Reviews on Pain Management

Cochrane Review Tackles Acute Postoperative Pain

This review begins a process of reevaluating the effect of pain medication.  It appears they are currently working on a similar paper on chronic pain which should be very interesting.  Even though PTs do not prescribe pain medications, it is important for us to understand the current thoughts on usage of medications.  I will be watching for more on this.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008659.pub2/abstract 

http://www.medscape.com/viewarticle/749816?src=nl_topic 

National Coverage Analysis (NCA) Tracking Sheet for Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain (CAG-00429N)

More review of the treatment of pain.  Unfortunately this may result in loss of coverage for TENS units. 

“CMS will review available evidence on the use of TENS for the treatment of chronic low back pain. We are particularly interested in receiving evidence speaking to the health outcomes attributable to the use of TENS in home settings.” 

Would be good for PTs to post if you have some input / evidence.

http://tinyurl.com/TENSreview

Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women.

Very interesting paper on biofeedback for PFM dysfunction.  Unfortunately it does point out the argument against biofeedback – increased patient contact.  Is it only the increased patient contact or does the machine add to the treatment. 

Cochrane Database Syst Rev.  2011; (7):CD009252 (ISSN: 1469-493X)

Herderschee R ; Hay-Smith EJ ; Herbison GP ; Roovers JP ; Heineman MJ
Department of Obstetrics & Gynaecology Academic Medical Centre, University of Amsterdam, Kerkstraat 379b, Amsterdam, Netherlands, 1017 HW.
BACKGROUND: Pelvic floor muscle training (PFMT) is an effective treatment for stress urinary incontinence in women. Whilst most of the PFMT trials have been done in women with stress urinary incontinence, there is also some trial evidence that PFMT is effective for urgency urinary incontinence and mixed urinary incontinence. Feedback or biofeedback are common adjuncts used along with PFMT to help teach a voluntary pelvic floor muscle contraction or to improve training performance.
OBJECTIVES: To determine whether feedback or biofeedback adds further benefit to PFMT for women with urinary incontinence.To compare the effectiveness of different forms of feedback or biofeedback.

Five Interesting Articles

I receive table to contents from a number of journals each month.  Here are a few I have found interesting in the past several months.  Hope you find them interesting also.  I would love to know what articles you are finding that are interesting.  Post on the blog or email me beth@bethshelly.com

NAFC's New Health Forum

NAFC recently partnered with Inspire.com to bring you a new online support community. NAFC and Inspire have created a community where members can discuss bladder and bowel health and offer support to each other.

More than just a forum where individuals can post discussion topics, Inspire is a community of members in which one can write journal entries, add friends, maintain a profile and contribute to the discussion. NAFC's support community serves as a safe place to exchange questions, stories and suggestions about bladder and bowel control problems and even make some new friends along the way.

Click here to access NAFC's New Online Support Community!

Bladder Health Awareness Campaign

Recently, NAFC began its nation-wide Bladder Health Awareness campaign. With the launch of the new website, last month, NAFC now has more tools to help educate the public about bladder health. Activities throughout this campaign are channeled in a countdown to National Bladder Health Week, November 14-18, 2011.

Read the blogs, articles and news bulletins to stay up-to-date with the latest treatment and management options for bladder dysfunction. Participate in the simple suggested activities to improve your bladder health and promote this campaign to others.

Specific exercises to treat pregnancy-related low back pain in a South African population. Kluge J, Hall D, Louw Q, Theron G, Grové D. Int J Gynaecol Obstet. 2011 Jun;113(3):187-91.

OBJECTIVE:

To investigate the effect of an exercise program, including specific stabilizing exercises, on pain intensity and functional ability in women with pregnancy-related low back pain.

METHODS:

Fifty women between 16 and 24 weeks of pregnancy were recruited at Tygerberg and Paarl Hospitals, Western Cape, South Africa. Twenty-six women were randomized to a 10-week exercise program and 24 were randomized as controls.

RESULTS:

Overall, the most frequent type of back pain experienced was lumbar pain (36 [72.0%]). Pain intensity (P=0.76) and functional ability (P=0.29) were comparable between the groups on study entry. In the study group, there was a significant improvement in pain intensity (P<0.01) and an improvement in functional ability (P=0.06) at the end of the study. In the control group, there were no significant changes in pain intensity (P=0.89) or functional ability (P=0.70) at the end of the study.

CONCLUSION:

A specific exercise program decreased back pain intensity and increased functional ability during pregnancy in South African women with lumbar and pelvic girdle pain.

Article supports use of exercise in decreasing pregnancy related LBP. 

September 7, 2011 Pelvic Physiotherapy Distance Journal Club

Discussion continues on intra-abdominal pressure adding the component of levator avulsion.  Each month adds more to the picture and brings up more questions.

The group also discussed the need for more patient education on birth trauma and recovery.  It was proposed that the SOWH consider another task force to develop and disseminate such a document.     

Unfortunately I was not able to record this month’s call but will work on fixing that for next month.   See outlines below.  We will be thinking about the schedule for next year.  I would like to send out a short survey to all on the journal club list.  Please let us know what is working or not working for you.  Looking forward to next month’s call.

This month’s discussion

Dietz HP, Simpson JM. Levator trauma is associated with pelvic organ prolapse. BJOG 2008;115:979-984.

Beales DJ, O’Sullivan PB, Briffa NK. Motor control patterns during an active straight leg raise in pain-free subjects.  Spine 2008;34(1):E1-E8.

Beales DJ, O’Sullivan PB, Briffa NK. Motor control patterns during an active straight leg raise in chronic pelvic girdle pain subjects.  Spine 2009;34(9):861-870.

World Congress of Physical Therapy 2011

All of the available abstracts and PowerPoint presentations from the World Congress of Physical Therapy 2011 can now be accessed online at the link below. Notice that there is a search function at the top of the page.

http://www.wcpt.org/posters_and_ppts

Abstracts and web cast for the International Contenence Society meeting just completed are also aviable on the ICS web site.  More details and highlights coming soon.