Migraine & Cardiovascular Disease: The Missing Link
Although associations between migraine headaches and CVD have been known for more than 40 years, the underlying pathobiology of this connection has not been appreciated until recently.
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Long-Term Neurodevelopmental Effects of Prenatal Opioid Exposure
Perinatal exposure to opioids may have significant immune, neural, and behavioral effects that can alter CNS development.
Updated Guidelines for the Management of Hand, Hip, and Knee OA
The American College of Rheumatology and the Arthritis Foundation developed evidence-based guidelines for the management of hand, hip, and knee osteoarthritis.
Cybersecurity Lessons and Trends to Review for the New Year
Use staff meetings or emails to keep current issues like phishing or social engineering in front of employees.
Awareness of Physician Burnout Has Peaked, But What Is the Next Step In Addressing It?
Burnout is thought to be the direct result of occupational demands that consistently outweigh the physical, mental, and psychological abilities of individuals suffering from it.
Closed-Loop SC Stimulation for Chronic Back and Leg Pain (Part 2)
Lead author Nagy Mekhail, MD, PhD discusses the importance of neuromodulation, specifically a closed loop spinal cord stimulation system (SCS), for the management of chronic pain.
Closed-Loop Spinal Cord Stimulation for Chronic Back and Leg Pain
Spinal cord stimulation (SCS) with a closed-loop system that uses recorded evoked compound action potentials (ECAPs) is superior to a fixed-output, open-loop system for patients with chronic back and leg pain.
Big Fines With Failure to Report Health Information Breaches
The federal Office for Civil Rights fined Sentara Hospitals nearly $2.2 million for mailing protected health information to wrong addresses.
A Look Inside the First Annual Science of Cannabis Symposium
The Science of Cannabis Symposium welcomed both clinicians and legal experts and aimed to provide medical and legal education for healthcare providers who are considering the use of cannabis in their medical practice.
Disclosing Conflicts of Interest Ensures Patient Trust
Physicians must be open about secondary interests such as financial gain that have the potential to bias their clinical judgment.
Phenotypes May Aid Diagnosis and Treatment of Pediatric Headache
Researchers posit that adult studies on headache can help to create a multidisciplinary treatment plan.
Proposal Aims to Define Standard THC Units Across Products, Administration Routes
Clinicians are routinely asked by their patients if CBD products are safe and effective, but research is lagging behind public acceptance.
How Do Disparities in the Physician Workforce Affect Patients?
Recent research indicates that disparities related to physician race or ethnicity, sex, or disability status may play a role in physician burnout.
Codeine and Tramadol Overused for Pediatric Pain Management Despite Recommendations
Experts advise using ibuprofen and acetaminophen rather than codeine and tramadol to treat children in pain.
Optimizing Intrathecal Drug Therapy for Neuropathic Pain
When traditional oral analgesics no longer control pain, some physicians are turning to alternative drug delivery methods that provide pain relief while avoiding systemic adverse effects.
Neurosurgery for Craniofacial Pain Syndromes: Update and Expert Interview
Many patients with craniofacial pain syndromes such as trigeminal neuralgia, cluster headache, and migraine have an adequate response to pharmacologic therapies.
Off-Label Use of Antidepressants for Chronic Pain
In recent years, the off-label prescription of antidepressants for the treatment of chronic pain has increased, along with evidence of their effectiveness and mechanistic underpinnings when used for this purpose. Depression is a common comorbidity among patients with chronic pain, and the use of these agents may alleviate symptoms of both disorders. Typically, however, significantly…
Reviewing Interventional Treatments for Chronic Headache
Interventional pain modalities provide alternative analgesia in patients who are intolerant of pharmacologic agents, have comorbidities that require multiple medications, or have pain refractory to oral medications.
Laser Therapies for the Healing of Burn Scars: An Interview With Jill Waibel, MD
The innovative use of fractionation of laser beam technology in dermatology has led to significant improvements in the treatment of burn scars, regardless of how mature.
