NEW ZEALAND MEDICAL JOURNAL http://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2014/vol-127-no-1407/6398

METHUSELAH

Efficacy of paracetamol for acute low-back pain Regular paracetamol is the recommended first-line analgesic for acute low-back pain; however, no high-quality evidence supports this recommendation. This report concerns a randomised trial concerning this hypothesis. 1652 patients with acute low-back pain were randomly assigned to receive regular doses of paracetamol, as needed doses of paracetamol, or placebo. The median time to recovery was 17 days in the regular group, 17 days in the as-needed group, and 16 days in the placebo group. Adverse effects were reported in 18.5%, 18.7%, and 18.5% in the 3 groups. No differences were noted in secondary outcomes (short-term pain relief between 1 and 12 weeks, disability, function, global rating of symptom change, sleep, or quality of life) between the 3 groups. All patients received advice to remain active, avoid bed rest, and were reassured of a favourable outcome. At 12 weeks about 85% of participants had recovered. The researchers concluded that regular or as-needed dosing with paracetamol does not affect recovery time compared with placebo in low-back pain, and question the universal endorsement of paracetamol in this patient group. Lancet 2014;384:1586–96.

Postherpetic neuralgia Approximately a fifth of patients with herpes zoster report some pain at 3 months after the onset of symptoms, and 15% report pain at 2 years. Approximately 6% have a score for pain intensity of at least 30 out of 100 at both time points. The incidence of both herpes zoster and postherpetic neuralgia are both related to age. In one study, the incidence of the neuralgia rose from 8% in the 50–54 year old cohort to 21% at 80–84 years of age. This review looks at treatment of this painful condition. Lidocaine patches and capsaicin cream may be effective but can cause erythema, and the capsaicin may cause pain. Gabapentin, pregabalin and tricyclic antidepressants may help but their adverse effects may limit their use. Opiates may cause more problems than benefits. Unfortunately, clinical trials reveal that fewer than half these patients have a 50% reduction in pain. A live attenuated varicella-zoster virus vaccine which became available (in the UK) in 2006 for use in immunoincompetent individuals can significantly reduce the incidence of both zoster and postherpetic neuralgia. N Eng J Med 2014;371:1526–33.

Effects of hospital-acquired conditions on length of stay for patients with diabetes This study evaluates the rates and types of hospital-acquired conditions among patients with and without diabetes and assesses any effects on their length of stay (LOS) in hospital. 47,615 admission episodes in a Victorian Hospital were reviewed. The incidence of Hospital-Acquired Diagnoses and the LOS were compared between diabetics with end organ sequelae (EOS), diabetics without EOS, and non-diabetics. Almost 30% of patients with diabetes and EOS had at least one Hospital-Acquired Diagnosis compared with 13% for non-diabetics. The predominant complications were infections, cardiovascular complications, and metabolic complications. The mean LOS in hospital was found to

NZMJ 19 December 2014, Vol 127 No 1407; ISSN 1175-8716 Page 92 Subscribe to the NZMJ: http://www.nzma.org.nz/journal/subscribe © NZMA

NEW ZEALAND MEDICAL JOURNAL http://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2014/vol-127-no-1407/6398 be 8.26 days for diabetics with EOS, 4.01 days for diabetics without EOS, and 2.52 days for non- diabetic subjects. Internal Medicine Journal 2014;44:1109–1116.

NZMJ 19 December 2014, Vol 127 No 1407; ISSN 1175-8716 Page 93 Subscribe to the NZMJ: http://www.nzma.org.nz/journal/subscribe © NZMA