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The Low Back Pain Clinical Care Standard provides an excellent guide for how each of the professions can contribute to better care of low back pain. Conclusion The Low Back Pain Clinical Care Standard meets an urgent need to provide a resource to ensure curricula relevant to low back pain are up to date, and a clear roadmap for existing clinicians to deliver best care for people with low back pain. Keywords: Back pain; Guidelines as topic EN Back pain Guidelines as topic 354 356 3 05/03/23 20230501 NES 230501 A new clinical care standard provides evidence-based guidance to help clinicians deliver best care for people with low back pain In September 2022, the Australian Commission on Safety and Quality in Health Care released its Low Back Pain Clinical Care Standard.[1] The Standard covers the early clinical management of people who present with a new acute episode of low back pain. [Extracted from the article]

Objective: To evaluate the efficacy and safety of opioids for analgesic therapy for people with osteoarthritis. Study design: Systematic review and meta‐analysis of randomised, placebo‐controlled trials of opioid therapies for treating the pain of osteoarthritis. The primary outcome was medium term pain relief (six weeks to less than 12 months). Quality of evidence was assessed with GRADE criteria. Data sources: MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews and Central Register of Controlled Trials, CINAHL, PsycINFO, AMED, and the WHO International Clinical Trials Registry; trials published to 31 October 2020. Data synthesis: We extracted pain, disability, health‐related quality of life, and adverse events data for 36 eligible trials (overall dose range: 10‒210 oral morphine milligram equivalents [MME] per day). Continuous pain and disability outcomes were converted to common 0–100‐point scales; changes of less than ten points were deemed to be very small effects. Differences in dichotomous outcomes were expressed as risk ratios. Data were pooled for meta‐analysis in random effects models. The evidence from 19 trials (8965 participants; dose range, 10–126 MME/day) for very small medium term pain relief (mean difference [MD], –4.59 points; 95% CI, –7.17 to –2.02 points) was low quality, as was that from 16 trials (6882 participants; dose range, 10–126 MME/day) for a very small effect on disability (MD, –4.15 points; 95% CI, –6.94 to –1.35 points). Opioid dose was not statistically significantly associated with either degree of pain relief or incidence of adverse events in a meta‐regression analysis. Evidence that opioid therapy increased the risk of adverse events (risk ratio, 1.43; 95% CI, 1.29‒1.59) was of very low quality. Conclusions: Opioid medications may provide very small pain and disability benefits for people with osteoarthritis, but may also increase the risk of adverse events. PROSPERO registration: CRD42019142813 (prospective). [ABSTRACT FROM AUTHOR]

Keywords: Adverse events; Adverse drug reactions; Clinical trials as topic EN Adverse events Adverse drug reactions Clinical trials as topic 502 504 3 11/14/22 20221115 NES 221115 Better reporting of harms is needed in clinical trials to support better decision making Harms in clinical trials may be characterised by adverse events (AEs) and adverse reactions. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. For drug trials, researchers should clearly distinguish between AEs occurring during and after treatment (ie, report them separately); and for surgical trials, AEs should be reported separately for the intra- and postoperative period. [Extracted from the article]

Objective: To evaluate the efficacy and safety of paracetamol as an analgesic medication in a range of painful conditions.Study Design: Systematic review of systematic reviews of the analgesic effects of paracetamol in randomised, placebo-controlled trials. Conduct of systematic reviews was assessed with AMSTAR-2; confidence in effect estimates (quality of evidence) was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.Data Sources: MEDLINE, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews; systematic reviews published 1 January 2010 - 30 April 2020.Data Synthesis: We extracted pain and adverse events outcomes from 36 systematic reviews that assessed the efficacy of paracetamol in 44 painful conditions. Continuous pain outcomes were expressed as mean differences (MDs; standardised 0-10-point scale); dichotomous outcomes were expressed as risk ratios (RRs). There is high quality evidence that paracetamol provides modest pain relief for people with knee or hip osteoarthritis (MD, -0.3 points; 95% CI, -0.6 to -0.1 points) and after craniotomy (MD, -0.8 points; 95% CI, -1.4 to -0.2 points); there is moderate quality evidence for its efficacy in tension-type headache (pain-free at 2 hours: RR, 1.3; 95% CI, 1.1-1.4) and perineal pain soon after childbirth (patients experiencing 50% pain relief: RR, 2.4; 95% CI, 1.5-3.8). There is high quality evidence that paracetamol is not effective for relieving acute low back pain (MD, 0.2 points; 95% CI, -0.1 to 0.4 points). Evidence regarding efficacy in other conditions was of low or very low quality. Frequency of adverse events was generally similar for people receiving placebo or paracetamol, except that transient elevation of blood liver enzyme levels was more frequent during repeated administration of paracetamol to patients with spinal pain (RR, 3.8; 95% CI, 1.9-7.4).Conclusions: For most conditions, evidence regarding the effectiveness of paracetamol is insufficient for drawing firm conclusions. Evidence for its efficacy in four conditions was moderate to strong, and there is strong evidence that paracetamol is not effective for reducing acute low back pain. Investigations that evaluate more typical dosing regimens are required.Prospero Registration: CRD42015029282 (prospective). [ABSTRACT FROM AUTHOR]