Psychological Interventions for Comorbid Migraine and Sleep Dysfunction
Researchers found data that showed, regardless of the number of headaches reported in addition to insomnia that cognitive behavioral therapy is indicated as first-line treatment.
Working for a Health System vs Remaining Independent
Physician practices need to weigh the pros and cons of remaining independent or joining an integrated health care delivery system.
Reviewing Noninvasive Vagus Nerve Stimulation for Migraine, Cluster Headache
A substantial percentage of patients with primary headache disorders are unresponsive to standard pharmacologic therapies, with pain-free response rates of 45% at 15 minutes and 30% at 2 hours, following the use of rescue medications.1 Such findings, along with the range of side effects associated with these agents, highlight the need for novel treatment options…
Should Aging Physicians Be Required to Undergo Cognitive Testing? Three Experts Weigh In
The issue of aging physicians poses serious challenges to the medical profession, with concerns that judgment or skills might decline with age.
Managing Migraine During Pregnancy and Lactation
A particular challenge in this population is the effective management of migraine during pregnancy and lactation while minimizing the risk for harm to the fetus.
Clinician Roundtable: Does Marijuana Affect Fertility?
Rates of marijuana use are especially high among men and women of reproductive age. How should physicians advise patients who are trying to conceive about marijuana?
Online Health Information Gathering: Changing the Physician-Patient Relationship
A 2013 Pew Research Center and Internet Life Project report found that 59% of US adults said that they turned to the Internet regarding a health problem during the past year.
Examining Post-Intensive Care Syndrome
As mortality rates associated with admission to the intensive care unit have decreased in recent decades, there has been increasing interest in the long-term negative consequences of critical care.
How to Deal With “Difficult” Patients
Clinicians can manage their emotions and behaviors to meet the challenges of working productively with sometimes abrasive and argumentative patients.
ACP Releases Policy Statement on DOI, COI Management for Clinical Guideline Development
The American College of Physicians endorses the necessity of a comprehensive process for disclosure of potential conflicts of interest to ensure the integrity of clinical guidelines and guidance statements.
Does Religion Have a Place in Medicine?
Benjamin Frush MD, a resident in internal medicine-pediatrics at Vanderbilt University Medical Center in Nashville, argues in favor of a role that physicians can play in integrating religion into their clinical practice. Rob Poole MB, FRCPsych, contends that physicians should never incorporate a religious element into clinical practice.
A Review of the Use of CBD and Other Cannabinoids in Pain Management
The therapeutic potential of cannabinoids to manage several clinical conditions, including pain, inflammation, sleep disorders, and epilepsy, is finding support through a growing body of evidence.
Chronic Pancreatitis: Challenging to Diagnose, Difficult to Treat
Chronic pancreatitis stems from a variety of pathogenic entities that result in chronic inflammation, fibrosis, and irreversible damage to the pancreas.
Headache and Trigeminal Neuralgia in Multiple Sclerosis
Researchers found that abnormal magnetic resonance imaging suggests that in patients with multiple sclerosis, headaches often precede diagnoses.
Post-ICU Syndrome: Identifying Challenges and Improving Mortality
Post-ICU syndrome includes psychological effects — depression, anxiety, and PTSD — as well as worsened physical functioning.
Reviewing the Efficacy of Dietary Supplements to Manage Chronic Musculoskeletal Pain
The use of dietary supplements to manage pain is common in individuals with musculoskeletal disorders.
On the Need for a Multidisciplinary Approach for Pediatric Pain Management
Increasing attention has focused on the use of multidisciplinary approaches that combine pharmacologic and integrative nonpharmacologic therapies for pain management.
The Link Between Misconceptions About Opioid Use Disorders and Current Policies
An estimated 20 million people in the United States meet the criteria for substance use disorder.
Improving Physician Comfort With Treating Transgender Patients
Estimates indicate that ~1.4 million people self-identify as transgender in the United States, which is double the initial estimate is made by the Williams Institute in 2011.
