA Internal Medicine Author Interviews. Conversations with authors exploring the latest clinical research, reviews, and opinions featured in JAMA Internal Medicine.

Author/s:

Romi Haas, MPH, PhD, Michael A. Incze, Eve Rittenberg, MD

Online Unsupervised Tai Chi Intervention for Knee Pain and Function in People With Knee Osteoarthritis: The RETREAT Randomized Clinical Trial

Megan George — Tue, 06 Jan 2026 14:16:13 +0000

Date Added:

January 6, 2026

Journal/Publication:

JAMA Internal Medicine

Publication Date:

October 27, 2025

URL:

Online Unsupervised Tai Chi Intervention for Knee Pain and Function in People With Knee Osteoarthritis: The RETREAT Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamainternmed.2025.5723

Keywords

PMID (1):

41143827

MeSH

aged

Arthralgia* / etiology

Arthralgia* / therapy

Knee* / physiopathology

Middle Aged

Knee* / therapy

Pain Management* / methods

Tai Ji* / methods

A free online Tai Chi app improved comfort and function in patients with OA of the knees. James W. Mold, MD, MPH

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Importance Tai chi is a type of exercise recommended for knee osteoarthritis, but access to in-person tai chi can be limited.

Objective To evaluate the effects of an unsupervised multimodal online tai chi intervention on knee pain and function for people with knee osteoarthritis.

Design, Setting, and Participants The RETREAT study was a 2-group superiority randomized clinical trial enrolling participants who met clinical criteria for knee osteoarthritis in Australian communities from August 2023 and November 2024.

Interventions Participants in the control group received access to a purpose-built website containing information about osteoarthritis and exercise benefits. Participants in the intervention group received the My Joint Tai Chi intervention comprising access to the same website plus tai chi information, a 12-week unsupervised video-based Yang-style tai chi program, and encouragement to use an app to facilitate program adherence.

Main Outcomes and Measures Changes in knee pain during walking (Numeric Rating Scale; range 0-10 with higher scores indicating greater pain) and difficulty with physical function (Western Ontario and McMaster Universities Osteoarthritis Index; range 0-68 with higher scores indicating greater dysfunction) during 12 weeks. Secondary outcomes included another knee pain measure, sport and recreation function, quality of life, physical and mental well-being, fear of movement, self-efficacy, balance confidence, positive activated affect, sleep quality, global improvement, and oral medication use.

Results Of 2106 patients screened, 178 met inclusion criteria and were randomized, 89 (mean [SD] age, 61.0 [8.7] years; 66 female [74%] and 23 [26%] male participants) to the control group and 89 (mean [SD] age, 62.1 [7.3] years; 59 [66%] female and 30 male [34%] participants) to the tai chi intervention. Of the total, 170 (96%) completed both of the primary outcomes at 12 weeks. The tai chi group reported greater improvements in knee pain (control, −1.3; tai chi, −2.7; mean difference, −1.4 [95% CI, −2.1 to −0.7] units; P < .001) and function (control, −6.9; tai chi, −12.0; mean difference, −5.6 [95% CI, −9.0 to −2.3] units; P < .001) compared to the control group. More participants in the tai chi than in the control group achieved a minimal clinically important difference in pain (73% vs 47%; risk difference, 0.3; 95% CI, 0.1 to 0.4; P < .001) and function (72% vs 52%; risk difference, 0.2; 95% CI, 0.1 to 0.3; P = .007). Between-group differences for most secondary outcomes favored tai chi, including another knee pain measure, sport and recreation function, quality of life, physical and mental well-being, global improvement, pain self-efficacy, and balance confidence. No associated serious adverse events were reported.

Conclusions and Relevance This randomized clinical trial found that this unsupervised multimodal online tai chi intervention improved knee pain and function compared with the control at 12 weeks. This free-to-access web-based intervention offers an effective, safe, accessible, and scalable option for guideline-recommended osteoarthritis exercise.

