The use of neuroimaging as a diagnostic tool remains at the discretion of the clinician, necessitating more research to improve clinical understanding of primary and secondary headaches.
Hemicrania continua, one of the trigeminal primary headaches, causes intense unilateral pain for ≥3 months.
A study by the National Survey of Drug Use and Health (NSDUH) found that from 2002-2014 the proportion of adults aged 50 to 64 who reported cannabis use in the past year more than tripled from 2.9% to 9.0%. Among adults age 65 or older, there was more than a ten-fold increase (from 0.2% to 2.1%).
There is significant evidence that opioids are not the right treatment of choice for migraine in the emergency department.
The continued observation of this delayed headache syndrome may point to a different pathophysiology from tension-type headache or acute poststroke headache.
The guideline formulated by the Centers for Disease Control and Prevention in an effort to curb opioid overdose-related deaths included a recommendation for steep reductions in opioid doses for patients taking high doses of the drug for chronic pain.
Big data has enabled public health authorities to identify doctor-shopping patients and those who needed treatment for opioid abuse. The trade-off, however, could be patient and provider privacy.
"Chasing the dragon" is an increasingly popular method of heroin inhalation among drug users.
The opioid system is responsible for social pain and reward in the brain; therefore, understanding its underpinnings may help clinicians manage patients with depression and suicidal ideation.
When alcohol and opioid addiction occur together, managing them concomitantly becomes challenging. Whereas some patients may not need medication for alcohol addiction, opioid abuse does require pharmacotherapy.
The perioperative management of pain in patients with opioid use disorders presents multiple challenges to clinicians. A recent review offered clinical guidance for various subgroups of these individuals.
Up to 85% of amputees experience phantom limb pain: sensations in the missing limb that patients may describe as burning, cramping, tingling, itching, stabbing, throbbing, or a feeling of "pins and needles."
Data in children do support an association between pediatric obesity and headache disorders in general, but more research is needed to confirm the association specifically with pediatric migraine.
Emerging evidence indicates that the placebo effect can in some instances reduce patients' pain. The current debate is whether clinicians need to disclose to patients that they are using placebos instead of active ingredients.
Because they're busy looking in different directions, "innocent until proven guilty" and "first, do no harm" don't always get along.
Bipolar disorder is often comorbid with substance use disorders, with alcohol being the top substance. Clinicians should take a thorough history to uncover substance use disorder because it will guide the management of both disorders.
Chronic, noninflammatory pain in children and adolescents encompasses a wide range of pain syndromes. Clinicians need to consider not only the physical manifestations of pain but also the psychosocial and academic impact of the child's pain and impairment.
Pediatric neurologist Lalitha Sivaswamy, MD, discusses challenges in diagnosing primary intracranial hypertension in pediatric patients.
Adults who received pharmacologic treatment for opioid use disorder following a non-fatal overdose may have a reduced risk for opioid-related and all-cause mortality in the subsequent 12 months compared with adults who did not receive medication-assisted treatment.
Headaches are a common occurrence in the general population and are often present in patients with an underlying brain tumor, although it is not yet clear to what degree they are related.
Abuse-deterrent opioid formulations have not yet been widely accepted despite their proposed value in reducing opioid abuse and related mortality. Many of the current barriers to broader use are related to their higher cost compared with conventional formulations.
Preliminary evidence has found an association between the cannabinoid system and other rheumatic conditions, but the studies have not provided conclusive results that could drive recommendations.
Despite the availability of long-acting opioid antagonists, many patients with OUD never receive adequate treatment.
Patients are increasingly recording physician visits on their phones, should physicians do the same. MPR spoke with physician who advocates for recording in clinical practice.
People with migraines and comorbid mood disorders often need treatments that address both conditions, as well as management of sleep, stress, and lifestyle issues.
Acute confusional migraine has not been specifically studied and many clinicians remain unaware of the condition, which may result in underestimation of the prevalence.
Although there is a scarcity of evidence pertaining to the management of postoperative pain medication in the ambulatory setting, some findings suggest an approach similar to that used for the treatment of acute pain.
Current oral contraceptive products contain lower doses of estrogen than those used in the past, prompting reconsideration of risks and benefits.
Chronic low back pain (LBP) defined as persistent or fluctuating musculoskeletal pain of lower back and lumbar spine lasting >3 months.
An improved understanding of the gender differences in axial spondyloarthritis can improve disease treatment and reduce disease burden.
Pain resulting from osteoporotic fractures should be treated with a multimodal approach that includes pharmacological and nonpharmacological strategies.
Functional restoration is a multimodal approach to chronic pain and depression, and includes psychoeducation about pain, biofeedback, mindfulness training, physical and occupational therapy, and detoxification of narcotics.
Although all of the guidelines acknowledge that there are emergent situations in which providing care for a family member or friend is not only permissible but also essential, other situations are frowned upon.