Using Digital Therapeutics to Treat Substance Use Disorders
The convenience and confidentiality of computer-based and mobile technologies may encourage more individuals with substance use disorders to access treatment.
Managing Migraine During Pregnancy and Lactation
A particular challenge in this population is the effective management of migraine during pregnancy and lactation while minimizing the risk for harm to the fetus.
Reviewing Off-Label Uses of Gabapentinoids
As part of current efforts to reduce unnecessary opioid consumption, clinicians have increasingly prescribed gabapentinoids for a range of pain disorders.
Managing Opioid-Induced Androgen Deficiency
The increased opioid use has been associated with a rising incidence of opioid-induced endocrinopathy, most commonly in the form of androgen deficiency.
Cannabinoids in the Treatment of RA: Current Status and Future Prospects
Researchers found data that showed in patients with rheumatoid arthritis, the delta-tetrahydrocannabinol found in medical cannabis is likely to contribute to an increase in heart rate in patients who are susceptible to atherosclerosis and cardiovascular disease. Medical cannabis was also not found to provide therapeutic effects when comparing it with a combination of cannabinoid type 1 antagonist, fatty acid amide hydrolase inhibitor, and nonpsychotropic cannabidiol.
The Complex Interplay Between Metacognition and Headache in Pediatric Patients
Researchers found data that in adults who had headaches as children, cognitive and psychomotor ability are compromised. In a Norwegian study, it was found that attention deficits were associated with migraine and nonclassifiable headache in patients aged 15 to 17 years. Metacognitive skills and anxiety, depression, motivation, academic performance, human social interactions, and stress symptoms are common headache triggers that researchers posit can be controlled and monitored by patients.
Potential Role of Arterial Hypertension in Migraine Pathogenesis
Researchers posit that the reduction in arterial baroreflex contributes to the development of arterial hypertension in migraine.
Prevention Strategies for Pediatric Migraine
Researchers found data that support intervention in chronic migraine for both the mother and child as headache frequency in children correlates with that of their mothers.
Changing the Way Chronic Pain Is Categorized
The 11th edition of the International Classification of Diseases includes chronic pain in the “Symptoms, Signs or Clinical Findings” category.
Nonmigraine Headache and Facial Pain: Overview & Expert Interview
Headache is the most commonly experienced form of pain.
Cannabinoids in the Treatment of RA: Current Status and Future Prospects
Researchers found data that showed in patients with rheumatoid arthritis, the delta-tetrahydrocannabinol found in medical cannabis is likely to contribute to an increase in heart rate in patients who are susceptible to atherosclerosis and cardiovascular disease. Medical cannabis was also not found to provide therapeutic effects when comparing it with a combination of cannabinoid type 1 antagonist, fatty acid amide hydrolase inhibitor, and nonpsychotropic cannabidiol.
Intersection of ID & OUD Epidemic: What ID Clinicians Should Know
The epidemic of opioid use disorder has led to substantial increases in new cases of HCV and HIV infection, as well as hospitalizations for other OUD-related infections.
Headache in the ED: Overview and Expert Interview
Researchers found data that showed, after consultation with an expert, optimal prevention of migraine headaches for patients who present in the emergency department includes both antiseizure medications, specifically, divalproex sodium, sodium valproate, or topiramate, and β-blockers, namely, metoprolol, propranolol, and timolol. In addition, triptans are suggested, as well as antidepressants, amitriptyline, and venlafaxine.
Physician House Calls: An Old Model With a Modern-Day Twist
Physician house calls are making a comeback, to understand why MPR interviewed three experts.
Significance and Prevalence of Headache in Multiple Sclerosis
Research study results showed that treatments for multiple sclerosis precipitated headaches and migraines.
Complementary and Integrative Treatments for Migraine: An Expert Interview
Approximately half of the 14% of Americans who have severe headache and migraine report having tried interventions such as meditation, yoga, and deep breathing exercises.
