Steven A. King, MD, MS, is in the private practice of pain medicine in New York, and he is Clinical Professor of Psychiatry at the New York University School of Medicine, New York.
Steriod injections have long been the go-to treatment for musculoskeletal ailments like low back pain and tennis elbow. Here, conventional wisdom gets a closer look.
Epidural steroid injections turned deadly raise pointed controversy over poor oversight of compounding pharmacies. But tainted or not, are the injections a valid therapy for back pain at all? Here, one expert’s opinion.
There is some evidence for counseling patients with chronic pain about their intake of specific types of foods. Polyunsaturated fatty acids, polyamines, and foods rich in flavonoids are discussed here.
When is it time to refer your patient with low back pain to a specialist for possible spine surgery? How long should you give conservative measures a try? What symptoms signal the need for urgent care? In this video, an expert addresses these and other pressing questions.
Screening instruments used to assess risk for abuse of opioid analgesics aren’t infallible, but they can be an adjunct to regular in-depth conversation with your patients.
The Alliance for Rational Use of NSAIDs has been launched to inform health care professionals, patients, and the public about using NSAID therapy safely and appropriately and balancing the benefits and risks.
Reliable predictors of pain were identified by surveying hospital patients throughout their stays about the severity of their pain and their levels of satisfaction with how their pain was managed by hospital staff.
Which prescribers will be most affected by the FDA's Risk Evaluation and Mitigation Strategy program for extended-release and long-acting opioids? Probably not those it seeks to reign in. More, here.
The American Academy of Radiology guideline for use of imaging in the diagnosis of headache says these tests are rarely beneficial. Here, a review of when, and when not, to order MRIs or CT scans.
Benzodiazepines are overprescribed and abused; are increasingly responsible for emergency room visits; and are contraindicated for patients with chronic pain. Is this a surprise? Read more, here.
Patients often worry that low back pain indicates serious injury or disease that may rapidly progress. However, most acute back pain improves significantly within a month of onset and requires little treatment apart from OTC analgesics and sometimes heat.
Chronic pain management in the elderly is complex. Safe and effective use of analgesic medications in geriatric patients requires risk-benefit analysis.
Medication overuse headache can result from overuse of any drug to abort acute headache. Discontinuation is the only effective treatment and is difficult.
Complex regional pain syndrome (CRPS) can be tricky to
diagnose. This review describes criteria for identifying CRPS, and gives guidance for treatment, with case studies and photographs. More »
ABSTRACT: Osteoarthritis (OA) was considered a disease of articular
cartilage but now is thought to involve the entire joint. Research findings
have helped improve the understanding of disease progression
and the strategies used to alter the disease course. There is no laboratory
or pathological... More »
Opioid analgesics provide effective treatment for noncancer
pain, but many physicians have concerns about adverse effects,
tolerance, and addiction. Misuse of these drugs is prominent
in patients with chronic pain. Recognition and early prevention of
misuse helps physicians identify the causes... More »
ABSTRACT: Physicians treating patients with fibromyalgia syndrome
(FMS) should rule out coexisting disorders and establish possible inducing
factors. They can work with patients to address their symptoms
by providing patient education, instilling a sense of self-worth,
advising avoidance of... More »
Low back pain (LBP) is a major public health problem and a common reason for patient visits to a primary care physician. A pathoanatomically precise diagnosis cannot be made in most patients, and the primary care physician typically has only limited time to conduct a complete examination. A... More »
Shin pain is a common complaint in runners and other
active patients. Making a diagnosis can be difficult because the differential
is broad and symptoms may overlap. Palpation is an important
part of the physical examination. The primary presenting
symptom in medial tibial stress syndrome, or... More »
Open communication between patient and physician is essential, but there is a discrepancy between physicians’ perception of their communication effectiveness and the reality.More »
New formulations of several opioids were introduced during the past year. This month's column reviews current recommendations for the use of these medications and how they compare with previously available opioids. More »
Highlights from the International Headache Congress are presented by Stephen D. Silberstein, MD, professor of neurology at Jefferson Medical College and director of the headache center at Thomas Jefferson University, Philadelphia, as well as chair of the congress organizing committee.
Purpose: Mechanical low back pain is common in the pediatric population; recent studies have shown that undiagnosed mechanical low back pain (UMLBP) is the most common cause of low back pain presenting in adolescents, accounting for up
Background: There are contradictory reports on the overall prevalence of back pain in the adolescent population compared with adolescent idiopathic scoliosis (AIS) patients. Most reports do not investigate pain in patients with AIS but tr
Objectives: To assess the magnitude of management delay of pediatric malignant spinal cord compression (MSCC). Methods: Twenty-four patients with MSCC were recruited from 3 Egyptian pediatric oncology centers and assessed for MSCC clinical present
Background: The aim of this study was to investigate if an association existed between the reflected head of rectus femoris avulsion injuries and labral tears in pediatric patients referred for magnetic resonance arthrography (MRA) or ma
Additional components of societal burden omitted from our study include intangibles from pain and suffering, resources from care provided by nonpaid caregivers, and the burden associated with undiagnosed diabetes.
