Contents part 1: Introduction

Finnerup NB, Otto M, Jensen TS, Sindrup SH. An evidence-based algorithm for the treatment of neuropathic pain. MedGenMed. 2007 May 15;9(2):36

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Finnerup NB, Otto M, Jensen TS, Sindrup SH. An evidence-based algorithm for the treatment of neuropathic pain. MedGenMed. 2007 May 15;9(2):36.

METHOD: A treatment algorithm for neuropathic pain was formulated on the basis of a review of 105 high-quality, randomized, placebo-controlled clinical trials. RESULTS: TCAs had the lowest NNT followed by opioids and AEDs, such as gabapentin and pregabalin.

Rating: 1b

Finsen V, Persen L, Lovlien M, Veslegaard EK, Simensen M, Gasvann AK, Benum P. Transcutaneous electrical nerve stimulation after major amputation. J Bone Joint Surg Br. 1988 Jan;70(1):109-12.

Sham TENS had a considerable placebo effect on pain. There were, however, no significant differences in the analgesic requirements or reported prevalence of phantom pain between the groups during the first four weeks.
PMID: 3257494
Rating: 2c

Fishbain D, Evidence-based data on pain relief with antidepressants, Ann Med. 2000 Jul;32(5):305-16.

Finally, this evidence indicated that antidepressants could be effective for pain associated with some specific pain syndromes, such as chronic low back pain, osteoarthritis or rheumatoid arthritis, fibrositis or fibromyalgia, and ulcer healing.
PMID: 10949061

Rating: 5b

Fishbain DA, Lewis JE, Cole B, Cutler B, Rosomoff HL, Rosomoff RS. Lidocaine 5% patch: an open-label naturalistic chronic pain treatment trial and prediction of response. Pain Med. 2006;7:135-42.
CONCLUSIONS: A significant percentage of CPPs exposed to an L5P 3-day naturalistic trial perceived clinical improvement. However, this can only be concluded as an initial effect, and whether or not this effect is attributable to L5P cannot be derived from our data as the effect could have been nonspecific.
PMID: 16634726
Rating: 4c

Fisher R, Hassenbusch S, Krames E, Leong M, Minehart M, Prager J, Staats P, Webster L, Willis KD.A Consensus Statement Regarding the Present Suggested Titration for Prialt (Ziconotide). Neuromodulation 2005; 8:153–154.

This was a titration that stated the following: Because of the side-effect profile of this drug, the recommended maximum titration rate approved by the FDA on December 28, 2004 and stated in the package insert is considered, unanimously, by the undersigned authors of this editorial and the vast majority of Prialt clinical investigators, to be two and one-half to five times too rapid.

They also stated: Given the severity of the side-effects of this drug, it is recommended by a consensus of the most experienced clinical investigators (signatures below), that the "mantra" regarding the initiation of intrathecal Prialt for pain control should be to "Start Low and Go Slo. The rinse process is also very important to the infusion of this drug.

Rating: 8a
Flor H, Fydrich T, Turk DC. Efficacy of multidisciplinary pain treatment centers: a meta-analytic review. Pain. 1992 May;49(2):221-30.
The beneficial effects of multidisciplinary treatment were not limited to improvements in pain, mood and interference but also extended to behavioral variables such as return to work or use of the health care system.
PMID: 1535122

Rating: 1a

Flor H, Birbaumer N. Comparison of the efficacy of electromyographic biofeedback, cognitive-behavioral therapy, and conservative medical interventions in the treatment of chronic musculoskeletal pain. J Consult Clin Psychol. 1993 Aug;61(4):653-8.

Results suggest that pain patients who suffer from musculoskeletal pain problems and display few physical disabilities may profit the most from short-term EMG biofeedback treatment.

