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 42-year-old woman had a "life-long" history of mild to moderate low back pain, without radiation, anesthesia, weakness, or incontinence. She denied recent trauma or an inciting event. The pain was constant and worse at the end of the day and with prolonged activity. Physical therapy, NSAIDs, tramadol, opioids, and manipulation provided minimal relief.
That's the question we put to Dr. Leigh Callahan, and in the next 10 minutes, she will address this important issue. Dr. Callahan has over 20 years of experience in arthritis and health outcomes research, and she was an arthritis epidemiologist at the CDC.
Right upper quadrant pain of 24 hours’ duration prompted a 20-year-old man with a history of gastritis to seek medical attention. The pain was sharp and nonradiating, with no alleviating or aggravating factors. The patient occasionally consumed alcohol and regularly smoked cigarettes (tobacco and marijuana). He denied nausea, vomiting, diarrhea, and diaphoresis. Right upper quadrant pain of 24 hours’ duration prompted a 20-year-old man with a history of gastritis to seek medical attention. The pain was sharp and nonradiating, with no alleviating or aggravating factors.
A 36-year-old man presented with persistent right shoulder weakness and pain (4 out of 10 on the visual analog scale). He also had an “odd pulling sensation” with arm adduction. During a wrestling match 2 years earlier, his arm was abducted and extended, after which he heard a popping noise and felt burning pain in his shoulder.
A 21-year-old man presented for evaluation after he sprained his right ankle while hiking. Radiographs of the ankle showed no fractures but revealed diffuse sclerotic lesions in most of the visualized bones.
Depression was diagnosed 6 years earlier in a 37-year-old woman; it has been successfully managed since then with fluoxetine and outpatient psychotherapy. Since her teenage years, the patient has also experienced sporadic (fewer than 3 or 4 per year) mild or occasionally severe headaches, which she has usually self-treated with over-thecounter (OTC) agents or "just slept off."
A 47-year-old woman complains of severe headaches that involve only the right orbital, temporal, and occipital areas. She describes the pain as sharp and stabbing, and she rates its severity as 9 or 10 on a 10-point visual analog scale.
The headaches vary in severity, but she usually has severe
headaches (8 on a 10-point visual analog scale
[VAS]) once or twice a week; she describes the latter as
severe throbbing or pounding pain on the top of the
head but also involving the occipital and frontal
areas and occasionally one or the other temple.
Here's a simple way to calculate the correct pediatric dosage of acetaminophen/codeine elixir. In children aged 3 to 10 years, give 1 mL per year of age at each dose.
Exercise is a key part of your care plan. It promotes strength and flexibility, helps you maintain a healthy weight, reduces pain, and improves overall mobility and quality of life.
ABSTRACT: Heel pain that occurs with the first several steps in the morning and diminishes as walking continues is the classic symptom of plantar fasciitis. Assessment of risk factors, such as improper footwear, a change in physical activities, and a new running surface, is important. Radiographs are rarely useful. Plantar fasciitis is generally self-limited; symptoms typically take 6 to 18 months to resolve. Conservative measures may include relative rest, stretching, strengthening, shoe modifications, orthoses, night splints, NSAIDs, and ice therapy. A corticosteroid injection may be warranted in resistant cases. If extensive conservative treatment is unsuccessful, referral to an orthopedic surgeon may be indicated.
A 47-year-old woman complains of
episodic headaches that began several
months earlier and are accompanied
by sweating, flushing, abdominal pain,
and vomiting; these attacks have progressively
worsened. She takes no medications
and denies fever, chills, and
night sweats. The medical history is
unrevealing.
For the past week, a 16-year-old boy has had a progressively worsening dry, irritating cough; dyspnea on exertion; and intermittent fever and chills. During the past 24 hours, he has had no appetite and has vomited greenish material 3 or 4 times.
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
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.
A 42-year-old woman had a "life-long" history of mild to moderate low back pain, without radiation, anesthesia, weakness, or incontinence. She denied recent trauma or an inciting event. The pain was constant and worse at the end of the day and with prolonged activity. Physical therapy, NSAIDs, tramadol, opioids, and manipulation provided minimal relief.
Right upper quadrant pain of 24 hours’ duration prompted a 20-year-old man with a history of gastritis to seek medical attention. The pain was sharp and nonradiating, with no alleviating or aggravating factors. The patient occasionally consumed alcohol and regularly smoked cigarettes (tobacco and marijuana). He denied nausea, vomiting, diarrhea, and diaphoresis. Right upper quadrant pain of 24 hours’ duration prompted a 20-year-old man with a history of gastritis to seek medical attention. The pain was sharp and nonradiating, with no alleviating or aggravating factors.
A 36-year-old man presented with persistent right shoulder weakness and pain (4 out of 10 on the visual analog scale). He also had an “odd pulling sensation” with arm adduction. During a wrestling match 2 years earlier, his arm was abducted and extended, after which he heard a popping noise and felt burning pain in his shoulder.
A 21-year-old man presented for evaluation after he sprained his right ankle while hiking. Radiographs of the ankle showed no fractures but revealed diffuse sclerotic lesions in most of the visualized bones.
In many patients, episodic migraines increase in frequency and transform into a refractory pattern.