Commentary on: JenningsPA, Cameron P, Bernard S, et al.. Morphine and ketamine is superior to morphine alone for out-of-hospital trauma analgesia: a randomized controlled trial. <I>Ann Emerg Med</I>2012;59:497–503.
Commentary on: RakelBABlodgettNPBridget ZimmermanM. Predictors of postoperative movement and resting pain following total knee replacement. <strong>Pain</strong>2012;153:2192–203.
Implications for practice and research
Younger patients with higher preoperative pain and depression are more likely to have hig
Commentary on Manias E. Complexities of pain assessment and management in hospitalised older people: a qualitative observation and interview study. Int J Nurs Stud 2012;49:1243–54
Implications for practice and research
Staff need more education around identification of pain and options for management among the older population.
Pain assessment methods should be brief and simple, followed by an algorithm for mana
Although the relationship between psychosocial workplace conditions and musculoskeletal problems has been extensively studied, the causal impact of psychosocial workplace factors in the development of musculoskeletal problems remains unclear. The purpose of the present study was to conduct a systematic review of baseline-adjusted prospective longitudinal studies estimating the lagged effect of psychosocial risk factors on musculoskeletal problems in industrialized work settings. A literature review was conducted by searching the MEDLINE, EMBASE, and PsychINFO databases dated until August 2009. The authors classified studies into categories of psychological work stressors and musculoskeletal problems. Available effect sizes were converted to odds ratios (OR). ORs were then pooled for each stressor-problem relationship using a random-effects model. Additionally, the possibility of publication bias was assessed with the Duval and Tweedie nonparametric "trim and fill" procedure. In total,
To update the 2005 Cancer Care Ontario practice guidelines for the diagnosis and treatment of adult patients with a suspected or confirmed diagnosis of extradural malignant spinal cord compression (MESCC).|A review and analysis of data published from January 2004 to May 2011. The systematic literature review included published randomized control trials (RCTs), systematic reviews, meta-analyses, and prospective/retrospective studies.|An RCT of radiation therapy (RT) with or without decompressive surgery showed improvements in pain, ambulatory ability, urinary continence, duration of continence, functional status, and overall survival. Two RCTs of RT (30 Gy in eight fractions vs. 16 Gy in two fractions; 16 Gy in two fractions vs. 8 Gy in one fraction) in patients with a poor prognosis showed no difference in ambulation, duration of ambulation, bladder function, pain response, in-field failure, and overall survival. Retrospective multicenter studies reported that protracted RT schedules
Five Steps to Improving Patient Access Judy Capko, May 21, 2013 Patient access is getting increased attention through reform initiatives. Here are five steps you can take to make sure patients get appropriate access to care in your office.
Growing HIPAA Threat – Ignore Windows XP at Your Own Peril Marion K. Jenkins, May 21, 2013 Chances are good that you have some major ticking software time bombs lurking in your medical practice's computer environment, namely Windows XP and Server 2003.
Three Areas to Reduce Costs at Your Medical Practice Greg Mertz, May 19, 2013 By taking a hard look at reducing costs for staffing, overhead, and technology at your medical practice, you may see increased physician compensation.
Dos and Don’ts for Starting a Physician Blog Michael Woo-Ming, MD, May 18, 2013 Starting a physician blog can provide your medical practice with marketing benefits, but it's important to do it right.
Reviews the evidence for and against hundreds of preventive health services, recommending tests, and counseling interventions when evidence exists that it is effective.
Reviews the evidence for and against hundreds of preventive health services, recommending tests, and counseling interventions when evidence exists that it is effective.
Steriod injections have long been the go-to treatment for musculoskeletal ailments like low back pain and tennis elbow. Here, conventional wisdom gets a closer look.
Epidural steroid injections turned deadly raise pointed controversy over poor oversight of compounding pharmacies. But tainted or not, are the injections a valid therapy for back pain at all? Here, one expert’s opinion. 
Screening instruments used to assess risk for abuse of opioid analgesics aren’t infallible, but they can be an adjunct to regular in-depth conversation with your patients. 
Which prescribers will be most affected by the FDA's Risk Evaluation and Mitigation Strategy program for extended-release and long-acting opioids? Probably not those it seeks to reign in. More, here. 
The American Academy of Radiology guideline for use of imaging in the diagnosis of headache says these tests are rarely beneficial. Here, a review of when, and when not, to order MRIs or CT scans. 
Benzodiazepines are overprescribed and abused; are increasingly responsible for emergency room visits; and are contraindicated for patients with chronic pain. Is this a surprise? Read more, here. 
Chronic pain management in the elderly is complex. Safe and effective use of analgesic medications in geriatric patients requires risk-benefit analysis. 
Medication overuse headache can result from overuse of any drug to abort acute headache. Discontinuation is the only effective treatment and is difficult.
In many patients, episodic migraines increase in frequency and transform into a refractory pattern.