PMID: 8370861

Rating: 2c

Fock KM, Katelaris P, Sugano K, Ang TL, Hunt R, Talley NJ, Lam SK, Xiao SD, Tan HJ, Wu CY, Jung HC, Hoang BH, Kachintorn U, Goh KL, Chiba T, Rani AA; Second Asia-Pacific Conference.Second Asia-Pacific Consensus Guidelines for Helicobacter pylori infection. J Gastroenterol Hepatol. 2009;24:1587-600.
It was recommended that H. pylori infection should be tested for and eradicated prior to long-term aspirin or non-steroidal anti-inflammatory drug therapy in patients at high risk for ulcers and ulcer-related complications.
PMID: 19788600
Rating: 8b

Forman JP, Rimm EB, Curhan GC. Frequency of analgesic use and risk of hypertension among men. Arch Intern Med. 2007;167:394-9.

CONCLUSIONS: The frequency of nonnarcotic analgesic use is independently associated with a moderate increase in the risk of incident hypertension.

PMID: 17325302
Rating: 3a

Forouzanfar T, Kemler MA, Weber WE, Kessels AG, Van Kleef M, Spinal cord stimulation in complex regional pain syndrome: cervical and lumbar devices are comparably effective, Br J Anaesth. 2004 Jan 22

RESULTS: According to the GPE, at least 42% of the cervical SCS patients and 47% of the lumbar SCS patients reported at least 'much improvement'. Complications and adverse effects occurred in 64% of the patients and consisted mainly of technical defects.

PMID: 14742334
Rating: 4c

Forouzanfar T, Köke AJ, van Kleef M, Weber WE. Treatment of complex regional pain syndrome type I. Eur J Pain. 2002;6:105-22.

Controversy exists about the effectiveness of therapeutic interventions for the management of RSD/CRPS I.
PMID: 11900471
Rating: 1b

Feuerstein TJ, Chronic pain treatment with antidepressants – Metaanalysis. Schmerz. 1997 Jun 13;11(3):213-26.

Both preclinical and clinical evidence support the usefulness of antidepressants in chronic pain treatment. 57 Clinical trials were separated into 5 groups according to their scientific quality. The most effective antidepressants in chronic pain treatment only included unselective monoamine reuptake inhibitors in the following rank order: amitriptyline > clomipramine >/= desipramine >/= imipramine >/= doxepin.

PMID: 12799822

Rating: 1b

Fredheim OM, Moksnes K, Borchgrevink PC, Kaasa S, Dale O. Clinical pharmacology of methadone for pain. Acta Anaesthesiol Scand. 2008 Mar 6; [Epub ahead of print].
Conclusion: In spite of challenges related to the variable pharmacokinetics and concerns regarding increase in QTc time, current evidence indicates that opioid switching to methadone improves pain control in a substantial proportion of patients who are candidates for opioid switching.
PMID: 18331375
Rating: 1c

Freeman R, Durso-Decruz E, Emir B. Efficacy, safety and tolerability of pregabalin treatment of painful diabetic peripheral neuropathy: findings from 7 randomized, controlled trials across a range of doses. Diabetes Care. 2008 Mar 20 [Epub ahead of print].

CONCLUSIONS Treatment with pregabalin across its effective dosing range is associated with significant, dose-related improvement in pain in patients with DPN.
PMID: 18356405
Rating: 1b
Friedman AP, DiSerio FJ. Symptomatic treatment of chronically recurring tension headache: a placebo-controlled, multicenter investigation of Fioricet and acetaminophen with codeine. Clin Ther. 1987;10(1):69-81.
Fioricet, but not acetaminophen with codeine, was significantly better than placebo in alleviating emotional or psychic tension; Fioricet was also significantly better than acetaminophen with codeine in relieving this symptom.
PMID: 3329967
Rating: 2b

Friedman MJ. PTSD: Pharmacotherapeutic Approaches. Focus. 2013;11(3):315-320.

Rating: 8a
Fritz JM, Cleland JA, Brennan GP. Does adherence to the guideline recommendation for active treatments improve the quality of care for patients with acute low back pain delivered by physical therapists? Med Care. 2007 Oct;45(10):973-80.
CONCLUSIONS: Adherence to the guideline recommendation for active care was associated with better clinical outcomes and reduced cost.
PMID: 17890995
Rating: 4a

Frost H, Lamb SE, Klaber Moffett JA, Fairbank JC, Moser JS. A fitness programme for patients with chronic low back pain: 2-year follow-up of a randomised controlled trial. Pain. 1998;75:273-9.