Introduction: Research in the past decade supports some major changes to the primary care management of non-specific low back pain (LBP). The present article summarises recommendations from recently published United Kingdom, Danish, Belgian and United States guidelines to alert readers to the important changes in recommendations for management, and the recommendations from previous guidelines that remain unchanged. Main recommendations: Use a clinical assessment to triage patients with LBP. Further diagnostic workup is only required for the small number of patients with suspected serious pathology. For many patients with non-specific LBP, simple first line care (advice, reassurance and self-management) and a review at 1-2 weeks is all that is required. If patients need second line care, non-pharmacological treatments (eg, physical and psychological therapies) should be tried before pharmacological therapies. If pharmacological therapies are used, they should be used at the lowest effective dose and for the shortest period of time possible. Exercise and/or cognitive behavioural therapy, with multidisciplinary treatment for more complex presentations, are recommended for patients with chronic LBP. Electrotherapy, traction, orthoses, bed rest, surgery, injections and denervation procedures are not recommended for patients with non-specific LBP. Changes in management as a result of the guidelines: The major changes include: emphasising simple first line care with early follow-up; encouraging non-pharmacological treatments over pharmacological treatments; and recommending against the use of surgery, injections and denervation procedures. [ABSTRACT FROM AUTHOR]

Introduction: Overactive bladder (OAB) is a highly prevalent medical condition that has an adverse impact on various health-related quality-of-life domains, including a significant psychosocial and financial burden. This position statement, formulated by members of the Urological Society of Australia and New Zealand and the UroGynaecological Society of Australasia, summarises the current recommendations for clinical diagnosis and treatment strategies in patients with non-neurogenic OAB, and guides clinicians in the decision-making process for managing the condition using evidence-based medicine. Main recommendations: Diagnosis and initial management should be based on thorough clinical history, examination and basic investigations to exclude underlying treatable causes such as urinary tract infection and urological malignancy. Initial treatment strategies for OAB involve conservative management with behavioural modification and bladder retraining. Second-line management involves medical therapy using anticholinergic or β3 agonist drugs provided there is adequate assessment of bladder emptying. If medical therapy is unsuccessful, further investigations with urodynamic studies and cystourethroscopy are recommended to guide further treatment. Intravesical botulinum toxin and sacral neuromodulation should be considered in medical refractory OAB. Changes in management as a result of this statement: OAB is a constellation of urinary symptoms and is a chronic condition with a low likelihood of cure; managing patient expectations is essential because OAB is challenging to treat. At present, the exact pathogenesis of OAB remains unclear and it is likely that there are multiple factors involved in this disease complex. Current medical treatment remains far from ideal, although minimally invasive surgery can be effective. Further research into the pathophysiology of this common condition will hopefully guide future developments in disease management. [ABSTRACT FROM AUTHOR]

Diagnostic triage is an essential guideline recommendation for low back pain (LBP), which is the most frequent musculoskeletal condition that general practitioners encounter in Australia. Clinical diagnosis of LBP - informed by a focused history and clinical examination - is the key initial step for GPs, and determines subsequent diagnostic workup and allied health and medical specialist referral. The goal of diagnostic triage of LBP is to exclude non-spinal causes and to allocate patients to one of three broad categories: specific spinal pathology (< 1% of cases), radicular syndrome (∼ 5-10% of cases) or non-specific LBP (NSLBP), which represents 90-95% of cases and is diagnosed by exclusion of the first two categories. For specific spinal pathologies (eg, vertebral fracture, malignancy, infection, axial spondyloarthritis or cauda equina syndrome), a clinical assessment may reveal the key alerting features. For radicular syndrome, clinical features distinguish three subsets of nerve root involvement: radicular pain, radiculopathy and spinal stenosis. Differential diagnosis of back-related leg pain is complex and clinical manifestations are highly variable. However, distinctive clusters of characteristic history cues and positive clinical examination signs, particularly from neurological examination, guide differential diagnosis within this triage category. A diagnosis of NSLBP presumes exclusion of specific pathologies and nerve root involvement. A biopsychosocial model of care underpins NSLBP; this includes managing pain intensity and considering risk for disability, which directs matched pathways of care. Back pain is a symptom and not a diagnosis. Careful diagnostic differentiation is required and, in primary care, diagnostic triage of LBP is the anchor for a diagnosis. [ABSTRACT FROM AUTHOR]