A 90-year-old woman with a history of coronary disease and gallstones presents to the emergency department with generalized abdominal pain that started suddenly about 7 hours prior.
Nonpharmacological strategies, including bed rest, have a lack of evidence supporting their use in the treatment of postdural puncture headache.
With the increasing number of patients presenting to surgery with opioid tolerance, clinicians should be familiar with their specific analgesic needs.
Ranking or otherwise gauging physician quality isn't just a way to assign bragging rights — performance metrics can be used to set reimbursement levels, tailor insurance, and identify physicians who are falling behind.
While many treatments for substance use disorder are not evidence based, several evidence-based approaches have shown effectiveness in court-mandated treatment settings.
Rheuatology Advisor speaks with a psychologist about addressing mental health in patients with inflammatory arthritis.
Patients will still be at risk for schizophrenia or bipolar disorder even several years after an episode of substance-induced psychosis.
Neurology Advisor spoke with Dr Peter McAllister about how to best discern migraine with aura from stroke.
Providing guidance to improve dietary behavior, which may include supplementation to achieve an optimal nutritional status, can contribute to improved control of fibromyalgia symptoms.
Clinicians address issues relating to treating patients with comorbid chronic fatigue syndrome and mood disorders.
Based on current evidence, there is a strong consensus that medication-assisted treatment is recommended over detoxification in the treatment of opioid use disorder during pregnancy.
Migraine is highly prevalent in children and adolescents, affecting almost 10% of children between 5 and 15 years old and 30% of adolescents between 15 and 19 years old.
Mental health professionals regularly grapple with the best way to support clients navigating an onslaught of sexual violence in their daily lives.
Physician burnout has gained traction as a public health concern because more physicians are leaving medical practice altogether, resulting in decreased patient access and continuity of care.
Identifying a patient's preferences and goals leads to a care plan that can reflect those goals, and this may improve patient satisfaction.
Airplane cockpits have a lot in common with operating rooms: both host a small team that's trusted to perform an extraordinarily complex task with the clear understanding that any misstep could spell doom.
Although high-quality studies on the use of peripheral nerve blocks for the treatment of headache disorders are scarce, results observed in clinical practice support their use.
No single solution to address sexual harassment in medicine exists, but physicians of all genders must come together to make progress.
It is important for clinicians to quickly and accurately determine potential underlying causes and to prescribe treatments that take into account comorbidities and medications that older patients may be taking for them.
John M. Davis III, MD, MS, from the Mayo Clinic in Rochester, Minnesota, and Jennifer Gorman, MD, MPH, from The Polyclinic in Seattle, Washington, discuss the evolving collaborative care therapy model in RA.
Intrathecal drug delivery systems and spinal cord stimulation have shown promise for the treatment of cancer pain in initial studies.
Clinicians discuss the clinical implications of headache and comorbid sleep disturbances.
Customer service is a critical part of every physician's job, but there's a big difference between a Yelp review and a risk-adjusted mortality rate in determining
We are sharing your stories about the women behind the white coats.
Emerging evidence suggests that sphenopalatine ganglion stimulation may be an effective treatment for refractory cluster headache.
The available evidence suggests that radiofrequency ablation is a feasible treatment option for chronic hip pain associated with degenerative diseases.
The #MeToo movement has inspired many women to relate stories of harassment, and medicine is no exception.
Given the unique challenges presented by aging, new cases of headache in older adults should be evaluated carefully for a differential diagnosis of primary headache and to exclude underlying causes of secondary headache.
Direct-to-consumer genetic testing has been receiving a lot of attention over the past 10 years from medical providers, consumers, consumer advisory boards, regulatory entities, and ethicists.
A Lancet series of articles outlines the array of factors that contribute to low back pain and presents effective prophylactic strategies and treatment options for the condition.
New findings suggest that DSM-5 criteria may apply to betel use disorder and offer opportunities to advance the study and understanding of substance use disorder in general.
Women continue to propel medicine into the future. Take a glimpse at just a handful of the remarkable women in medicine making history today.
Although peripheral neuropathy is one of the most common neurologic problems seen in the primary care setting, recognizing and evaluating peripheral neuropathy in a patient can be challenging due to its diverse presentations.
Many studies attempt to quantify the effect of the various malpractice claim regulations on physician practice by linking it to the prevalence of defensive medicine, which is when a physician alters his or her clinical approach for the purpose of reducing malpractice exposure.
The use of non-opioid analgesic therapies is increasing among ED physicians.
Although current guidelines define remission as the absence of clinical and laboratory evidence of significant inflammatory disease,the parameters against which axial spondyloarthritis is assessed to demonstrate clinical remission are unclear.
Various strategies to reduce opioid overdose deaths have been implemented and it has been suggested that access to medical cannabis may lead to a reduction in opioid use for pain management.
Substantial evidence suggests a close connection between neuropathic pain and mood disorders.
Advancements in research have led to the identification of a growing number of genetic and neuroimaging markers of migraine.
