Typology of patients with fibromyalgia: cluster analysis of duloxetine study patients

Background: To identify distinct groups of patients with fibromyalgia (FM) with respect to multiple outcome measures. Methods: Data from 631 duloxetine-treated women in 4 randomized, placebo-controlled trials were included in a cluster analysis based on outcomes after up to 12 weeks of treatment. Corresponding classification rules were constructed using a classification tree method. Probabilities for transitioning from baseline to Week 12 category were estimated for placebo and duloxetine patients (Ntotal = 1188) using logistic regression. Results: Five clusters were identified, from “worst” (high pain levels and severe mental/physical impairment) to “best” (low pain levels and nearly normal mental/physical function). For patients with moderate overall severity, mental and physical symptoms were less correlated, resulting in 2 distinct clusters based on these 2 symptom domains. Three key variables with threshold values were identified for classification of patients: Brief Pain Inventory (BPI) pain interference overall scores of 80% of patients were in the 3 worst categories. Duloxetine patients were significantly more likely to improve after 12 weeks than placebo patients. A sustained effect was seen with continued duloxetine treatment. Conclusions: FM patients are heterogeneous and can be classified into distinct subgroups by simple descriptive rules derived from only 3 variables, which may guide individual patient management. Duloxetine showed higher improvement rates than placebo and had a sustained effect beyond 12 weeks

Treatment of Chronic Fatigue Syndrome: Findings, Principles and Strategies

Chronic fatigue syndrome (CFS) is a debilitating condition characterized by serious medically unexplained mental and physical fatigue. The high prevalence and both direct and indirect health costs of CFS patients represent a huge problem for contemporary health care. Moreover, the prognosis of CFS, even when treated, is often poor. In this paper, we first critically review current evidence based treatments of CFS. Second, we discuss the growing insights into the etiopathogenesis of CFS, and the need to translate and integrate these insights into future treatments. In particular, we formulate a pragmatic and empirically testable treatment approach, tailored to the individual needs of patients, which aims at restoring the mental and physical equilibrium of CFS patients by trying to bring about sustained life style changes

Low back pain and radicular pain : assessment and management - Summary

32 p.ill.,FOREWORD 1 -- ALGORYTHM. 4 -- SUMMARY 5 -- 1. INTRODUCTION 7 -- 1.1. METHODS 7 -- 2. ASSESSMENT OF LOW BACK PAIN AND RADICULAR PAIN 8 -- 2.1. HISTORY TAKING AND CLINICAL EXAMINATION 8 -- 2.2. RISK STRATIFICATION 11 -- 2.3. IMAGING 13 -- 3. NON-INVASIVE MANAGEMENT 14 -- 3.1. SELF-MANAGEMENT 14 -- 3.2. SUPERVISED EXERCISE PROGRAMME 15 -- 3.3. MANUAL TECHNIQUES 15 -- 3.4. PSYCHOLOGICAL INTERVENTIONS 16 -- 3.5. MULTIDISCIPLINARY REHABILITATION PROGRAMME 16 -- 3.6. RETURN TO WORK 17 -- 4. PHARMACOLOGICAL INTERVENTIONS 18 -- 4.1. NSAIDS, OPIOIDS OR PARACETAMOL 18 -- 4.2. ANTIDEPRESSANTS AND ANTICONVULSANTS 20 -- 5. INVASIVE INTERVENTIONS 21 -- 5.1. EPIDURAL INFILTRATIONS FOR (SUB)ACUTE RADICULAR PAIN 21 -- 5.2. RADIOFREQUENCY DENERVATION: FOR SUSPECTED CHRONIC FACET JOINT PAIN 22 -- 5.3. SURGICAL SPINAL DECOMPRESSION FOR PERSISTENT RADICULAR PAIN 23 -- 5.4. ARTHRODESIS: ONLY FOR VERY SPECIFIC CASES OF LOW BACK PAIN 23 -- 6. INTERVENTIONS NOT RECOMMENDED 24 -- 7. INTERVENTIONS WITHOUT A CLEAR RECOMMENDATION 26 -- 8. RESEARCH PROPOSITIONS 27 -- 9. TOPICS NOT STUDIED 28 -- 10. IMPLEMENTATION 28 -- 11. GLOSSARY 29 -- 12. QUESTIONNAIRES 3

