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.
Malpractice claims in outpatient chronic pain management most commonly involved patient noncooperation in care and provider deficits in clinical judgment, communication, and documentation.
The HIV Medicine Association of the Infectious Diseases Society of America has released new guidelines for the management of chronic pain in patients living with human immunodeficiency virus.
Some patients with migraines prefer nonpharmacological approaches to treatment and for these patients, evidence-based behavioral treatments may be at least as effective for migraine prophylaxis as medication.
Senator Bernie Sanders' Health Policy Advisors on Causes and Solutions to Healthcare Inequality in America
Healthcare disparities have increased along with widening economic inequality between wealthy and low-income Americans.
Findings suggest that up to 15% of encounters with adult patients can be described as "difficult".
The need for data transparency carries an ethical and moral obligation and requires nonselective and unbiased publication of clinical results.
Although a range of incidental findings may be observed on MRI obtained in pediatric headache, they are rarely indicative of a serious underlying condition.
A recently published article exposes a gaping hole in the access to an effective first-line therapy for a portion of patients with cluster headache in the United States.
The Centers for Medicare & Medicaid Services has issued a final rule that could result in steep payment reductions for physicians of certain specialties in 2018.
Although animal studies have shed light on various aspects of the role of oxytocin in pain processing, the small number of human studies on the topic have produced inconsistent results.
A recent study provides a comprehensive summary of the relevant published studies linking migraine and gastrointestinal or related disorders.
There is a suggested link between migraine and the presence of patent foramen ovale, with the suggestion that PFO closure surgery might be a preventative measure against future migraine attacks, but what are the consequences?
Findings from animal studies indicated that anesthetics may be neurotoxic and could result in long-term central nervous system alterations and cognitive dysfunction.
Although more than three-quarters of TBI cases are mild with rapid symptom resolution, some people suffer persistent debilitation and pain.
Serving an estimated 141.4 million patients a year and providing an average of 47.7% of all medical care in the United States, our emergency departments reflect all the good and bad about our nation's healthcare system.
Pain management in athletes requires a clear understanding of the different types of pain and various factors that can contribute to pain in this population.
Cluster headaches are considered the most severe headache type and the most difficult to treat. In 2016, the American Headache Society released new evidence-based guidelines for the treatment of cluster headache.
Despite growing awareness of physician burnout in recent years, the problem has continued to increase. Take a look at risk factors and consequences of physician burnout, and how to address the issue.
Obama Administration Senior Policy Advisor and Addiction Expert on White House Initiative to Address the Opioid Crisis
On October 30, 2017, the Clinton Foundation's Health Matters Initiative held a panel event at the Johns Hopkins Bloomberg School of Public Health for the release of a report co-written by these 2 organizations, titled "The Opioid Epidemic - From Evidence to Impact."
As survival rates for patients with burns have improved, the need for effective treatments for chronic pain in this population has become more pressing.
Clinical Pain Advisor Articles
- Opioid Use Disorders: Advances in Pharmacotherapy Provide Long-term Results
- Abuse-Deterrent Opioid Formulations: Barriers to Broader Use
- Women Frequently Prescribed High Doses of Opioids After Vaginal Delivery
- Notifications by PDMPs May Not Effectively Reduce Opioid Misuse
- Medical Cannabis Legalization Associated With Reduced Schedule III Opioid Prescriptions
- Neuropathic Pain Medications
- Higher Buprenorphine Dose May Not Increase Severity of Neonatal Abstinence Syndrome
- Terms Used for Addiction May Be Associated With Explicit, Implicit Bias
- Ketamine Infusions May Be Effective for Refractory Headache
- Physical, Psychosocial Activity May Be Protective Against Development of Chronic Pain in Older Adults
- Prioritizing Rest in Hospital Settings: Poor Sleep Increases Costs, Complications, and Mortality
- Pain Catastrophizing Decreases in Rheumatoid Arthritis After DMARD Initiation
- Addressing Commercial Incentives in the Medical Device Industry
- Cancer Patients Treated With Step III Opioids Often Have Sleep Disturbances
- Individual, Group Low Literacy Self-Management Program for Chronic Pain May Be Effective