Between group comparisons demonstrated a statistically significant difference in disability scores between the treatment and control group (mean difference 5.8, 95% confidence interval 0.3, 11.4 P < 0.04).
PMID: 9583763
Rating: 2c

Furlan AD, Sandoval JAS, Mailis A. Spinal cord stimulation for chronic pain (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.

Spinal Cord Stimulation (SCS), first called Dorsal Column Stimulation (DCS), is a treatment that has been used for more than 30 years, but only in the past five years has it met with widespread acceptance and recognition by the medical community. In the first decade after its introduction, SCS was extensively practiced and applied to wide spectrum of pain diagnoses, probably indiscriminately. The results at follow-up were poor and the method soon fell in disrepute. As a result, in the late 1970s and 1980s SCS was, at least in the United States, still used in only few specialized pain centers. In Europe, SCS was not introduced until the early 1970s and then practiced to a very limited extent. In the last decade there has been growing awareness that SCS is a reasonably effective therapy for many patients suffering from neuropathic pain for which there is no alternative therapy. There are several reasons for this development, the principal one being that the indications have been more clearly identified. The enhanced design of electrodes, leads, and receivers/stimulators has substantially decreased the incidence of reoperations for device failure. Further, the introduction of the percutaneous electrode implantation has enabled trial stimulation, which is now commonly recognized as an indispensable step in assessing whether the treatment is appropriate for individual patients. SCS involves the use of an electrical generator which delivers pulses by means of an electrode placed in the epidural space adjacent to a targeted spinal cord area, which is causing the pain. The leads, which are special devices containing the set of electrodes, can be implanted by laminectomy or percutaneously. Nowadays, protocols for SCS implantation stipulate a screening trial period with temporary percutaneous placement of the leads and using an external generator. Despite the limited evidence for SCS efficacy because of the lack of controlled studies, the use of spinal stimulation for pain relief has increased exponentially during the last decade. In 1995 it was estimated that 14000 stimulators were being implanted worldwide each year and in Europe in 1997 the figure was 5000 units per annum. Since the publication of Turner's review a number of clinical trials have been published, and it is the objective of this review to assess the current evidence.
Rating: 5b

Furlan AD, Mailis A, Papagapiou M. Are we paying a high price for surgical sympathectomy? A systematic literature review of late complications. J Pain. 2000 Winter;1(4):245-57.

The main indication was primary hyperhidrosis in 84.3% of the patients. Surgical sympathectomy, irrespective of approach, is accompanied by several potentially disabling complications. Detailed informed consent is recommended when surgical sympathectomy is contemplated.
PMID: 14622605
Rating: 1c

Furlan AD, Sjölund BH. Igniting the spark? Pain. 2007 Jul;130(1-2):1-3. Epub 2007 May 22.

Comment on: Johnson M, Martinson M. Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: A meta-analysis of randomized controlled trials. Pain. 2007 Jul;130(1-2):157-65.
PMID: 17521812
Rating: 11b
There has been another letter to the editor about this article from Furlan et al. They state the following:

1. The methodological quality of the studies that the meta-analysis was based on was low.

2. There was still a need to demonstrate the benefits of ENS to other modalities to assess the pain conditons that are most responsive

3. What is the most appropriate duration.

This author did not pick up the above discrepencies in disease states.

Furlan writes for Cochrane

Editorial -- Igniting the spark?

In the past, the evidence about the effectiveness of electrical nerve stimulation (ENS) for the treatment of pain was combined in various systematic reviews of randomized controlled trials (RCTs). However most of these systematic reviews focused on a specific regional pain condition or a particular type of ENS and therefore were not able to combine the studies using statistical methods because they included only a subset of RCTs. On the other hand, some people view this as a disadvantage, because combining different studies may neutralize a negative study with a positive study, meaning that clinically important differences might explain differences and therefore it is not appropriate to combine heterogeneous studies. There is still a need to demonstrate the benefits of ENS compared to other modalities and therapies, to assess what kind of pain conditions are most responsive to ENS and to estimate the most appropriate duration of therapy.

