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Leg Pain

The sensation of pain or other unpleasant feelings in the lower limb.

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(Source: NIH - National Cancer Institute)

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Evidence reviews

Major Trauma: Assessment and Initial Management

This guideline provides guidance on the assessment and management of major trauma, including resuscitation following major blood loss associated with trauma. For the purposes of this guideline, major trauma is defined as an injury or a combination of injuries that are life-threatening and could be life changing because it may result in long-term disability. This guideline covers both the pre-hospital and immediate hospital care of major trauma patients but does not include any management after definitive lifesaving intervention. It has been developed for health practitioners and professionals, patients and carers and commissioners of health services.

Ginkgo biloba for people with leg pain while walking (intermittent claudication)

The main symptom of peripheral arterial disease (PAD) is leg pain in one or both calves while walking. Typically, this pain occurs during walking and is relieved by a short period of rest. This clinical phenomenon is called intermittent claudication (IC). Peripheral arterial disease is caused by progressive narrowing of the arteries in one or both legs and is a manifestation of systematic atherosclerosis, possibly leading to cardiovascular events. Conservative treatment consists of treatment for cardiovascular risk factors and symptomatic relief by exercise therapy and pharmacological treatments. One of the pharmacotherapeutical options is Ginkgo biloba extract, which is derived from the leaves of the Ginkgo biloba tree and has been used in traditional Chinese medicine for centuries. It is a vasoactive agent which is believed to have a positive effect on walking ability in patients with PAD. This review shows that people using Ginkgo biloba could walk 64.5 metres further, which was a non‐significant difference compared with the placebo group. Overall, there is no evidence that Ginkgo biloba has a clinically significant benefit for patients with PAD.

Effectiveness of surgery for people with leg or back pain due to symptomatic spinal stenosis

Spinal stenosis is the narrowing of the spinal canal in the lower back region caused by thickening of the soft tissues and bones. It is a common condition for which surgery is usually performed after non‐surgical treatments (such as physiotherapy) have failed to bring sufficient relief to patients. Spinal stenosis is a common cause of low back pain that radiates to the legs, and it is more common in older adults. Surgery for lumbar spinal stenosis normally involves taking pressure off the spinal cord or spinal nerves (known as decompression) by removing bone and soft tissues from around the spinal canal. Another common surgical approach is to fuse two or more vertebrae together after decompression in the patient whose spine seems to be unstable. The usefulness of some types of surgery for lumbar spinal stenosis, however, has been questioned, and previous studies have reported that patients who receive fusion are more likely to have major complications and higher costs when compared with patients who undergo decompression only. More recently, spinal implants were created to help indirectly reduce pressure in the spinal canal and at the same time stabilise the bones. However, these implants have also been linked to worse outcomes (e.g., higher reoperation rates) when compared to conventional decompression.

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Summaries for consumers

Ginkgo biloba for people with leg pain while walking (intermittent claudication)

The main symptom of peripheral arterial disease (PAD) is leg pain in one or both calves while walking. Typically, this pain occurs during walking and is relieved by a short period of rest. This clinical phenomenon is called intermittent claudication (IC). Peripheral arterial disease is caused by progressive narrowing of the arteries in one or both legs and is a manifestation of systematic atherosclerosis, possibly leading to cardiovascular events. Conservative treatment consists of treatment for cardiovascular risk factors and symptomatic relief by exercise therapy and pharmacological treatments. One of the pharmacotherapeutical options is Ginkgo biloba extract, which is derived from the leaves of the Ginkgo biloba tree and has been used in traditional Chinese medicine for centuries. It is a vasoactive agent which is believed to have a positive effect on walking ability in patients with PAD. This review shows that people using Ginkgo biloba could walk 64.5 metres further, which was a non‐significant difference compared with the placebo group. Overall, there is no evidence that Ginkgo biloba has a clinically significant benefit for patients with PAD.

Effectiveness of surgery for people with leg or back pain due to symptomatic spinal stenosis

Spinal stenosis is the narrowing of the spinal canal in the lower back region caused by thickening of the soft tissues and bones. It is a common condition for which surgery is usually performed after non‐surgical treatments (such as physiotherapy) have failed to bring sufficient relief to patients. Spinal stenosis is a common cause of low back pain that radiates to the legs, and it is more common in older adults. Surgery for lumbar spinal stenosis normally involves taking pressure off the spinal cord or spinal nerves (known as decompression) by removing bone and soft tissues from around the spinal canal. Another common surgical approach is to fuse two or more vertebrae together after decompression in the patient whose spine seems to be unstable. The usefulness of some types of surgery for lumbar spinal stenosis, however, has been questioned, and previous studies have reported that patients who receive fusion are more likely to have major complications and higher costs when compared with patients who undergo decompression only. More recently, spinal implants were created to help indirectly reduce pressure in the spinal canal and at the same time stabilise the bones. However, these implants have also been linked to worse outcomes (e.g., higher reoperation rates) when compared to conventional decompression.

Topical agents or dressings for reducing pain in venous leg ulcers

Venous leg ulcers are often painful, both during and between dressing changes, and during surgical removal of dead tissue (debridement). Dressings, topical creams and lotions have been promoted to reduce the pain of ulcers. Two trials tested a dressing containing ibuprofen, however, the pain measures and time frames reported were different. One trial indicated that pain relief achieved over 5 days with ibuprofen dressings could represent a clinically relevant reduction in pain. The other trial found no significant difference in the chance of pain relief, measured on the first night of treatment, for ibuprofen dressings compared with foam dressings. This trial, however, was small and participants were only followed for a few weeks, which may not be long enough to assess whether the dressing affects healing. There was evidence from five trials that a local anaesthetic cream (EMLA 5%) reduces the post‐procedural pain of debriding leg ulcers but there was insufficient evidence regarding any side effects of this cream and its impact on healing.

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