Klinische Richtlijn rond lage rugpijn en radiculaire pijn : Samenvatting

32 pill.,Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) publiceert vandaag een klinische richtlijn voor de aanpak van één van onze belangrijkste moderne kwalen: acute of chronische lage rugpijn. Om het probleem vanuit alle invalshoeken te bekijken, werden 31 experten van de belangrijkste beroepsgroepen bij het project betrokken. De nadruk ligt op ‘de-medicalisering’, want lage rugpijn verdwijnt meestal spontaan. In beweging blijven is belangrijk en medische beeldvorming is vaak niet nodig. Patiënten die een hoger risico lopen dat hun pijn chronisch wordt, moeten worden geïdentificeerd, zodat zij vanaf het begin een specifieke behandeling krijgen.VOORWOORD .. 1 -- ALGORITME .. 4 -- SAMENVATTING 5 -- 1. INLEIDING .. 7 -- 1.1. METHODES 7 -- 2. EVALUATIE VAN LAGE RUGPIJN EN RADICULAIRE PIJN. 8 -- 2.1. ANAMNESE EN KLINISCH ONDERZOEK 8 -- 2.2. RISICO-STRATIFICATIE 11 -- 2.3. BEELDVORMING .. 13 -- 3. NIET-INVASIEVE AANPAK 14 -- 3.1. SELF-MANAGEMENT 14 -- 3.2. BEGELEID OEFENPROGRAMMA 15 -- 3.3. MANUELE TECHNIEKEN .. 15 -- 3.4. PSYCHOLOGISCHE INTERVENTIES 16 -- 3.5. MULTIDISCIPLINAIR REVALIDATIEPROGRAMMA 17 -- 3.6. WERKHERVATTING 17 -- 4. FARMACOLOGISCHE INTERVENTIES 18 -- 4.1. NSAID’S, OPIOÏDEN OF PARACETAMOL 18 -- 4.2. ANTIDEPRESSIVA EN ANTI-EPILEPTICA 20 -- 5. INVASIEVE INTERVENTIES 21 -- 5.1. EPIDURALE INFILTRATIES VOOR (SUB)ACUTE RADICULAIRE PIJN 21 -- 5.2. RADIOFREQUENTE DENERVATIE: BIJ VERMOEDEN VAN CHRONISCHE FACETGEWRICHTSPIJN .. 22 -- 5.3. CHIRURGISCHE SPINALE DECOMPRESSIE VOOR PERSISTENTE RADICULAIRE PIJN 23 -- 5.4. ARTRODESE: ENKEL VOOR ZEER SPECIFIEKE GEVALLEN VAN LAGE RUGPIJN 23 -- 6. NIET AANBEVOLEN INTERVENTIES 24 -- 7. INTERVENTIES ZONDER DUIDELIJKE AANBEVELING 26 -- 8. ONDERZOEKSVOORSTELLEN 27 -- 9. NIET-BESTUDEERDE ONDERWERPEN .. 28 -- 10. IMPLEMENTATIE.. 28 -- 11. GLOSSARIUM 29 -- 12. VRAGENLIJSTEN 3

Guide de pratique clinique pour les douleurs lombaires et radiculaires : Résumé

33 pill.,Le Centre fédéral d’Expertise des Soins de Santé (KCE) publie un guide de pratique clinique sur la prise en charge de l’un de nos principaux « maux de civilisation », le mal de dos, qu’il soit lumbago aigu ou lombalgie chronique. Pour cerner le problème sous toutes ses facettes, les chercheurs du KCE se sont entourés de 31 experts représentant les principales professions de santé concernées. L’accent est mis sur la « démédicalisation » : guérison spontanée dans la majorité des cas, importance de rester physiquement actif, inutilité des examens d’imagerie et nécessité d’identifier les personnes pour lesquelles existe un risque élevé de passage à la chronicité afin de leur proposer d’emblée une approche spécifique

