Items in AFP with MESH term: Pain
Are Opioids Effective in the Treatment of Neuropathic Pain? - Cochrane for Clinicians
Acupuncture for Pain - Article
ABSTRACT: Acupuncture is increasingly used as an alternative or complementary therapy for the treatment of pain. It is well tolerated, with a low risk of serious adverse effects. Traditional and modern acupuncture techniques may result in reported improvement in pain patterns. Research on acupuncture has had a number of limitations, including: incomplete understanding of the physiologic effects of acupuncture; ineffective blinding of participants; unclear adequacy of acupuncture "dose;" difficulty in identification of suitable sham or placebo treatments; and the use of standardized treatment regimens rather than the individualized approach that characterizes most acupuncture practice. Controlled trials have been published regarding acupuncture for lumbar, shoulder, and neck pain; headache; arthritis; fibromyalgia; temporomandibular joint pain; and other pain syndromes. Enough data are available for some conditions to allow systematic evaluations or meta-analyses. Based on published evidence, acupuncture is most likely to benefit patients with low back pain, neck pain, chronic idiopathic or tension headache, migraine, and knee osteoarthritis. Promising but less definitive data exist for shoulder pain, fibromyalgia, temporomandibular joint pain, and postoperative pain. Acupuncture has not been proven to improve pain from rheumatoid arthritis. For other pain conditions, there is not enough evidence to draw conclusions.
Painful Oral Ulcerations in a 51-Year-Old Woman - Photo Quiz
Diagnosing Lumbar Spinal Stenosis - Point-of-Care Guides
Custom vs. Prefabricated Orthoses for Foot Pain - Cochrane for Clinicians
ABSTRACT: Compared with placebo or sham, custom-made foot orthoses modestly reduce foot pain from pes cavus (high arch), arthritis, plantar fasciitis, and painful hallux valgus. However, there is no evidence that custom orthoses are more effective than prefabricated ones.
Nonmalignant Chronic Pain: Taking the Time to Treat - Curbside Consultation
Hip Pain in Preschool-Age Children - FPIN's Clinical Inquiries
ABSTRACT: Peripheral nerve injury of the upper extremity commonly occurs in patients who participate in recreational (e.g., sports) and occupational activities. Nerve injury should be considered when a patient experiences pain, weakness, or paresthesias in the absence of a known bone, soft tissue, or vascular injury. The onset of symptoms may be acute or insidious. Nerve injury may mimic other common musculoskeletal disorders. For example, aching lateral elbow pain may be a symptom of lateral epicondylitis or radial tunnel syndrome; patients who have shoulder pain and weakness with overhead elevation may have a rotator cuff tear or a suprascapular nerve injury; and pain in the forearm that worsens with repetitive pronation activities may be from carpal tunnel syndrome or pronator syndrome. Specific history features are important, such as the type of activity that aggravates symptoms and the temporal relation of symptoms to activity (e.g., is there pain in the shoulder and neck every time the patient is hammering a nail, or just when hammering nails overhead?). Plain radiography and magnetic resonance imaging are usually not necessary for initial evaluation of a suspected nerve injury. When pain or weakness is refractory to conservative therapy, further evaluation (e.g., magnetic resonance imaging, electrodiagnostic testing) or surgical referral should be considered. Recovery of nerve function is more likely with a mild injury and a shorter duration of compression. Recovery is faster if the repetitive activities that exacerbate the injury can be decreased or ceased. Initial treatment for many nerve injuries is nonsurgical.
ABSTRACT: Understanding the distinctions between the management of clinical problems in nursing homes compared with the community setting helps improve the overall care of nursing home residents. Liberalizing diets helps avoid unintentional weight loss in nursing home residents, although the use of feeding tubes usually does not improve nutrition or decrease aspiration risk. Medical assessment, treatment of comorbidities, and appropriate use of rehabilitation therapies minimize the frequency of falls. Toileting programs may be used to treat incontinence and retention in cooperative patients. Adverse effects and drug interactions should be considered when initiating pharmacologic treatment of overactive bladder. Urinary tract infection and pneumonia are the most common bacterial infections in nursing home residents. Signs and symptoms of infection include fever or hypothermia, and functional decline. Virus identification is recommended for influenza-like illnesses. Nonpharmacologic behavioral management strategies are the preferred treatment for dementia-related problem behaviors. The Beers criteria, which outline potentially inappropriate medication use in older persons, provide guidance for medication use in the nursing home.
Pain In the Quiet (Not Red) Eye - Article
ABSTRACT: Although eye pain is often accompanied by redness or injection, pain can also occur with a quiet eye. Pain in a quiet eye can be the first sign of a vision-threatening condition, a more benign ophthalmologic condition, or a nonophthalmologic condition. Acute narrow-angle glaucoma is an emergent vision-threatening condition that requires immediate treatment and referral to an ophthalmologist. Although most nonophthalmologic conditions that cause eye pain do not need immediate treatment, giant cell (temporal) arteritis requires urgent treatment with corticosteroids. Other vascular conditions, such as carotid artery disease, thrombosis of the cavernous sinus, and transient ischemic attack or stroke, rarely cause eye pain but must be considered. Pain may also be referred from the sinuses or from neurologic conditions, such as trigeminal neuralgia, migraine and cluster headaches, and increased intracranial pressure. The differential diagnosis of eye pain in the quiet eye is extensive, necessitating a systematic and thorough approach. (Am Fam Physician. 2010;82(1):69-73. Copyright © 2010 American Academy of Family Physicians.)