Pass Me the Psychological Scalpel: Lessons on Resilience for Doctors
As rates of physician burnout continue to climb, a diverse group of researchers weigh in on enhancing resilience and particularly emphasize enlightening educators about how resilience develops during residency.
Reconsidering Lidocaine as an Acute Treatment for Headache
Researchers found that intranasal lidocaine is effective in the treatment of acute migraine and cluster headache because of its ability to block the sphenopalatine ganglion, which is associated with facial pain from the trigeminal nerve.
Are Hospital Readmission Reduction Programs Truly Evidence Based?
When politicians attempt to make changes to health policy based on sentiments rather than on evidence-based conclusions, physicians often find themselves trying to meet unrealistic expectations.
Not so Inactive: Excipients in Medications May Trigger Adverse Reactions in Some Patients
A team of investigators from both Brigham and Women’s Hospital and the Massachusetts Institute of Technology analyzed data on thousands of inactive ingredients in approved medications to further characterize them and enhance our knowledge of their safety.
Emotionally Responsive Virtual Coach Helps Address Patient Concerns in New Simulation
Kognito, a health simulation company, is applying its simulation technology to patient education, to address a gap in patient knowledge.
Helping Patients Navigate Clinical Trials: What Physicians Can Do
Patient participation rates in clinical trials remain low, despite the overall good that clinical trials can provide to the healthcare community.
The Grey’s Anatomy Effect: When TV Warps Perception, Proactive Communication is Key
The Grey’s Anatomy effect is a term that describes the disconnect between real-life and television medicine.
Thunderclap Headache: An Overview
In an interview with Neurology Advisor, Robert Cowan, MD, FAAN explains how thunderclap headache may be the only early warning sign of vascular changes or brain injury.
ICD-10, Diagnostic Errors, and the Payment Reforms to Improve Diagnostic Accuracy
In 2015, 1 in 20 adults in the United States experienced a diagnostic error every year; yet by the beginning of 2019, nothing had been done to improve the situation.
Satisfaction of Psychological Needs and Chronic Pain in Adolescents
An estimated 25% of children and adolescents report having pain that persists for more than 3 months, with severe and disabling pain affecting 8% of this population.
Case Study: Gradually Worsening Elbow Pain
A 51-year-old woman presents to the emergency department with pain in the elbow that has gradually worsened over the past 12 hours.
Health Literacy and the Older Adult
Every day, low health literacy results in patients’ misunderstanding the instructions of their clinicians, sometimes with very serious consequences.
Navigating Effective Approaches to Migraine Treatment for the Underinsured
Approximately, 26% of participants who were underinsured or uninsured were able to navigate through consultation, diagnosis, and treatment.
HHS Task Force Issues Draft Report on Best Practices for Pain Management
In a draft report issued December 28, 2018 by the US Department of Health and Human Services-sponsored Pain Management Best Practices Inter-Agency Task Force, recommendations for a multidisciplinary approach to pain management were formulated.
AHA Issues Scientific Statement on Accurate Blood Pressure Readings
The American Heart Association has updated its scientific statement on blood pressure readings.
Physician Mental Health: The Role of Self-Compassion and Detachment
Prioritization of patients’ well-being can lead physicians to neglect their own well-being, including their mental health.
Menstruation and Migraine: Can We End the Cycle?
Researchers found that lower levels of estrogen during menstruation cause women to be more vulnerable to migraines than men.
Overcoming Aftershock: Six Ways You Can Prepare to Return to Work After a Long Absence
As with any profession, returning to work after long-term absence because of illness or injury can be daunting for healthcare providers.
Point: Dietary Supplements Can Mitigate Poor Diet, Improve Health
Although it is estimated that more than 166 million Americans use dietary supplements, many healthcare providers are unfamiliar with how these substances are regulated by the US Food and Drug Administration.
Treating Migraine in the Elderly: Navigating Polypharmacy and Comorbidities
Considering individual patient factors, effects of aging, and using online tools for drug interactions will aid in treatment of migraines in the elderly.
