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Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Facial pain referrals to neurology

Centre for Sustainable Delivery

Introduction

This Fact Sheet provides information on how to treat patients with facial pain with different symptoms, situations and circumstances.

Please note this fact sheet is only designed as a brief summary of management.

 

What are the common causes of facial pain?

Like headache, facial pain diagnoses are fundamentally based on history. Common causes are:

 

Migraine

Facial pain is common as part of acute migraine.

 

Oral / dental structures / salivary glands

This is usually intra-oral pain, occasionally facial pain.

 

Persistent idiopathic facial pain (previously “atypical facial pain”)

Usually constant unilateral pain and resistant to all medication. Similar patient profile to fibromyalgia and other chronic pain syndromes.

 

Sinusitis

Over diagnosed from a neurology perspective (usually migraine or persistent idiopathic facial pain). ENT state that sinusitis always includes one of nasal blockage, nasal congestion or nasal discharge.

 

Temporal arteritis

A rare but important cause of facial pain, usually in people >70 and rare in <60 years. Have a low threshold for checking ESR (usually >50) or CRP (>5). If suspected refer urgently to neurology.

 

Temporomandibular joint disorders (TMJ)

This is usually associated with jaw movement.

 

Trigeminal neuralgia

Trigeminal neuralgia is the most common of the craniofacial neuralgias; characteristic history, 70% are over 60 years old, almost always unilateral (bilateral with alternating unilaterality very rare), typically V2 and V3 (cheek and jaw). Lancinating, stabbing, jolts of pain usually lasting seconds. Pain is spontaneous or triggered by simple stimuli such as touching, teeth brushing, talking/chewing. About half have underlying persistent facial pain.

 

When should I request a CT head?

CT head in persistent idiopathic facial pain or migraine is not usually indicated.

For trigeminal neuralgia it may be reasonable to refer for assessment and subsequent MRI, if you think the patient may be a candidate for surgical treatment. If they are not, and there are no other focal neurological symptoms or signs, then reasonable to manage in primary care.

 

What treatments can I try in primary care and when should I refer?

Facial pain not fitting with above descriptions

Treatment: If mild, consider tricyclic prior to referral

 

Migraine

Treatment: As per headache pathway

When to refer to neurology: Treatment resistant migraine only (3 preventative agents >3 months and appropriate acute treatment (see RefHelp guidance on Migraine).

 

Persistent idiopathic facial pain (previously “atypical facial pain”)

Treatment: Tricyclics, e.g. amitriptyline, nortriptyline

When to refer to neurology: If no focal neurological symptoms or signs then suggest referral to pain service.

 

Sinusitis / TMJ / oral

Referral to Ear Nose and Throat (ENT) / maxillofacial / oral surgery

 

Temporal arteritis

Refer to on call neurology service if typical story and ESR and CRP high

 

Trigeminal neuralgia

Treatment:

  • Carbamazepine or oxcarbazepine are the drugs of choice
  • Second line agents (with poor evidence base) include lamotrigine, gabapentin, pregabalin, baclofen, phenytoin
  • Invasive therapies: microvascular decompression or ablative procedures

When to refer to neurology: 

  • If not responding to medication then patient may be suitable for surgical treatment (refer to neurosurgery)
  • If not suitable for neurosurgery or diagnostic uncertainty refer to neurology

 

References

Lambru G, Zakrzewska J, Matharu M. Trigeminal neuralgia: a practical guide. Practical Neurology 2021;21:392-402. DOI: 10.1136/practneurol-2020-002782 

Siccoli MM, Bassetti CL, Sándor PS. Facial pain: clinical differential diagnosis. Lancet Neurol. 2006 Mar;5(3):257-67. DOI: 10.1016/S1474-4422(06)70375-1

 

Editorial Information

Last reviewed: 20/12/2024

Next review date: 17/12/2027

Author(s): Centre for Sustainable Delivery.

Version: 2