Author/s:

Shiyi Julia Zhu, Rana S. Hinman, Rachel K. Nelligan

A Simplified Approach to Evaluate and Manage Shoulder Pain

Erin Blanchette — Mon, 24 Mar 2025 16:18:35 +0000

Date Added:

March 24, 2025

Journal/Publication:

Journal of the American Board of Family Medicine

Publisher:

American Board of Family Medicine

Publication Date:

November 1, 2024

Issue:

Volume:

Pages:

1156-1166

URL:

A Simplified Approach to Evaluate and Manage Shoulder Pain

Type:

Best Local Practices

Format:

Article

DOI (1):

10.3122/jabfm.2024.240114R2

Keywords

PMID (1):

40118541

MeSH

Physical Examination / methods

A simplified algorithmic approach to the evaluation of shoulder pain. James W. Mold, MD, MPH

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With the lifetime prevalence of shoulder pain approaching 70%, accurate diagnosis and management remains essential. The shoulder is a complex joint with a vast range of motion making it susceptible to injury due to limited bony stabilization. This manuscript shares a simplified, novel approach to evaluating and managing atraumatic shoulder pain based on triaging symptoms on presence or loss of range of motion. In patients with loss of active and passive range of motion, the likely etiologies of pain include adhesive capsulitis or glenohumeral joint arthritis depending on imaging. In patients with preserved active and passive range of motion, implementing specific special testing can help pinpoint the diagnosis, and further guide appropriate management. Ultrasound plays an increasingly key role in diagnosing and managing shoulder pathology.

Author/s:

Kartik Sidhar, Hyung Jin Lim, Laurel Gutierrez

Conservative Treatments in the Management of Acute Painful Vertebral Compression Fractures: A Systematic Review and Network Meta-Analysis

Erin Blanchette — Wed, 11 Sep 2024 21:25:57 +0000

Date Added:

September 11, 2024

Journal/Publication:

JAMA Network Open

Publisher:

American Medical Association

Publication Date:

September 3, 2024

Issue:

Volume:

Pages:

e2432041

URL:

Conservative Treatments in the Management of Acute Painful Vertebral Compression Fractures: A Systematic Review and Network Meta-Analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2024.32041

Keywords

Compression Fractures

PMID (1):

39240564

MeSH

Compression Fractures

RPR Commentary: Conservative treatment of patients with acute painful vertebral compression fractures should usually include NSAIDs and teriparatide. James W. Mold, MD, MPH

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Importance: Osteoporotic vertebral compression fractures (VCFs) frequently cause substantial pain and reduced mobility, posing a major health problem. Despite the critical need for effective pain management to restore functionality and improve patient outcomes, the value of various conservative treatments for acute VCF has not been systematically investigated.

Objective: To assess and compare different conservative treatment options in managing acute pain related to VCF.

Data sources: On May 16, 2023, 4 databases-PubMed, Embase, Scopus, and CINAHL-were searched. In addition, a gray literature search within Scopus and Embase was also conducted.

Study selection: Included studies were prospective comparative and randomized clinical trials that assessed conservative treatments for acute VCF.

Data extraction and synthesis: Data extraction and synthesis were performed by 2 authors according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Network Meta-Analyses recommendations. A frequentist graph-theoretical model and a random-effects model were applied for the meta-analysis.

Main outcomes and measures: Primary outcomes were short-term (4 weeks) pain during activity and long-term (latest available follow-up) nonspecified pain in patients with acute VCF.

Results: The study included 20 trials, encompassing 2102 patients, and evaluated various interventions for managing VCF. Calcitonin (standardized mean difference [SMD], -4.86; 95% CI, -6.87 to -2.86) and nonsteroidal anti-inflammatory drugs (NSAIDs; SMD, -3.94; 95% CI, -7.30 to -0.58) were beneficial regarding short-term pain during activity compared with placebo. For long-term nonspecific pain management, bisphosphonates were associated with inferior pain outcomes compared with daily (SMD, 1.21; 95% CI, 0.11 to 2.31) or weekly (SMD, 1.13; 95% CI, 0.05 to 2.21) administration of teriparatide, with no treatment being superior to NSAIDs. The qualitative analysis of adverse events highlighted that typical adverse events associated with these medications were observed.

Conclusions and relevance: NSAIDs and teriparatide may be the preferred treatment options for pain management in acute osteoporotic VCF. Although calcitonin also proved to be beneficial, its safety profile and potential adverse effects restrict its widespread application. The limited evidence on braces and analgesics underscores the urgent need for future research.

Author/s:

Assil-Ramin Alimy, Athanasios D Anastasilakis, John J Carey, Stella D'Oronzo, Anda M Naciu, Julien Paccou, Maria P Yavropoulou, Willem F Lems, Tim Rolvien

I Am Worried I Have Sciatica-What Do I Need to Know?

