Evidence Based Reports
Peripheral nerve-field stimulation for chronic low back pain. (2013) [NICE] NEW
Opioids compared to placebo or other treatments for chronic low-back pain. (2013) [Cochrane Library] NEW
Traction for low-back pain with or without sciatica. (2013) [Cochrane Library] NEW
A systematic review and meta-analysis of yoga for low back pain. (2013) [DARE] NEW
Motor control exercises reduces pain and disability in chronic and recurrent low back pain: a meta-analysis. (2013) [DARE] NEW
Percutaneous adhesiolysis in the management of chronic low back pain in post lumbar surgery syndrome and spinal stenosis: a systematic review. (2013) [DARE] NEW
Exploring the cost-utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups. (2013) [NHS EED] NEW
Red flags to screen for malignancy in patients with low-back pain. (2012) [Cochrane LIbrary] NEW
Spinal manipulative therapy for acute low-back pain. (2012) [Cochrane Library] NEW
Back pain, acute low back (2011)[Clinical Evidence]Athens Log-in required
Back pain, chronic low back (2010)[Clinical Evidence]Athens Log-in required
Complementary and Alternative Therapies for Back Pain II (2010)[Agency for Healthcare Research and Quality]
A multicentred randomised controlled trial of a primary-care based cognitive behavioural programme for low back pain. The Back Skills Training (BeST) trial (2010)[NIHR HTA]
Effectiveness of exercise on work disability in patients with non-acute non-specific low back pain: systematic review and meta-analysis of randomized controlled trials (2010)[DARE]
Systematic review of the effectiveness of thermal annular procedures in treating discogenic low back pain (2010)[DARE]
Percutaneous intradiscal electrothermal therapy for low back pain (2009) [National Institute for Health and Clinical Excellence - Interventional Procedures]
Antidepressants for non-specific low back pain (2009)[Cochrane]
Exercise for the primary, secondary and tertiary prevention of low back pain in the workplace: a systematic review (2009)[DARE]
Individual patient education for low back pain (2008) [Cochrane]
Non-steroidal anti-inflammatory drugs for low back pain (2008) [Cochrane]
Lumbar supports for prevention and treatment of low back pain (2008) [Cochrane]
Opioids for chronic low-back pain (2007) [Cochrane]
Clinical Guidelines
Non-rigid stabilisation techniques for the treatment of low back pain (2010)[ National Institute for Health and Clinical Excellence - Interventional Procedures]NEW
Low back pain: Early management of persistent non-specific low back pain (2009)[NICE]
Back pain - low (without radiculopathy) (2009)[CKS]
Recent articles in core journals
Effectiveness of rocker sole shoes in the management of chronic low back pain: a randomized clinical trial. (2013) [EvidenceUpdates] NEW
Pilates exercise or stationary cycling for chronic nonspecific low back pain: does it matter? a randomized controlled trial with 6-month follow-up. (2013) [EvidenceUpdates] NEW
Short-term effects of interferential current electro-massage in adults with chronic non-specific low back pain: a randomized controlled trial. (2013) [EvidenceUpdates] NEW
Effects of Functional Fascial Taping on pain and function in patients with non-specific low back pain: a pilot randomized controlled trial. (2013) [EvideneUpdates] NEW
Effect of intravenous tropisetron on modulation of pain and central hypersensitivity in chronic low back pain patients. (2013)[EvidenceUpdates] NEW
The McKenzie method compared with manipulation when used adjunctive to information and advice in low back pain patients presenting with centralization or peripheralization: a randomized controlled trial. (2012) [EvidenceUpdates] NEW
Effectiveness of self-management of low back pain: systematic review with meta-analysis. (2012) [EvidenceUpdates] NEW
Multicenter randomized controlled trial to evaluate the effect of home-based exercise on patients with chronic low back pain: the Japan low back pain exercise therapy study (2010)[EvidenceUpdates]
Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain (2010)[EvidenceUpdates
Graded activity and graded exposure for persistent nonspecific low back pain: a systematic review (2010)[EvidenceUpdates]
Role of physical exercise in low back pain rehabilitation: a randomized controlled trial of a three-month exercise program in patients who have completed multidisciplinary rehabilitation (2010)[EvidenceUpdates]
Effect of glucosamine on pain-related disability in patients with chronic low back pain and degenerative lumbar osteoarthritis: a randomized controlled trial (2010[JAMA]
Causal assessment of awkward occupational postures and low back pain: results of a systematic review (2010)[EvidenceUpdates]
Causal assessment of occupational bending or twisting and low back pain: results of a systematic review (2010)[EvidenceUpdates]
New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS) (2009)[EvidenceUpdates]
Prognosis for patients with chronic low back pain: inception cohort study.(2009)[BMJ]
Evaluation of the effectiveness and efficacy of iyengar yoga therapy on chronic low back pain (2009)[EvidenceUpdates]
Efficacy of microcurrent therapy in the treatment of chronic nonspecific back pain: a pilot study (2009)[EvidenceUpdates]
A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain (2009)[EvidenceUpdates]
Comparison of isokinetic exercise versus standard exercise training in patients with chronic low back pain: a randomized controlled study (2009)[EvidenceUpdates]
A randomised controlled trial of spinal manipulative therapy in acute low back pain (2009)[EvidenceUpdates]
L2 spinal nerve-block effects on acute low back pain from osteoporotic vertebral fracture (2009)[EvidenceUpdates]
Intramuscular oxygen-ozone therapy in the treatment of acute back pain with lumbar disc herniation: a multicenter, randomized, double-blind, clinical trial of active and simulated lumbar paravertebral injection (2009)[EvidenceUpdates]
Early physiotherapy intervention in an Accident and Emergency Department reduces pain and improves satisfaction for patients with acute low back pain: a randomised trial (2009)[EvidenceUpdates]
Evidence-informed management of chronic low back pain with lumbar extensor strengthening exercises(2008) [EvidenceUpdates]
Evidence-informed management of chronic low back pain with lumbar stabilization exercises (2008)[EvidenceUpdates]
Evidence-informed management of chronic low back pain with herbal, vitamin, mineral, and homeopathic supplements (2008)[EvidenceUpdates]
eTextbooks
Low Back Pain and Sciatica (2013)[Mentor]updated
GP Notebook (2009) [GP Notebook]
Clinical Queries
A patient is claiming sildenafil (Viagra) helps relief back pain. Is there any evidence to support this? (2010)[ATTRACT]
Is there any evidence for chiropractic advice and treatment for simple back pain? I am interested in all aspects of the intervention and not just manipulations. (2010)[ATTRACT]
What level of evidence do we have for the effectiveness or absence of effectiveness, for non-specific, acute low back pain and non-specific chronic low back pain? (2009)[TRIPAnswers]
Is there any evidence for the use of benzodiazepines in acute back pain? (2007)[ATTRACT]
Is there any evidence for physiotherapy, osteopathy or chiropractic manipulation in the treatment of chronic non-specific back pain? (2007) [TRIP answers]
How does acupuncture performed in a primary care setting for mechanical low back pain compare with outcomes from standard physiotherapy treatment? (2007)[TRIP answers]
What is the evidence that core stability exercises reduce low back pain? (2006) [TRIP answers]
Is chiropractic care, for the treatment of mechanical low back pain, safe during pregnancy? (2006) [TRIP answers]
Do you have any information on the management of back pain during pregnancy? (2006) [TRIP answers]
Patient Information
Back Pain (2013) [BUPA Health Information]updated
Back Pain (2013)[NHS Choices]updated
Back pain (2010)[MedlinePlus]updated
Important
1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.