Depending on the extent of the injury, pain due to burns can range from mild to severe to excruciating.
There's only one way to resolve the dissonance between personal beliefs and professional obligations: remembering that physicians take an oath pledging fealty to patients' health, not their own belief systems.
Many translational barriers exist between preclinical research and clinical practice.
Systemic lidocaine administered via IV or patch has consistently shown effectiveness for the treatment and prevention of chronic pain.
Suicide among physicians is a staggering public health crisis that has gone largely ignored; one physician shares his insight.
Headache screening should be a routine part of a prenatal visit so that if and when a patient presents with an attack, a suitable plan of action is already established.
In recent years, atypical antipsychotics - particularly olanzapine and quetiapine - have gained increasing attention as adjuncts in pain management regimens.
The monoclonal antibody erenumab has shown favorable results regarding efficacy and safety for the prevention of migraine.
Despite its prevalence, tension-type headache is often complicated by overlapping symptoms and a weak understanding of tension-type headache etiology.
One physician shares his thoughts on the importance of balancing autonomy, beneficence, and nonmaleficence when prescribing opioids to patients.
Special caution is warranted in the administration of pain treatment to patients with severe obesity, and additional research in this population is needed.
The adoption of telehealth technology continues to expand, but requires further research to fully realize the potential it has to address socially desirable goals such as improving the patient experience of care.
An expert shares his insight on how victims of sexual harassment respond to trauma, and how you can best support your patients who have experienced sexual harassment or abuse.
Dike Drummond, MD, and CEO of The Happy MD, an organization focused on physician burnout prevention and leadership, shares his insights on how to tackle compassion fatigue and burnout in the emergency department.
The most promising tools to predict acute pain after cesarean delivery are local anesthetic infiltration before placement of spinal anesthesia, and asking patients simple questions about anticipated pain and analgesic needs.
Increasing evidence suggests a relationship between migraine and multiple sclerosis that is beyond comorbidity and may help clarify the pathophysiology of both disorders.
Neuromodulation techniques have been explored as alternative treatment options in patients with trigeminal neuralgia who do not achieve adequate pain relief with pharmacologic therapies and surgical interventions.
Concierge medicine gives many patients an attractive alternative to accessing health services, but is this model of healthcare sustainable?
Neda Ratanawongsa, MD, MPH, Associate Chief Health Informatics Officer for Ambulatory Services, shares her insight on how to best manage the challenge of tackling electronic health record requirements while also optimizing patient encounters.
The scourge of defensive medicine — the practice of recommending tests or treatments for the purpose of avoiding or mitigating litigation — has been dissected tirelessly.
Although much of the response to the opioid epidemic exempts treatment for cancer-related pain, a recent Oncology Nurse Advisor online survey showed that more than 80% of respondents were concerned about how current restrictions set up to manage the opioid crisis are affecting cancer patient pain management.
Machine learning programs can process enormous quantities of information and make meaningful and actionable predictions about future behaviors and outcomes, but what are the potential pitfalls?
The 2017 revisions to the Common Rule deal largely with improving the transparency and clarity of intended uses under the current standard of informed consent while introducing a new concept of "broad consent".
The National Vaccine Advisory Committee highlighted 5 core concepts and strategies that can increase integration of social psychological components with health communication principles to improve the perceived benefits of adult vaccination.
"Infodemiology" and "infoveillance" are terms used to describe an emerging approach to public health research, based on Google Trends big data monitoring and data mining.
The prevalence of opioid abuse has not only resulted in a substantial increase in drug-related deaths and HIV transmissions, but has also led to an increase in the number of people infected with HCV.
Scientists warn that unless there is an adequate response and proactive measures are taken, society will soon have to deal with direct and indirect effects of the changing climate on human health.
Peripheral nerve blocks for pediatric headache treatment are associated with significant benefit and minimal risk.
Clinical Pain Advisor Articles
- Rimegepant Orally Dissolving Formulation Provides Rapid Relief From Acute Migraine
- Hemicrania Continua: Diagnosis and Treatment
- Quantity of Opioids Prescribed Linked to Higher Patient-Reported Consumption
- Treating Acute Migraine During Pregnancy: The Need for Guidelines
- Ensuring Safety During Long-Term Opioid Therapy
- Serum Vitamin D Levels and Risk for Migraine
- Rimegepant Orally Dissolving Formulation Provides Rapid Relief From Acute Migraine
- Updated Evidence-Based Recommendations for Buprenorphine Treatment
- Business Degree Increasingly Useful for Doctors
- Two Screening Tools May Accurately Predict Transition From Acute to Chronic Low Back Pain
- Screening for Hyperglycemia Prior to Steroid Injections for Chronic Pain
- Opioids: Clinician Concern and Prescribing Practices
- Persistence of Post-Traumatic CRPS Associated With Initial Pain Sensitization
- Ensuring Safety During Long-Term Opioid Therapy
- Education Can Up Emotional Intelligence in Residents