Erin Blanchette — Tue, 21 Nov 2023 20:35:07 +0000

Date Added:

November 21, 2023

Journal/Publication:

JAMA Internal Medicine

Publisher:

American Medical Association

Publication Date:

November 13, 2023

URL:

I Am Worried I Have Sciatica-What Do I Need to Know?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jamainternmed.2023.5990

Keywords

PMID (1):

37955926

MeSH

Anti-Inflammatory Agents

Hypesthesia

Information for patients about sciatica. James W. Mold, MD, MPH

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This JAMA Internal Medicine Patient Page reviews sciatica, its symptoms, and treatment options for those who have it.

Sciatica is a type of pain that is caused by irritation of the sciatic nerve. This nerve travels from the low back down the legs. Sciatica most commonly happens when a disk in your spine gets damaged or worn out and presses on the sciatic nerve.

Author/s:

Grace Y Zhang, Michael A Incze

Topical Nonprescription Pain Medications for Adults

Erin Blanchette — Tue, 14 Nov 2023 20:48:41 +0000

Date Added:

November 14, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

November 3, 2023

URL:

Topical Nonprescription Pain Medications for Adults

Type:

Patient Education Materials

Format:

Article

DOI (1):

doi:10.1001/jama.2023.13813

Keywords

clinical pharmacy and pharmacology

PMID (1):

37921785

MeSH

Anti-Inflammatory Agents

Anti-Inflammatory Agents, Non-Steroidal

Nonprescription Drugs

Information for patients on three types of nonprescription topical analgesics. James W. Mold, MD, MPH

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This JAMA Patient Page describes the types of topical nonprescription pain medications and tips for using them.

Topical nonprescription pain medications are over-the-counter drugs applied to the skin to treat pain.

Topical pain medications can effectively treat pain caused by several acute and chronic conditions. Because they are applied directly to the skin, topical pain medications are easy to use and less likely to cause side effects or interact with other medications than oral pain medications. Pain relief typically occurs within several days of starting a topical pain medication.

Author/s:

Sarah E. Vordenberg

Management of de Quervain Tenosynovitis: A Systematic Review and Network Meta-Analysis

Erin Blanchette — Mon, 13 Nov 2023 16:38:32 +0000

Date Added:

November 14, 2023

Journal/Publication:

JAMA Network Open

Publisher:

American Medical Association

Publication Date:

October 27, 2023

Issue:

Volume:

URL:

Management of de Quervain Tenosynovitis: A Systematic Review and Network Meta-Analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2023.37001

Keywords

de Quervain tenosynovitis

corticosteroid injection

CSI

ultrasonography

tendonitis

PMID (1):

37889490

MeSH

Tenosynovitis* / therapy

pain

bias

Network Meta-Analysis

Tenosynovitis

Visual Analog Scale

Results of a systematic review and meta-analysis of interventions for treatment of DeQuervain tendonitis. Yet another reason to become proficient at ultrasonography. James W. Mold, MD, MPH

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Importance: There is a plethora of treatment options for patients with de Quervain tenosynovitis (DQT), but there are limited data on their effectiveness and no definitive management guidelines.

Objective: To assess and compare the effectiveness associated with available treatment options for DQT to guide musculoskeletal practitioners and inform guidelines.

Data sources: Medline, Embase, PubMed, Cochrane Central, Scopus, OpenGrey.eu, and WorldCat.org were searched for published studies, and the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, The European Union Clinical Trials Register, and the ISRCTN registry were searched for unpublished and ongoing studies from inception to August 2022.

Study selection: All randomized clinical trials assessing the effectiveness of any intervention for the management of DQT.

Data extraction and synthesis: This study was prospectively registered on PROSPERO and conducted and reported per Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions (PRISMA-NMA) and PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science (PERSIST) guidance. The Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluations tool were used for risk of bias and certainty of evidence assessment for each outcome.

Main outcomes and measures: Pairwise and network meta-analyses were performed for patient-reported pain using a visual analogue scale (VAS) and for function using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale. Mean differences (MD) with their 95% CIs were calculated for the pairwise meta-analyses.