Tuesday, 4 March 2014
Monday, 3 March 2014
Menopause
Evidence Based Reports
Acupuncture for menopausal hot flushes. (2013) [Cochrane Library] NEW
Ospemifene for vulvo-vaginal atrophy in postmenopausal women. (2013) [HTA] NEW
Short and long term effects of tibolone in postmenopausal women. (2012) [Cochrane Library] NEW
Hormone therapy in postmenopausal women and risk of endometrial hyperplasia. (2012) [Cochrane Library] NEW
Cost effectiveness of secondary vs tertiary prevention for post-menopausal osteoporosis. (2012) [NHS EED] NEW
Black cohosh (Cimicifuga spp.) for menopausal symptoms. (2012) [Cochrane Library] NEW
Long term hormone therapy for perimenopausal and postmenopausal women (2012) [Cochrane Library] NEW
Short and long term effects of tibolone in postmenopausal women. (2012) [Cochrane Library] NEW
Adjuvant gonadotropin-releasing hormone analogues for the prevention of chemotherapy induced premature ovarian failure in premenopausal women (2011)[Cochrane Library]
Timing of breast surgery in premenopausal breast cancer patients (2011)[Cochrane Library]
Exercise for vasomotor menopausal symptoms (2010)[Cochrane Library]
Menopausal hormone therapy and risk of lung cancer: systematic review and meta-analysis (2010)[DARE]
Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis (2010)[DARE]
Hormone therapy for endometriosis and surgical menopause (2009)[Cochrane Library]
Cost-effectiveness of hormone replacement therapy for menopausal symptoms in the UK (2009)[NHS Economic Evaluation Database]
Trifolium pratense isoflavones in the treatment of menopausal hot flushes: a systematic review and meta-analysis (2008)[DARE]
Clinical Guidelines
Menopause (2008)[CKS] updated
Alternatives to HRT for the Management of Symptoms of the Menopause. (2010)[RCOG]
Recent articles in core journals
Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. (2013) [JAMA] NEW
Denosumab Compared With Ibandronate in Postmenopausal Women Previously Treated With Bisphosphonate Therapy: A Randomized Open-Label Trial. (2013) [EvidenceUpdates] NEW
Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese postmenopausal women. (2013) [EvidenceUpdates] NEW
Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. (2012) [BMJ] NEW
Paced Respiration for Vasomotor and Other Menopausal Symptoms: A Randomized, Controlled Trial. (2012) [EvidenceUpdates] NEW
Health symptoms during midlife in relation to menopausal transition: British prospective cohort study. (2012) [BMJ] NEW
Effect of 12 months of whole-body vibration therapy on bone density and structure in postmenopausal women: a randomized trial.(2011)[Annals of Internal Medicine]
Efficacy of escitalopram for hot flashes in healthy menopausal women: a randomized controlled trial.(2011)[JAMA]
Benefits and risks of postmenopausal hormone therapy when it is initiated soon after menopause (2009)[EvidenceUpdates]
Desvenlafaxine for the treatment of vasomotor symptoms associated with menopause: a double-blind, randomized, placebo-controlled trial of efficacy and safety (2009)[EvidenceUpdates]
Revisiting the duration of vasomotor symptoms of menopause: a meta-analysis (2009)[EvidenceUpdates]
Increased risk of parkinsonism in women who underwent oophorectomy before menopause. (2008)[EvidenceUpdates]
Menopause. (2008)[Lancet]
eTextbooks
Menopause and its Management (2013)[Mentor]UPDATED
Menopause andMood Disorders (2012)[eMedicine] updated
Menopause (2011)[eMedicine]
Clinical Queries
How long can we safely use topical HRT e.g.vagifem for atrophic vaginitis in postmenopausal women? (2013) [ATTRACT] NEW
I am looking after a 44yr old woman with recurrent DVT and who is on life-long Warfarin. She is menopausal with debilitating hot flushes. What is the evidence with regards to use of HRT or antidepressant therapy respectively in such a patient? (2013) [ATTRACT] NEW