Low back pain and radicular pain : assessment and management - Supplement

402 p.ill.,1. COMPOSITION OF EXPERTS AND STAKEHOLDERS GROUPS 6 -- 1.1. COMPOSITION OF THE GUIDELINE DEVELOPMENT GROUP 6 -- 1.2. COMPOSITION OF THE STAKEHOLDERS GROUP 8 -- 1.3. COMPOSITION OF THE KCE EXPERT TEAM 9 -- 2. INITIAL INTERVENTIONS PROPOSED FOR THE SCOPE OF THE GUIDELINE 10 -- 3. SEARCH STRATEGIES FOR GUIDELINES 12 -- 4. QUALITY APPRAISAL OF 17 SELECTED GUIDELINES 13 -- 5. QUALITY APPRAISAL OF THE NICE GUIDELINE 15 -- 6. EXAMPLE OF LIME SURVEY 18 -- 7. SUMMARY SHEETS 22 -- 7.1. CLINICAL EXAMINATION 22 -- 7.2. RISK ASSESSMENT AND STRATIFICATION 26 -- 7.3. IMAGING 40 -- 7.4. SELF-MANAGEMENT 51 -- 7.5. EXERCISE THERAPIES 64 -- 7.6. POSTURAL THERAPIES. 109 -- 7.7. ORTHOTICS AND APPLIANCES 116 -- 7.8. MANUAL THERAPIES 122 -- 7.9. ACUPUNCTURE 164 -- 7.10. ELECTROTHERAPIES 172 -- 7.11. PSYCHOLOGICAL INTERVENTIONS 195 -- 7.12. MULTIDISCIPLINARY BIOPSYCHOSOCIAL REHABILITATION (MBR) PROGRAMS 210 -- 7.13. RETURN TO WORK PROGRAMMES 231 -- 7.14. PHARMACOLOGICAL INTERVENTIONS 244 -- 7.14.1. General issues 244 -- 7.14.2. Specific points of discussion for NSAIDs 256 -- 7.14.3. Specific points of discussion for paracetamol 268 -- 7.14.4. Specific points of discussion for opioids 274 -- 7.14.5. Specific points of discussion for antidepressants 289 -- 7.14.6. Specific points of discussion for anticonvulsants 292 -- 7.14.7. Specific points of discussion for muscle relaxants 294 -- 7.14.8. Specific points of discussion for antibiotics 295 -- 7.14.9. Specific point of discussion for oral methylprednisolone 296 -- 7.15. SPINAL INJECTIONS 297 -- 7.16. RADIOFREQUENCY DENERVATION FOR FACET JOINT PAIN 313 -- 7.17. EPIDURAL INJECTIONS FOR RADICULAR PAIN 333 -- 7.18. SURGERY AND PROGNOSTIC FACTORS 360 -- 7.19. DISC REPLACEMENT 366 -- 7.20. SPINAL FUSION 376 -- 7.21. SPINAL DECOMPRESSION FOR RADICULAR PAIN 387 -- 8. EXTERNAL REVIEW. 40

The Belgian national guideline on low back pain and radicular pain: key roles for rehabilitation, assessment of rehabilitation potential and the PRM specialist

Low back pain (LBP) and radicular pain are very common health problems. They are rarely caused by serious underlying pathology and will usually recover spontaneously in time. In about one third of the cases however, the pain and functional impairment will persist one year after onset, being responsible for high health care costs and work absence. The management of LBP and radicular pain should focus therefore on excluding signs and symptoms of serious underlying pathology, on an active approach and on the prevention of chronicity. In 2017 the Belgian Health Care Knowledge Centre (KCE) published a guideline on LBP and radicular pain. This guideline formed the basis for a national pathway on LBP and radicular pain and is the first step to change and optimize our daily clinical practice. In this Belgian guideline the importance is stressed of a comprehensive clinical assessment and a tailored rehabilitation. Pharmacological and invasive treatments have a more doubtful effect or should only be considered under certain conditions. Implementing these recommendations in an interdisciplinary pathway necessitates a central role for Physical and Rehabilitation Medicine (PRM) especially in giving advice on and/or coordinating the tailored rehabilitation to prevent chronicity. To do this, the PRM specialist should perform a medical and functional assessment according to the ICF framework and taking into account the risk for chronicity or persistent impairment and the rehabilitation potential.status: publishe

The pivotal role for the multidisciplinary approach at all phases and at all levels in the national pathway for the management of low back pain and radicular pain in Belgium

INTRODUCTION: High level evidence on management of spinal disorders is scarce, which results in guidelines being of limited practical use for practitioners. Care pathways are complex interventions intended for the mutual decision making of organization of care processes for a well-defined group of patients. The goal of this project was to design a pathway for the management of low back pain and radicular pain for national implementation in Belgium. EVIDENCE ACQUISITION: An international and Belgian study on characteristics of low back pain care pathways was performed along with a literature study and focus group interrogation. Based on essential building elements identified and a consensus approach among all relevant stakeholders in primary, hospital and reintegration care, a national pathway was constructed. The process was endorsed by the Belgian Health Care Knowledge Center, Belgian National Institute of Health and Disability Insurance and the Spine Society of Belgium. EVIDENCE SYNTHESIS: Eleven international pathways were identified, varying in implementation width from hospital-based to region/province-based. Seven Belgian pathway initiatives were detected. Notwithstanding differences, consistent building elements were identified. Three groups of caregivers, divided in primary care, hospital care and reintegration and including all relevant medical/paramedical disciplines, worked on integrating the essential building elements into a single concrete patient pathway of direct use to any caregiver and patient and based on a consensus model including reference to the 2017 Belgian adaptation of the 2016 NICE guidelines. The resulting pathways on management of low back pain and radicular pain underpin the importance of multidisciplinary teamwork. CONCLUSIONS: Essential building elements were identified from literature and established pathways and were successfully integrated in a Belgian national low back pain and radicular pain pathway using an integrative consensus approach. The pathways are consultable at www.lowbackpain.kce.be.status: publishe

Proprioceptive postural control and functional outcome after first-time lumbar micro-discectomy: the effect of early individualized physical therapy

status: publishe