Furukawa TA, Watanabe N, Churchill R. Combined psychotherapy plus antidepressants for panic disorder with or without agoraphobia. Cochrane Database Syst Rev. 2007;(1):CD004364.
RESULTS: After termination of the acute phase and continuation treatment, the combined therapy was more effective than pharmacotherapy alone and was as effective as psychotherapy.
PMID: 17253502
Rating: 1b

Gaines, J., et al. The Effect of Neuromuscular Electrical Stimulation on Arthritis Knee Pain in Older Adults with Osteoarthritis of the Knee. Applied Nursing Research 2004. August; Volume 17, Number 3: 201-06.

Rating: 2c
Quality: Low. Total Rating: 3.0. Comment: Does not meet inclusion criteria for evidence-based review. [CA DWC]

Galantino ML, Bzdewka TM, Eissler-Russo JL, Holbrook ML, Mogck EP, Geigle P, Farrar JT, The impact of modified Hatha yoga on chronic low back pain: a pilot study, Altern Ther Health Med. 2004 Mar-Apr;10(2):56-9.

CONCLUSION: A modified yoga-based intervention may benefit individuals with CLB, but a larger study is necessary to provide definitive evidence.
PMID: 15055095
Rating: 2c

Galer BS, Bruehl S, Harden RN. IASP diagnostic criteria for complex regional pain syndrome: a preliminary empirical validation study. International Association for the Study of Pain. Clin J Pain. 1998 Mar;14(1):48-54.
Data analysis suggested that CRPS decision rules may lead to overdiagnosis of the disorder. Diagnosis based on self-reported symptoms can be diagnostically useful in some circumstances.
PMID: 9535313
Rating: 4b

Galer BS, Gammaitoni AR, Oleka N, Jensen MP, Argoff CE. Use of the lidocaine patch 5% in reducing intensity of various pain qualities reported by patients with low-back pain. Curr Med Res Opin. 2004;20 Suppl 2:S5-12.

CONCLUSIONS: In patients with moderate-to-severe LBP, 2 weeks and 6 weeks of treatment with the lidocaine patch 5% significantly reduces the intensity of pain qualities as measured by all 4 NPS composite measures.
PMID: 1556374
Rating: 4c
The Neuropathic Pain Scale was utilized to assess inclusion in this study and used as an outcome. The study was funded and written by Endo Pharmaceuticals.
Gallagher RM. Primary care and pain medicine. A community solution to the public health problem of chronic pain. Medical Clinics of North America. 01-May-1999; 83(3): 555-83, v.
The author emphasizes that pain is an important public health problem that demands attention. He discusses ineffective management and its causes, administrative and socioeconomic problems perpetuating poor care, problems in technology transfer, organizational models, specialists and subspecialists, and other topics.
Publication Type: Review

Gallagher RM. Treatment planning in pain medicine. Integrating medical, physical, and behavioral therapies. Medical Clinics of North America. 01-May-1999; 83(3): 823-49, viii.

Creating attitudes of self-help through knowledge and pain management training is complementary to the selective use of the advances in technology that have occurred in response to the explosion of neurosciences and clinical research.

Rating: 5b
Gallagher RM, Rauh V, Haugh LD, Milhous R, Callas PW, Langelier R, McClallen JM, Frymoyer J. Determinants of return-to-work among low back pain patients. Pain. 1989;39(1):55-67.
The data suggest that exclusive reliance on the physical examination to determine level of disability, without consideration of psychosocial conditions, and without adjusting for the confounding effects of age and length of time out-of-work, is not empirically justified.
PMID: 2530487
Rating: 3b

Gammaitoni A, Gallagher RM, Welz-Bosna M. Topical ketamine gel: possible role in treating neuropathic pain. Pain Med. 2000;1:97-100.

Until further information is available and larger trials can be conducted, we can only recommend this type of therapy for refractory cases in which all primary and secondary options have been exhausted.
PMID: 15101968
Rating: 5c

García Rodríguez LA, Jick H. Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs. Lancet. 1994;343:769-72. Erratum in: Lancet 1994 Apr 23;343(8904):1048.