Is it appropriate to leave a levonorgestrel releasing intrauterine system (LNG-IUS) in a woman indefinitely past the menopause? (2013) [FSRH] NEW
How long can we safely use topical HRT e.g.vagifem for atrophic vaginitis in postmenopausal women? (2013) [ATTRACT] NEW
is there any evidence to advise on dose of clonidine beneficial for menopausal flushes?I have a patient who feels that 75mcg works for her and 25mcg doesnt.what does evidence support? (2012) [TRIPanwers] NEW
How reliable is a single raised FSH and LH levels in diagnosing menopause in women age 46? (2012) [TRIPanswers] NEW
What is the risk of osteonecrosis of the jaw for a post-menopausal woman taking a bisphosphonate for osteoporosis? (2012) [TRIPanswers] NEW
Do patients who are needing oestrogen for relief of menopausal symptoms need progesterone also if they have a mirena coil in situ,or is this sufficient to provide the progesterone component? If the latter, for how long from time of insertion? (2011)[TripAnswers]
What would the advice be re. stopping microgynon in 50 yr old woman (who has been taking this for 32 yrs) - would changing to Mirena coil + watchful waiting for menopausal symtoms be best option? Addition of HRT if needed for symptom relief? (2011)[ATTRACT]
Should a 38 year women who has had a hysterectomy continue with HRT until normal menopause age (50) or stop sooner than this? No family history of breast cancer etc. (2010)[ATTRACT]
Is HRT recommended for a patient on goserelin for endometriosis experiencing menopausal symptoms? (2009)[ATTRACT]
What is an normal endometrial thickness and is it different during the menopause?
(2009)[TRIPAnswers]
Patient Information
Menopause and HRT(2013)[Patient UK] UPDATED
Menopause (inc HRT)(2013)[BUPA] UPDATED
Menopause (2012)[NHS Choices] UPDATED
Important
1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.
Acupuncture for menopausal hot flushes. (2013) [Cochrane Library] NEW
Ospemifene for vulvo-vaginal atrophy in postmenopausal women. (2013) [HTA] NEW
Short and long term effects of tibolone in postmenopausal women. (2012) [Cochrane Library] NEW
Hormone therapy in postmenopausal women and risk of endometrial hyperplasia. (2012) [Cochrane Library] NEW
Cost effectiveness of secondary vs tertiary prevention for post-menopausal osteoporosis. (2012) [NHS EED] NEW
Black cohosh (Cimicifuga spp.) for menopausal symptoms. (2012) [Cochrane Library] NEW
Long term hormone therapy for perimenopausal and postmenopausal women (2012) [Cochrane Library] NEW
Short and long term effects of tibolone in postmenopausal women. (2012) [Cochrane Library] NEW
Adjuvant gonadotropin-releasing hormone analogues for the prevention of chemotherapy induced premature ovarian failure in premenopausal women (2011)[Cochrane Library]
Timing of breast surgery in premenopausal breast cancer patients (2011)[Cochrane Library]
Exercise for vasomotor menopausal symptoms (2010)[Cochrane Library]
Menopausal hormone therapy and risk of lung cancer: systematic review and meta-analysis (2010)[DARE]
Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis (2010)[DARE]
Hormone therapy for endometriosis and surgical menopause (2009)[Cochrane Library]
Cost-effectiveness of hormone replacement therapy for menopausal symptoms in the UK (2009)[NHS Economic Evaluation Database]
Trifolium pratense isoflavones in the treatment of menopausal hot flushes: a systematic review and meta-analysis (2008)[DARE]
Clinical Guidelines
Menopause (2008)[CKS] updated
Alternatives to HRT for the Management of Symptoms of the Menopause. (2010)[RCOG]
Recent articles in core journals
Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. (2013) [JAMA] NEW
Denosumab Compared With Ibandronate in Postmenopausal Women Previously Treated With Bisphosphonate Therapy: A Randomized Open-Label Trial. (2013) [EvidenceUpdates] NEW
Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese postmenopausal women. (2013) [EvidenceUpdates] NEW
Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. (2012) [BMJ] NEW
Paced Respiration for Vasomotor and Other Menopausal Symptoms: A Randomized, Controlled Trial. (2012) [EvidenceUpdates] NEW
Health symptoms during midlife in relation to menopausal transition: British prospective cohort study. (2012) [BMJ] NEW
Effect of 12 months of whole-body vibration therapy on bone density and structure in postmenopausal women: a randomized trial.(2011)[Annals of Internal Medicine]
Efficacy of escitalopram for hot flashes in healthy menopausal women: a randomized controlled trial.(2011)[JAMA]
Benefits and risks of postmenopausal hormone therapy when it is initiated soon after menopause (2009)[EvidenceUpdates]
Desvenlafaxine for the treatment of vasomotor symptoms associated with menopause: a double-blind, randomized, placebo-controlled trial of efficacy and safety (2009)[EvidenceUpdates]
Revisiting the duration of vasomotor symptoms of menopause: a meta-analysis (2009)[EvidenceUpdates]
Increased risk of parkinsonism in women who underwent oophorectomy before menopause. (2008)[EvidenceUpdates]
Menopause. (2008)[Lancet]
eTextbooks
Menopause and its Management (2013)[Mentor]UPDATED
Menopause andMood Disorders (2012)[eMedicine] updated
Menopause (2011)[eMedicine]
Clinical Queries
How long can we safely use topical HRT e.g.vagifem for atrophic vaginitis in postmenopausal women? (2013) [ATTRACT] NEW
I am looking after a 44yr old woman with recurrent DVT and who is on life-long Warfarin. She is menopausal with debilitating hot flushes. What is the evidence with regards to use of HRT or antidepressant therapy respectively in such a patient? (2013) [ATTRACT] NEW
Is it appropriate to leave a levonorgestrel releasing intrauterine system (LNG-IUS) in a woman indefinitely past the menopause? (2013) [FSRH] NEW
How long can we safely use topical HRT e.g.vagifem for atrophic vaginitis in postmenopausal women? (2013) [ATTRACT] NEW
is there any evidence to advise on dose of clonidine beneficial for menopausal flushes?I have a patient who feels that 75mcg works for her and 25mcg doesnt.what does evidence support? (2012) [TRIPanwers] NEW
How reliable is a single raised FSH and LH levels in diagnosing menopause in women age 46? (2012) [TRIPanswers] NEW
What is the risk of osteonecrosis of the jaw for a post-menopausal woman taking a bisphosphonate for osteoporosis? (2012) [TRIPanswers] NEW
Do patients who are needing oestrogen for relief of menopausal symptoms need progesterone also if they have a mirena coil in situ,or is this sufficient to provide the progesterone component? If the latter, for how long from time of insertion? (2011)[TripAnswers]
What would the advice be re. stopping microgynon in 50 yr old woman (who has been taking this for 32 yrs) - would changing to Mirena coil + watchful waiting for menopausal symtoms be best option? Addition of HRT if needed for symptom relief? (2011)[ATTRACT]
Should a 38 year women who has had a hysterectomy continue with HRT until normal menopause age (50) or stop sooner than this? No family history of breast cancer etc. (2010)[ATTRACT]
Is HRT recommended for a patient on goserelin for endometriosis experiencing menopausal symptoms? (2009)[ATTRACT]
What is an normal endometrial thickness and is it different during the menopause?
(2009)[TRIPAnswers]
Patient Information
Menopause and HRT(2013)[Patient UK] UPDATED
Menopause (inc HRT)(2013)[BUPA] UPDATED
Menopause (2012)[NHS Choices] UPDATED
Important
1. If you are a Welsh Primary Care Professional with a clinical query send it to ATTRACT online or email us at questions@attract.wales.nhs.uk or call 01495 332343.
2. If you would like to comment on this CME topic, or suggest a new topic for ATTRACTcme, go to the comments hyperlink below.
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