Appraisal of Clinical Practice Guideline: Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury

摘要

Date of latest update: 2018. Date of next update: Not specified. Patient group:Patients with acute pain following musculoskeletal injury. Intended audience: Pa-tients with acute pain following musculoskeletal injury, orthopaedic practice clini-cians in both operative and nonoperative settings and other specialties in charge ofacute musculoskeletal pain management. Additional versions: Not specified.Expert working group: The panel included 15 members with expertise in ortho-paedic trauma, pain management, orthopaedics, sports rehabilitation, and other.Funded by: Not specified. Consultation with: No mention of consultation beyondthe working group. Approved by: This guideline was reviewed and approved byOrthopaedicTrauma Association on 16 October 2018. Location: The guidelines andadditional documents are available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485308/. Description and key recommendations: This clinical practiceguideline examines several strategies: pharmacological, cognitive, physical, andsystem strategies for acute musculoskeletal pain management. The recommenda-tions for each topic area are based on literature searches conducted by one or twomembersofthepanelinSeptember2018.Thedocumentsofeachincludedreferenceareavailableat:http://links.lww.com/JOT/A648.Thisguidelineaimedtoaddressthelack of an evidence-based guideline for acute musculoskeletal pain management.The GRADE approach was used to rate the strength of the recommendations andquality of the evidence. There is a strong recommendation in support of cognitiveand emotional strategies (moderate-quality evidence) such as anxiety reduction,self-efficacy improvement, aromatherapy, music therapy, or cognitive behaviouraltherapy.Theuseofphysicalmodalities,suchasTENS,isrecommendedasadjunctivetreatment for immediate painreduction either after injuryor postoperatively (low-qualityevidence).Theriskofmisuseofopioidsandtheiradverseclinicaleventswasnoted by the panel, and the lowest effective dose for the shortest period possible isalsostronglyrecommended(high-qualityevidence).Accordingtotheconclusionsofthis guideline, a multi-modal approach – including physical, pharmaceutical andcognitive strategies – based on patient safety and comfort is the best practice foracute musculoskeletal pain management.