NSAIDS should be used cautiously in patients who have other risk factors for UGIB; these include advanced age, smoking, history of peptic ulcer, and use of oral corticosteroids or anticoagulants.
PMID: 7907735
Rating: 3a

Gatchel RJ; Gardea MA. Psychosocial issues: their importance in predicting disability, response to treatment, and search for compensation. Neurologic Clinics. 01-Feb-1999; 17(1): 149-66
The conceptualization of pain and its progression into chronic disability has evolved from unidimensional models to more integrative, biopsychosocial models that take into account the many biological, psychosocial, social, and economic factors that may significantly contribute to the low back pain experience. Further, we examine the issue of compensation and how it too is intricately intertwined with the other variables contributing to lower back pain disability.
Publication Type: Review
Gatchel R., Polatin P. and Kinney R. Predicting Outcome of Chronic Back Pain Using Clinical Predictors of Psychopathology: A Prospective Analysis. Health Psychology 1995:14 (5);415-20.
These results demonstrate the presence of a psychosocial disability variable that is associated with those injured workers who are likely to develop chronic disability problems.
Rating: 3b, 324 cases
Authors’ conclusions: Psychosocial variables more important in development of back pain-related disability than injury severity and job demands. Comments: Cannot infer what psychosocial information ought to be elicited at initial office visit; SCID and MMPI not practical for routine clinical use
Gatchel RJ, Mayer TG, Kidner CL, McGeary DD. Are gender, marital status or parenthood risk factors for outcome of treatment for chronic disabling spinal disorders? J Occup Rehabil. 2005 Jun; 15(2):191-201.
Thus, in spite of the societal belief to the contrary, it seems that single parent patients can show similar chronic pain rehabilitation outcomes, relative to other CDWRSD patients, after a prescribed course of tertiary functional restoration rehabilitation.
PMID: 15844676
Rating: 4b

Gatchel RJ. Psychosocial factors that can influence the self-assessment of function. J Occup Rehabil. 2004 Sep;14(3):197-206.

The present article reviews the major psychosocial barriers to assessment/recovery that have been implicated as influencing the self-assessment of function.
PMID: 15156778
Rating: 5a

Gatchel RJ, Polatin PB, Noe C, Gardea M, Pulliam C, Thompson J. Treatment- and cost-effectiveness of early intervention for acute low-back pain patients: a one-year prospective study. J Occup Rehabil. 2003 Mar;13(1):1-9.

Results clearly indicated that the high-risk subjects who received early intervention displayed statistically significant fewer indices of chronic pain disability on a wide range of work, healthcare utilization, medication use, and self-report pain variables, relative to the high-risk subjects who do not receive such early intervention. In addition, the high-risk nonintervention group displayed significantly more symptoms of chronic pain disability on these variables relative to the initially low-risk subjects. Cost-comparison savings data were also evaluated.
PMID: 12611026
Rating: 3c

Gatchel RJ. 2005. Clinical Essentials of Pain Management. Washington, DC: American Psychological Association; 2005.

Going beyond traditional biomedical remedies, Robert Gatchel offers a comprehensive viewpoint that takes into consideration not only biological, but also psychological and social variables.
Rating: 9b

Gatchel RJ, Mayer TG, Theodore BR. The pain disability questionnaire: relationship to one-year functional and psychosocial rehabilitation outcomes. J Occup Rehabil. 2006 Mar;16(1):75-94.

RESULTS: Lower rates of work retention were associated with more severe pre-treatment PDQ scores. Higher post-treatment PDQ were associated with decreased return-to-work rates, decreased work retention and a greater percentage seeking health care from a new provider. In addition, PDQ scores were also associated with psychosocial measures such as depression and perceived pain intensity, as well as alternative measures of disability.
PMID: 16752090
Rating: 3c

Gavin, I., et al. Identification of Human Cell Responses to Hexavalent Chromium. Environmental and Molecular Mutagenesis. 2007. Volume 48: 650-57.