Back pain is very common; it has a point prevalence of 25% and is the third most common reason for consultation in Australian general practice. A thorough history and examination can identify the minority of patients who require urgent neuroimaging or other targeted investigations. Careful correlation of clinical and radiological findings is required when abnormal neurological findings are detected. Radiological investigations may detect abnormalities at multiple levels but cannot confirm which level is primarily responsible for a patient's symptoms. A trial of conservative treatment is appropriate, even in cases of radiculopathy. Most patients with an acute episode of back pain recover within 6-12 weeks, but at least a third go on to have a recurrent episode within 1 year. Various invasive treatments, such as transforaminal steroid injection and discectomy, may speed up recovery from radiculopathy, but the long-term benefits of invasive treatment are uncertain. [ABSTRACT FROM AUTHOR]

The article talks about the efforts by clinical, consumer and research organisations in Australia to deal with the challenges of overdiagnosis in the country, discussing the efforts of international community to deal with the issue, and the growth in global evidence base for the issue.

The article focuses on the Hepatitis C Incidence and Transmission Study-community (HITS-c), a community-based prospective observational study designed to inform future trials of candidate hepatitis C virus (HCV) vaccines, which found that opioid substitution therapy protects against HCV acquisition in people who inject drugs (PWID). It notes that HCV is highly prevalent globally among PWID. Figures are revealed on the percentage of people affected by HCV globally.

The article discusses the issues concerning the scope, funding and publication of musculoskeletal (MSK) clinical trials in Australia. The 2010 Global Burden of Disease study is highlighted which revealed that MSK conditions account 6.8 percent of the total disease burden. The funds allocated by the National Health and Medical Research Council (NHMRC) for MSK clinical trials from 2009 to 2014 are outlined.

The article focuses on back pain and leg weakness. It notes that back pain stands as the most common cause for medical consultation, risk factors of which include presumed musculo-ligamentous injury, radiculopathy and referred visceral pain. It explores the clinical case of a 67-year-old woman experiencing low back pain that radiates below the knee. It also provides the differential diagnoses of a footdrop which include radiculopathy, hemi-conus or -cord lesions and subcortical lesions.

Placebos, even when honestly described as inert, create important clinical effects It has been recently suggested that it may be possible for clinicians to openly describe placebos as inert, but still elicit important clinical effects.1 So-called open label placebos have moved beyond research settings and it is now possible to purchase Zeebo (Zeebo Effect) placebo pills branded as "Zeebo Relief Pure Honest Placebo". Reviews that appropriately estimate the placebo effect as the difference in outcomes between placebo and no treatment groups suggest that placebos usually have modest effects. A placebo supporter could counter that they could get a bigger placebo treatment effect by dispensing large, red, unusually shaped placebo pills, but they would be basing this on uncertain evidence. [Extracted from the article]

We examined if there was any relationship between MRFF funding and disease burden, and if fatal or non-fatal burden better explains MRFF allocation to disease groups. However, the current trend of MRFF distribution suggests targeted, disease-based funding provided through the MRFF tends to go to disease groups with a high death burden and does not target disability burden. Keywords: Resource allocation; Health financing EN Resource allocation Health financing 111 111 1 03/12/21 20210215 NES 210215 The disability burden of non-fatal disease is not reflected in allocation of grants The Medical Research Future Fund (MRFF) has become an increasingly important part of health and medical research funding in Australia. [Extracted from the article]

The article presents a randomised controlled trial (RCT) which investigates the effectiveness of laser therapy for genitourinary syndrome of menopause (GSM) or vaginal atrophy.

The authors discuss the need to enforce a policy which would support the implementation of prison needle and syringe programs in Australian prisons to prevent the transmission of blood-borne viruses (BBVs). They tackle the high prevalence of BBVs and the support of Jon Stanhope and Katy Gallagher, former chief ministers of the Australian Capital Territory (ACT), for the implementation of the programs. They commend the ACT government for prioritizing the prison BBV prevention.

A letter to the editor is presented in which the senders discuss the operation of the Sydney Medically Supervised Injecting Centre, the only supervised injecting facility (SIF) in Australia.

A letter to the editor is presented regarding the changes needed to the current direction and interpretation of clinical cancer research to meet the needs of the 21st century.