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.
A bright, active 10-year-old boy has been experiencing recurrent bouts of
abdominal pain with nausea and occasional vomiting for 3 years. Although he
has had 1 or 2 attacks at school, the pain usually occurs at home—frequently
on weekends. His mother has been unable to correlate these episodes with particular
foods or activities. She notes that her son has experienced motion sickness
during long auto trips and during a family holiday in the mountains of
Colorado.
A 65-year-old woman with a long history of hypertension treated with metoprolol and felodipine complained of dizziness, headache, nausea, and vomiting of acute onset. Her blood pressure was 220/110 mm Hg. She was drowsy and unable to stand or walk.
A 28-year-old man presents to
the emergency department
with high fever; progressive, severe,
generalized, throbbing headache;
blurred vision; and increasing
confusion. These symptoms started
3 days earlier.
A 37-year-old woman presents to the emergency department
with a diffuse, sharp, pounding headache,
which started 2 hours earlier. She rates her discomfort as
4 on a scale of 1 to 10. Neck muscle soreness is also present,
but the pain does not radiate.
Migraine is an episodic, often debilitating
condition that affects women more
often than men. Twenty-eight million
Americans suffer from migraine
headaches—and nearly 75% of these
are women.1 Unlike other chronic pain
conditions, migraine has its peak
prevalence during the years of greatest
productivity, when most women are
juggling family responsibilities and
careers.2 Many women are particularly
susceptible to migraine attacks just
before and during menses.
New in the non-rheumatology journals, much about pain: A review based on 2012 fibromyalgia guidelines from Canada, a viewpoint on safe use of opioids, the evidence to back spinal pain interventions. Also: fast-track arthroplasty, and more newfound genes. More »
A discovery that patients with fibromyalgia showed signs of small fiber impairment not present in depressed patients or controls may point to the first objectively measurable alteration of the peripheral nervous system in this disorder. More »
Evidence-based analysis shows that weak opioids have at best a weak effect in rheumatoid arthritis pain. Steroid injections offer no long-term relief for tennis elbow. More »
Pain is the main problem that sends patients to rheumatologists, but studies of medication for rheumatic disorders such as RA have focused on inflammation, not pain. A review points out what is not known currently about analgesia in inflammatory arthritis and urgently needs to be studied. More »
(AUDIO) A new paradigm in pain research provides simple ways to identify patients with disorders like arthritis or lupus who won't respond to standard treatments. Pain expert Daniel Clauw MD gives the details in this podcast. More »
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. More »
Results of studies of systemic treatments for patients with osteoarthritis indicate significant positive effects on biomarkers that may be associated with disease progression but no significant effects on joint-space narrowing. More »
Early intervention for knee osteoarthritis is crucial to prevent disability, but what are the best alternatives to long-term medication? This review examines and compares self-help and alternative interventions including exercise, strength training, glucosamine/chondroitin, acupuncture, and walking... 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
Primary Care Can't Thrive Without Nurse Practitioners Courtney H. Lyder, ND, May 17, 2013 With a projected shortfall of primary-care physicians, it's time for alternate solutions to patient care. Nurse practitioners are one logical remedy.
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.
A 65-year-old woman with a long history of hypertension treated with metoprolol and felodipine complained of dizziness, headache, nausea, and vomiting of acute onset. Her blood pressure was 220/110 mm Hg. She was drowsy and unable to stand or walk.
In many patients, episodic migraines increase in frequency and transform into a refractory pattern.