Rating: 5c
Quality: N/A. Total Rating: N/A. Comment: Does not meet inclusion criteria for evidence-based review. [CA DWC]

Ghoname EA, Craig WF, White PF, Ahmed HE, Hamza MA, Henderson BN, Gajraj NM, Huber PJ, Gatchel RJ, Percutaneous electrical nerve stimulation for low back pain: a randomized crossover study, JAMA 1999 Mar 3;281(9):818-23

The study concluded, “In this sham-controlled study, PENS was more effective than TENS or exercise therapy in providing short-term pain relief and improved physical function in patients with long-term LBP.”
PMID: 10071003
Rating: 2c, RCT, 60 cases
Comments: “Radiologically confirmed” disk disease may not be valid classification, since imaging tests not shown to identify discogenic pain. TENS usually applied prn; this trial applied TENS on fixed schedule & does not constitute a valid comparison of PENS with actual TENS use

Giesecke T, Williams DA, Harris RE, Cupps TR, Tian X, Tian TX, Gracely RH, Clauw DJ. Subgrouping of fibromyalgia patients on the basis of pressure-pain thresholds and psychological factors. Arthritis Rheum. 2003 Oct;48(10):2916-22.

CONCLUSION: These data help support the clinical impression that there are distinct subgroups of patients with fibromyalgia. There appears to be a group of fibromyalgia patients who exhibit extreme tenderness but lack any associated psychological/cognitive factors, an intermediate group who display moderate tenderness and have normal mood, and a group in whom mood and cognitive factors may be significantly influencing the symptom report.
PMID: 14558098
Rating: 3b

Gijsman HJ, Geddes JR, Rendell JM, Nolen WA, Goodwin GM. Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. Am J Psychiatry. 2004 Sep;161(9):1537-47.

CONCLUSIONS: Antidepressants are effective in the short-term treatment of bipolar depression. The trial data do not suggest that switching is a common early complication of treatment with antidepressants. It may be prudent to use a selective serotonin reuptake inhibitor or a monoamine oxidase inhibitor rather than a tricyclic antidepressant as first-line treatment.
PMID: 15337640
Rating: 1b

Gillis, B., et al. Identification of Human cell responses to benzene and benzene metabolites. Genomics. 2007. Number 90: 324-33.

Rating: 5c
Quality: N/A. Total Rating: N/A. Comment: Does not meet inclusion criteria for evidence-based review. [CA DWC]
Gilron I, Bailey JM, Tu D, Holden RR, Weaver DF, Houlden RL. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med. 2005 Mar 31;352(13):1324-34.
CONCLUSIONS: Gabapentin and morphine combined achieved better analgesia at lower doses of each drug than either as a single agent, with constipation, sedation, and dry mouth as the most frequent adverse effects.
PMID: 15800228
Rating: 2b
Clinical Question: Is the combination of gabapentin (Neurontin) and morphine more effective for neuropathic pain than either drug alone? Synopsis: Gabapentin and morphine are widely used for neuropathic pain, but it is unclear whether the combination is better than either drug alone. Bottom Line: The combination of gabapentin and morphine provides a small but clinically unimportant benefit over either drug alone. Tricyclic antidepressants have been shown in other studies to be as effective as gabapentin and are much less expensive, but were not studied in this trial. (Level of Evidence: 1b)

Gilron I, Watson CP, Cahill CM, Moulin DE. Neuropathic pain: a practical guide for the clinician. CMAJ. 2006;175:265-75.

We propose a primary care algorithm for treatments with the most favourable risk-benefit profile, including topical lidocaine, gabapentin, pregabalin, tricyclic antidepressants, mixed serotonin-norepinephrine reuptake inhibitors, tramadol and opioids.
PMID: 16880448
Rating: 5b

Gilron I, Coderre TJ. Emerging drugs in neuropathic pain. Expert Opin Emerg Drugs. 2007;12:113-26.
In the interest of improving patient care, the authors recommend implementing comparative studies throughout the development process in order to demonstrate the increased value of novel agents.
PMID: 17355217
Rating: 5b

Gimbel J, Linn R, Hale M, Nicholson B. Lidocaine patch treatment in patients with low back pain: results of an open-label, nonrandomized pilot study. Am J Ther. 2005;12:311-9.