Results: A total of 30 studies with 1663 patients (mean [SD] age, 46 [7] years; 80% female) were included, of which 19 studies were included in quantitative analyses. From the pairwise meta-analyses, based on evidence of moderate certainty, adding thumb spica immobilization for 3 to 4 weeks to a corticosteroid injection (CSI) was associated with statistically but not clinically significant functional benefits in the short-term (MD, 10.5 [95% CI, 6.8-14.1] points) and mid-term (MD, 9.4 [95% CI, 7.0-11.9] points). In the network meta-analysis, interventions that included ultrasonography-guided CSI ranked at the top for pain. CSI with thumb spica immobilization had the highest probability of being the most effective intervention for short- and mid-term function.

Conclusions and relevance: This network meta-analysis found that adding a short period of thumb spica immobilization to CSI was associated with statistically but not clinically significant short- and mid-term benefits. These findings suggest that administration of CSI followed by 3 to 4 weeks immobilization should be considered as a first-line treatment for patients with DQT.

Author/s:

Dimitris Challoumas, Rohan Ramasubbu, Elliot Rooney, Emily Seymour-Jackson, Amit Putti, Neal L. Millar

Diagnosis and acute management of migraine

Aubrey Delammermore — Wed, 08 Feb 2023 06:00:00 +0000

Date Added:

February 8, 2023

Journal/Publication:

CMAJ

Publisher:

CMA Impact Inc

Publication Date:

January 30, 2023

Issue:

Volume:

195

Pages:

E153-E158

URL:

Diagnosis and acute management of migraine

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.211969

Keywords

PMID (1):

36717129

MeSH

Humans

Migaine Disorders* / diagnosis

Migraine disorders* / therapy

Migraine Disorders

Cardiovascular Disease

A concise review of the presumed cause and treatment of migraine headaches. James W. Mold, MD, MPH

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Migraine is a leading cause of disability across all age groups.
• Routine imaging is not recommended in patients with migraine
who have no red flags, atypical symptoms or abnormal findings
on neurologic examination.
• A stratified approach for acute migraine treatment empowers
patients to choose from different treatment options
depending on attack symptoms and severity and encourages
patients to combine medications from different classes.
• Effective acute migraine treatment includes acetaminophen,
nonsteroidal anti-inflammatory drugs and triptans.
• Ubrogepant and rimegepant are new, effective migraine
treatments, suitable for patients with cardiovascular disease in
whom triptans are contraindicated.

Author/s:

Tzankova, V., Becker, W. J., Chan, T. L. H.

Association of Current Opioid Use With Serious Adverse Events Among Older Adult Survivors of Breast Cancer

Devin Evans — Wed, 03 Mar 2021 06:00:00 +0000

Date Added:

March 3, 2021

Journal/Publication:

Journal of the American Medical Association Network Open

Publication Date:

September 1, 2020

Issue:

Volume:

URL:

Association of Current Opioid Use With Serious Adverse Events Among Older Adult Survivors of Breast Cancer

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2020.16858

Keywords

RISEOK

aged

elderly

Opioid-Related Disorders

opioids

pain management

PMID (1):

32930779

MeSH

opioid-related disorders

drug overdose

This study documented a wide range of serious adverse events in older breast cancer patients prescribed opioids after surgery. James W. Mold, MD, MPH

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Importance: National efforts to improve safe opioid prescribing focus on preventing misuse, overdose, and opioid use disorder. This approach overlooks opportunities to better prevent other serious opioid-related harms in complex populations, such as older adult survivors of cancer. Little is known about the rates and risk factors for comprehensive opioid-related harms in this population.

Objective: To determine rates of multiple opioid-related adverse drug events among older adults who survived breast cancer and estimate the risk of these events associated with opioid use in the year after completing cancer treatment.

Design, setting, and participants: This retrospective cohort study used 2007 to 2016 Surveillance, Epidemiology and End Results-Medicare data from fee-for-service Medicare beneficiaries with first cancer diagnosis of stage 0 to III breast cancer at age 66 to 90 years from January 1, 2008, through December 31, 2015, who completed active breast cancer treatment. Data were analyzed from October 31, 2019, to June 10, 2020.

Exposures: Repeated daily measure indicating possession of any prescription opioid supply in Medicare Part D prescription claims.

Main outcomes and measures: Adjusted risk ratios (aRRs), estimated using modified Poisson generalized estimating equation models, for adverse drug events related to substance misuse (ie, diagnosed opioid abuse, dependence, or poisoning), other adverse drug events associated with opioid use (ie, gastrointestinal events, infections, falls and fractures, or cardiovascular events), and all-cause hospitalization associated with opioid supply the prior day, controlling for patient characteristics.