Medicaid Work Requirements Are Increasing the Cost of Being Sick in America
On the surface, a plan to get able-bodied individuals back to work in order to maintain their Medicaid benefits sounds reasonable — until it’s not.
Opioid-Induced Constipation: Insights Into Diagnosis and Effective Treatment
Conventional approaches to treatment of opioid-induced constipation include the use of treatment modalities that address non-opioid-related constipation as well as new medications that target the OIC mechanism of action.
Migraine and Alcohol: Encouraging a Healthy Balance of Indulgence and Vigilance
Based on the literature, investigators found no reason to tell patients with headache to abstain from alcohol.
Case Study: Shoulder Injury Following a Biking Accident
A 41-year-old man presents with a shoulder injury sustained as the result of a fall from his road bike.
In the Spotlight: How Racism Affects the Healthcare Workforce
Racism is embedded in all US institutions, including medicine — so what steps are being taken to improve the well-being of the healthcare workforce?
ACIP Updates Recommendations for US Adult Immunization Schedule
The ACIP and CDC have approved and released 2019 recommendations for the adult immunization schedule in the US.
Mobile Health Apps for Headache: An Ongoing Search for Clinical Relevancy
The main objection among clinical researchers is that commercially developed products often lack a scientific basis for their selection of features.
An Evidence-Based Road Map to Navigating the Opioid Epidemic
This rise in prescribing of prescription opioids in the last 2 decades of the 20th century occurred at a time during which medical professionals were urged to resort to prescription opioids to manage untreated and chronic noncancer pain.
Protecting Your Practice From Data Breaches: An Expert Interview
To shed light on issues of cybersecurity in medical practices, MPR spoke to Michael J Sacopulos, JD, CEO of Medical Risk Institute (MRI), a firm that provides “proactive counsel” to the healthcare community to identify where liability risks originate and to reduce or remove those risks.
Navigating Social Media Issues in Medical Practice: An Expert Interview
Issues that affect employees in all industries are compounded by a unique set of additional concerns that affect employees of medical practices.
Mentoring Women in the #MeToo Era: Expert Roundtable
Despite record numbers of women working in medicine, instances of gender discrimination and sexual harassment continue to proliferate.
Surgical, Nonsurgical Treatments for Chronic Migraine: Evidence and Relevancy
There are many procedural treatments for migraine that are effective and safe, including peripheral nerve blocks, trigger point injections, botulinum toxin injections, and sphenopalatine ganglion blocks.
Approved in Migraine, CGRP Antagonists Also Promising in Cluster Headache
Cluster headache and migraine are distinct primary headache disorders that are associated with substantial pain and disability.
Neuroimaging in Headache Disorders: When Is It Necessary?
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: Diagnosis and Treatment
Hemicrania continua, one of the trigeminal primary headaches, causes intense unilateral pain for ≥3 months.
Experts Offer Tips on Integrating Medical Marijuana Into Geriatric Practice
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%).
Migraine Treatment in the ED: Overcoming Our Penchant for Opioids
There is significant evidence that opioids are not the right treatment of choice for migraine in the emergency department.
Persistent Poststroke Headache: Finding Its Place in Stroke Aftercare
The continued observation of this delayed headache syndrome may point to a different pathophysiology from tension-type headache or acute poststroke headache.
The Unintended Consequences of the CDC Opioid Guideline According to Pain Management Specialists
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.
Striking a Balance Between Opioid Surveillance and Patient Privacy
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.
Popular Heroin Inhalation Method Tied to Leukoencephalopathy
“Chasing the dragon” is an increasingly popular method of heroin inhalation among drug users.
The Opioid System: The Foundation for Social Risk and Reward
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.
Managing Comorbid Opioid and Alcohol Use Disorder
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.
Perioperative Pain Management in Patients With Opioid Use Disorder
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.
The Role of Psychological Factors in Phantom Limb Pain Reviewed
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.”
Pediatric Migraine and Obesity: What We Know and Where We’re Going
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.
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