AFP Clinical Answers
Asthma, Back and Neck Pain, Pain During Labor, TIA, CBT for Anxiety
Am Fam Physician. 2019 Aug 15;100(4):208.
Is intravenous magnesium sulfate effective for the treatment of acute asthma exacerbations?
Patients presenting to the emergency department with an acute asthma exacerbation that has not responded to first-line therapy (short-acting bronchodilators and corticosteroids) can be treated effectively with intravenous magnesium sulfate. In children, magnesium sulfate reduced hospital admissions by 68%. In adults, magnesium sulfate reduced admissions by 25%.
Is manipulative therapy effective for back and neck pain?
Spinal manipulative therapy may be considered for patients with acute low back pain to provide modest improvement in pain and function at up to six weeks, comparable with other therapies. It may also be considered for patients with chronic low back pain. It results in modest improvement in pain and function for up to six months and is comparable with other therapies. Cervical manipulation and mobilization may be considered to provide short-term improvement in pain relief and function in patients with neck pain.
Are complementary and integrative treatments such as massage, thermal interventions, and relaxation techniques effective for managing pain during labor?
All the studied interventions had some benefit in labor, but the evidence is of low to very low quality. Massage, thermal interventions (warm and cold packs), relaxation techniques, yoga, and music reduce pain during latent labor, but not during active labor. Thermal interventions and yoga shorten the duration of labor, with a mean difference of 66 minutes for warm packs, 78 minutes for cold or intermittent warm and cold packs, and 140 minutes for yoga vs. usual care. Yoga improves satisfaction with pain relief, and relaxation techniques increase the likelihood that patients will report high satisfaction with pain control. Massage also improved satisfaction with the labor experience.
Does adding clopidogrel to aspirin following a TIA or minor stroke safely improve outcomes?
A randomized controlled trial provided support for a strategy of adding clopidogrel (Plavix) to aspirin for the first week or so after a minor ischemic stroke or transient ischemic attack (TIA) because this is when the greatest benefit occurs. Harms (hemorrhagic events) were spread fairly evenly throughout the study period.
Is therapist-guided, internet-delivered CBT an effective treatment for anxiety in adults?
Therapist-guided, internet-delivered cognitive behavior therapy (CBT) can be used as an effective treatment for anxiety in adults and is similar in effectiveness to face-to-face CBT.
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