Conclusions and relevance: These findings suggest that among older adults who survived breast cancer, continued prescription opioid use in the year after completing active cancer treatment was associated with an immediate increased risk of a broad range of serious adverse drug events related to substance misuse and other adverse drug events associated with opioid use. Clinicians should consider the comprehensive risks of managing cancer pain with long-term opioid therapy.

Author/s:

Winn, Aaron N., Check, Devon K., Farkas, Amy, Fergestrom, Nicole M., Neuner, Joan M., Roberts, Andrew W.

AAFP Chronic Pain Management Toolkit

Devin Evans — Wed, 03 Mar 2021 06:00:00 +0000

Date Added:

March 3, 2021

Journal/Publication:

American Academy of Family Physicians

Publication Date:

March 1, 2021

URL:

AAFP Chronic Pain Management Toolkit

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

Keywords

MeSH

An AAFP-endorsed toolkit for helping patients who are experiencing chronic pain. James W. Mold, MD, MPH

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Chronic pain is common in the U.S., with anywhere from 11% to 40% of the adult population reporting daily pain.1 Approximately one-third of patients experiencing pain receive a pain medication.2 While the number of prescriptions for pain management have declined in recent years3, opioid misuse remains a significant public health crisis. Roughly 21-29% of patients who are prescribed opioids for chronic pain will misuse them.4

This increase leads to a rise in opioid overdoses—at least half are attributed to prescription medications—and morbidity and mortality. Numerous groups—including the AAFP, other medical societies, the National Academy of Medicine and the U.S. Congress—are emphasizing the need to improve chronic pain care.

Treatments for Acute Pain: A Systematic Review

Carly Hughes — Sat, 16 Jan 2021 20:12:04 +0000

Date Added:

January 16, 2021

Journal/Publication:

Agency for Healthcare Research and Quality

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

December 1, 2020

URL:

Treatments for Acute Pain: A Systematic Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

pain management

MeSH

pain management

This is a systematic review of what we now know (and don’t know) about the treatment of acute pain. James W. Mold, MD, MPH

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Not available

Author/s:

Agency for Healthcare Research and Quality

Association of Therapies With Reduced Pain and Improved Quality of Life in Patients With Fibromyalgia: A Systematic Review and Meta-analysis

Devin Evans — Thu, 14 Jan 2021 06:00:00 +0000

Date Added:

January 14, 2021

Journal/Publication:

Journal of the American Medical Association Internal Medicine

Publication Date:

October 26, 2020

Issue:

Volume:

181

Pages:

104-112

URL:

Association of Therapies With Reduced Pain and Improved Quality of Life in Patients With Fibromyalgia: A Systematic Review and Meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2020.5651

Keywords

Fibromyalgia

quality of life

cognitive behavioral therapy

pain management

PMID (1):

33104162

MeSH

Cognitive Behavioral Therapy

This meta-analysis found that cognitive behavioral therapy, antidepressants, and CNS depressants like gabapentin had some effect in the short- and medium-term for relieving pain and/or improving quality of life in patients with fibromyalgia. No other therapies were supported by the current evidence. James W. Mold, MD, MPH

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Importance: Fibromyalgia is a chronic condition that results in a significant burden to individuals and society.

Objective: To investigate the effectiveness of therapies for reducing pain and improving quality of life (QOL) in people with fibromyalgia.

Data sources: Searches were performed in the MEDLINE, Cochrane, Embase, AMED, PsycInfo, and PEDro databases without language or date restrictions on December 11, 2018, and updated on July 15, 2020.

Study selection: All published randomized or quasi-randomized clinical trials that investigated therapies for individuals with fibromyalgia were screened for inclusion.

Data extraction and synthesis: Two reviewers independently extracted data and assessed risk of bias using the 0 to 10 PEDro scale. Effect sizes for specific therapies were pooled using random-effects models. The quality of evidence was assessed using the Grading of Recommendations Assessment (GRADE) approach.

Main outcomes and measures: Pain intensity measured by the visual analog scale, numerical rating scales, and other valid instruments and QOL measured by the Fibromyalgia Impact Questionnaire.