Significant improvements in pain interference with quality of life (QOL) were noted for all BPI.
PMID: 16041194
Rating 4c
A non-controlled study of six-weeks in duration of patients with axial low back pain (ranging from acute/subacute to chronic), normal neurological exam, and no more than one spinal surgery was performed by the manufacturer of lidocaine patches. Patients with chronic pain were required to have diagnoses of internal disk disruption, spinal stenosis, spondylolisthesis or facet arthropathy. The Neuropathic Pain Scale was not used for an outcome. A large number of patients dropped out of this study (40/131) with 13.7% complaining of adverse effects (skin reactions, dizziness/lightheadedness, and headache) and 11% complaining of lack of efficacy. Overall at six weeks, 54% of patients reported moderate to complete improvement from baseline. The results also showed end-of-treatment reductions in an 11-point pain intensity rating scale of 21% for the short-term chronic and 32% for the long-term chronic low-back pain subgroups (≥ 30% is suggested as a clinically important reduction).The acute group had a 40% reduction, and the authors note that improvement could be secondary to spontaneous recovery.

Gitlow S, Barthwell A. Marijuana Is Not Medicine. American Society of Addiction Medicine (ASAM) 44th Annual Medical-Scientific Conference. Press Conference. Presented April 25, 2013.

Rating: 10b

Goebel A, Barker CH, Turner-Stokes L, et al. Complex regional pain syndrome in adults: UK guidelines for diagnosis, referral and management in primary and secondary care. London: RCP, 2012.

Guidelines for treatment of CRPS compiled by the UK Royal College of Physicians.
Rating: 8a

Gold BD, Scheiman JM, Sabesin SM, Vitat P. Updates on the management of upper gastrointestinal disorders in the primary care setting: NSAID-related gastropathies and pediatric reflux diseases. J Fam Pract. 2007;56:S1-S12.

The use of "traditional" NSAIDs results in serious upper gastrointestinal (GI) adverse events in nearly one fourth of patients. Cyclooxygenase-2 (COX-2)-selective inhibitors are beneficial in alleviating GI adverse events, but with the possible trade-off of causing CV adverse events in at-risk patients.
PMID: 17343806
Rating: 5a

Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA. 2004 Nov 17;292(19):2388-95.

The study concluded, “current evidence suggests efficacy of low-dose tricyclic antidepressants, cardiovascular exercise, cognitive behavioral therapy, and patient education. A number of other commonly used FMS therapies, such as trigger point injections, have not been adequately evaluated. Despite the chronicity and complexity of FMS, there are pharmacological and nonpharmacological interventions available that have clinical benefit. Based on current evidence, a stepwise program emphasizing education, certain medications, exercise, cognitive therapy, or all 4 should be recommended.”
PMID: 15547167
Rating: 1b
Goldenberg DL. Pharmacological treatment of fibromyalgia and other chronic musculoskeletal pain. Best Pract Res Clin Rheumatol. 2007;2:499-511.
There is strong evidence that tricyclic antidepressants are effective, and moderate evidence for the effectiveness of serotonin reuptake inhibitors and dual serotonin-norepinephrine reuptake inhibitors.
PMID: 17602996
Rating: 5b
Goldberg RT; Pachas WN; Keith D. Relationship between traumatic events in childhood and chronic pain. Disability Rehabilitation. 01-Jan-1999; 21(1): 23-30.

CONCLUSIONS: Child traumatic events are significantly related to chronic pain.
Publication Type: Case Control Study, 91 cases

Gore M, Dukes E, Rowbotham DJ, Tai KS, Leslie D. Clinical characteristics and pain management among patients with painful peripheral neuropathic disorders in general practice settings. Eur J Pain. 2007;11:652-64.

Among both Pure and Mixed PND patients, use and doses of evidenced-based neuropathic pain-related medications was low, and lower than the use of NSAIDs (a medication class with no proven efficacy for PNDs) in each group, suggesting possible sub-optimal neuropathic pain management among these patients.

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