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It is not recommended to prescribe opioids (particularly long-acting opioids) as first-line or monotherapy for chronic non-cancer pain (CNCP).
Choosing Wisely Australia
Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists
The true place of opioids in chronic non-cancer pain (CNCP) is unknown. Most trials of their efficacy have been of less than twelve weeks duration and have shown only modest effects. By contrast opioid use in CNCP has been associated with increased distress, poorer self-rated health, inactivity during leisure, unemployment, higher healthcare utilisation and lower quality of life, suggesting failure to appreciate the complex nature of these conditions. Opioids should not be used alone or as ...
ver más ... 2018Do not order antidouble stranded (ds) DNA antibodies in ANA negative patients unless clinical suspicion of systemic lupus erythematosus (SLE) remains high.
Choosing Wisely Australia
Australian Rheumatology Association
International recommendations advise testing for anti-dsDNA antibodies only after detecting a positive ANA in patients with symptoms consistent with systemic lupus erythematosus. In patients who are ANA negative, anti-dsDNA should only be ordered in clinical situations where the pretest probability of SLE is very high. Where positive, repeating anti-dsDNA antibodies titres is a useful test for monitoring disease activity, especially in lupus nephritis.
ver más ... 2018It is not recommended to use ultrasound guidance to perform injections into the subacromial space as it provides no additional benefit in comparison to landmark-guided injection.
Choosing Wisely Australia
Australian Rheumatology Association
Currently there is no high-quality evidence to support the superiority of ultrasound-guided subacromial injections compared with injections guided by landmarks alone. Based upon moderate quality evidence from five trials, a Cochrane review was unable to find any advantage (in terms of pain, function, range of motion or adverse events) of ultrasound-guided injection over either landmark-guided or intramuscular injection. These results are consistent with a more recent trial. In view of the ...
ver más ... 2018It is not recommended to undertake imaging for low back pain in patients without indications of a serious underlying condition.
Choosing Wisely Australia
Australian Rheumatology Association
Most episodes of low back pain (~90%) do not require imaging. Imaging may identify irrelevant incidental findings and increase the risk of exposure to unnecessary, and sometimes invasive treatment, in addition to increasing costs. For patients with low back pain and no suggestion of serious underlying conditions there are no significant differences in pain or disability outcomes between immediate imaging as compared with usual care without imaging.
ver más ... 2018It is not recommended to order antinuclear antibody (ANA) testing without symptoms and/or signs suggestive of a systemic rheumatic disease.
Choosing Wisely Australia
Australian Rheumatology Association
Antinuclear antibodies (ANAs) are present in healthy individuals and ANA testing is only useful in patients with symptoms and/or signs of a rheumatic disease where it can aid in the confirmation or exclusion of systemic connective tissues diseases. ANA testing has a very high negative predictive value for excluding connective tissue diseases as a cause for patients’ symptoms. However, a positive ANA result does not have a high positive predictive value for diagnosing these conditions in ...
ver más ... 2018