Results: A total of 224 trials including 29 962 participants were included. High-quality evidence was found in favor of cognitive behavioral therapy (weighted mean difference [WMD], -0.9; 95% CI, -1.4 to -0.3) for pain in the short term and was found in favor of central nervous system depressants (WMD, -1.2 [95% CI, -1.6 to -0.8]) and antidepressants (WMD, -0.5 [95% CI, -0.7 to -0.4]) for pain in the medium term. There was also high-quality evidence in favor of antidepressants (WMD, -6.8 [95% CI, -8.5 to -5.2]) for QOL in the short term and in favor of central nervous system depressants (WMD, -8.7 [95% CI, -11.3 to -6.0]) and antidepressants (WMD, -3.5 [95% CI, -4.5 to -2.5]) in the medium term. However, these associations were small and did not exceed the minimum clinically important change (2 points on an 11-point scale for pain and 14 points on a 101-point scale for QOL). Evidence for long-term outcomes of interventions was lacking.

Conclusions and relevance: This systematic review and meta-analysis suggests that most of the currently available therapies for the management of fibromyalgia are not supported by high-quality evidence. Some therapies may reduce pain and improve QOL in the short to medium term, although the effect size of the associations might not be clinically important to patients.

Author/s:

Mascarenhas, Rodrigo O., Souza, Mateus B., Oliveira, Murilo X., Lacerda, Ana C., Mendonca, Vanessa A., Henschke, Nicholas, Oliveira, Vinicius C.

Best Practices, Research Gaps, and Future Priorities to Support Tapering Patients on Long-Term Opioid Therapy for Chronic Non-Cancer Pain in Outpatient Settings

Brian Desmarais — Tue, 01 Sep 2020 13:25:16 +0000

Date Added:

September 1, 2020

Journal/Publication:

NAM Perspectives

Publisher:

National Academy of Medicine

Publication Date:

August 10, 2020

URL:

Best Practices, Research Gaps, and Future Priorities to Support Tapering Patients on Long-Term Opioid Therapy for Chronic Non-Cancer Pain in Outpatient Settings

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.31478/202008c

Keywords

Opioid-Related Disorders

MeSH

A fairly long summary of the evidence and some reasonable guidance from the National Academy of Medicine about how to think about opioid tapering in patients with non-cancer pain. James W. Mold, MD, MPH

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Not available.

Author/s:

Rich, Robert, Mariano, Edward R., Dopp, Anna Legreid, Sullenger, Rebecca, Burstin, Helen

Tapering Long-term Opioid Therapy in Chronic Noncancer Pain: Evidence and Recommendations for Everyday Practice

Tracy Ashby — Mon, 15 Apr 2019 05:00:00 +0000

Date Added:

April 15, 2019

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Elsevier Inc.

Publication Date:

June 1, 2015

Issue:

Volume:

Pages:

828-842

URL:

Tapering Long-term Opioid Therapy in Chronic Noncancer Pain: Evidence and Recommendations for Everyday Practice

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2015.04.003

Keywords

opiods

taper

pain management

PMID (1):

26046416

MeSH

substance withdrawal syndrome

weaning

adaptation, psychological

This is a detailed article from Mayo on how to safely taper opioids. James W. Mold, MD, MPH

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Increasing concern about the risks and limited evidence supporting the therapeutic benefit of long-term opioid therapy for chronic noncancer pain are leading prescribers to consider discontinuing the use of opioids. In addition to overt addiction or diversion, the presence of adverse effects, diminishing analgesia, reduced function and quality of life, or the absence of progress toward functional goals can justify an attempt at weaning patients from long-termopioid therapy. However, discontinuing opioid therapy is often hindered by patients' psychiatric comorbidities and poor coping skills, as well as the lack of formal guidelines for the prescribers. The aim of this article is to review the existing literature and formulate recommendations for practitioners aiming to discontinue long-term opioid therapy. Specifically, this review aims to answer the following questions: What is an optimal opioid tapering regimen? How can the risks involved in a taper be managed? What are the alternatives to an opioid taper? A PubMed literature search was conducted using the keywords chronic pain combined with opioidwithdrawal, taper, wean and detoxification. Six hundred ninety-five documents were identified and screened; 117 were deemed directly relevant and are included. On the base of this literature review, this article proposes evidence-based recommendations and expert-based suggestions for clinical practice. Furthermore, areas of lack of evidence are identified, providing opportunities for further research.

Author/s:

Berna, Chantal, Kulich, Ronald J., Rathmell, James P.