Clavicle fractures in the
pediatric population are
very common. Clinical
decreased movement of
the arm on the affected side, crepitus,
and/or bony irregularity at the fracture
site. In neonates, the Moro reflex
may be absent on the affected side.
A 48-year-old woman with a history
of hypertension and mild
asthma has been transferred to the
medical service because of an abnormal
postoperative ECG. She had
been admitted 2 weeks earlier to the
gynecology-oncology service for local
recurrence of a previously resected
uterine sarcoma and underwent laparotomy
for debulking of the pelvic
mass and resection of the rectosigmoid
colon. She did well until postoperative
day 14, when sudden chest
pain and dyspnea developed.
A 39-year-old man complains of severe daily headaches that he describes as throbbing and "burning," with a sensation
of pressure. He rates the severity of his pain as 8 to 10 on a 10-point visual analog scale (VAS) in which 10 is
the most severe. The mean duration of the headaches is 12 hours, and the mean frequency is 5 days per week. Between
the episodes of severe headache, he has constant "minor" headaches that are not as severe (mean severity, 3 to 5 on a
10-point VAS). Within the past 5 months, he has never been totally free of headache.
ain management is a common
and challenging aspect of caring
for elderly patients. The principles
that guide therapeutic pain management
in these persons are different
from those used in the treatment
of younger persons.
The patient is a 56-year-old man who presents with daily headaches that occur
behind the right eye, right temple, and occasionally on the right side of the
forehead. He has never experienced this type of headache on the left side. He
describes the pain as “stabbing,” “throbbing,” and occasionally “burning.”
He rates the intensity of the pain a 7 on a 10-point visual analog scale on
which 10 is the most severe.
The Geriatric Depression Scale is the most widely
validated screening tool. The questionnaire has been
reduced to a single question that is as sensitive and as specific
as the 15-item shortened form of the original 30-item
scale. The question is: "How often do you feel sad or depressed?'
This is certainly something that is easy to ask in
the course of a general physical examination or routine office
A 34-year-old woman complains of headaches that interfere with work. Her first headache episode, approximately 6 years
earlier, was relatively mild. Initially, she experienced attacks only once every 3 to 4 months and managed them effectively
with over-the-counter (OTC) agents. However, in the last 6 months the attacks have become more frequent—they occur at
least twice a month—and are so severe that she misses work.
Patients with ankylosing spondylitis are
at increased risk for fractures (particularly
extension fractures of the cervical
and thoracolumbar spine) and spinal
cord injury. Fractures in these patients
are extremely unstable; in fact, they are
among the most complication-prone of
all cervical spine injuries likely to be
seen in the primary care setting.
In their case report, “Sudden Headache in a Woman With Hypertension” (CONSULTANT,
July 2002, page 1049), Drs Gary Quick and Maggie Law describe a
patient with uncharacteristically severe headache and very high blood pressure.
Calcium channel blockers
are commonly prescribed
to treat several
and may be helpful in
other conditions, such as migraine
and bipolar disorder.1 These agents
are associated with numerous clinically
significant drug interactions.1-3
While some of these interactions,
such as the effect of verapamil on
serum digoxin concentrations, are
well-known, others are not widely recognized—
yet warrant attention.
A 69-year-old retired accountant presents with a 2-month history of daily headaches. The pain is moderate, constant,
global, pressure-like, and occasionally pulsating; it is sometimes exacerbated when the patient lies down. He denies nausea
or vomiting, ocular symptoms, weakness, or sensitivity to light. His wife reports that years ago he experienced throbbing
A 64-year-old woman with a history of diabetes, hypertension, and lymphoma was admitted to the hospital with a dull headache, conjunctival congestion, and slight dyspnea. Her pulse rate was 96 beats per minute; blood pressure, 146/68 mm Hg; and respiration rate, 22 breaths per minute. She also had increased jugular venous distention; cardiovascular and chest examination findings were normal. Edema of both arms and dilated blood vessels on the anterior chest wall were noted.
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 »
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. Ann Emerg Med2012;59:497–503.
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