Top 10 AFP Community Blog Posts of 2024

Kenny Lin, MD, MPH
Posted on December 23, 2024

In 2024, the AFP Community Blog welcomed Dr. Lilian White as a regular contributor, replacing Dr. Jen Middleton, who had been writing for AFP since 2013. Below are excerpts from this year’s top 10 most-viewed blog posts on new health threats (kratom, nicotine pouches), questionable therapies (spinal cord stimulators, medical spas), and dogma-challenging studies (beta blockers after myocardial infarction, treating elevated blood pressure in the hospital), among others. We hope that you enjoy revisiting these popular posts, and we’ll be back with more in 2025.

**

Low-dose naltrexone reduces pain and improves sleep, fatigue, and cognitive symptoms in patients with fibromyalgia. In patients with Crohn’s disease, low-dose naltrexone improves quality of life and promotes disease remission. Low-dose naltrexone likewise improves mental health–related quality of life and disability in patients with multiple sclerosis.

Unlike patients with classic type 1 diabetes, patients with LADA have initially preserved pancreatic beta cell function and thus may have a transient response to noninsulin therapy and lifestyle modifications. However, as the disease progresses, they will require insulin to maintain blood glucose control, generally within one year of diagnosis.

At an estimated 50,000 procedures annually, spinal cord stimulators make up a relatively small portion of back surgeries. However, in a 2020 letter to health care providers, the FDA reported that over the preceding four-year period, it received “a total of 107,728 medical device reports related to spinal cord stimulators intended for pain, including 497 associated with a patient death [representing 428 deaths], 77,937 with patient injury, and 29,294 with device malfunction.”

Cross-sectional studies performed in Malaysia and case reports worldwide suggest that some patients who chronically use kratom experience withdrawal and dependence similar to other opioids. No formal guidelines are available for treatment of kratom dependence or misuse, and only a paucity of evidence is available regarding long-term outcomes and success of treatment in primary care.

POTS affects approximately 30% of highly symptomatic patients with long COVID. Symptoms of POTS and other forms of cardiac dysautonomia include palpitations, orthostatic symptoms, fatigue, brain fog, sleep disturbance, migraine, and muscle weakness, among others.

Family physicians should screen adolescents and young adults for the use of any nicotine-containing product, including oral nicotine pouches, vaping, and disposable e-cigarettes. We can nonjudgmentally inform them of the risks and unknowns about these products and provide guidance if they wish to quit.

The FDA approved Rejoyn after reviewing the results of a randomized controlled trial that enrolled 386 participants 22 to 64 years of age who had major depressive disorder and were also taking medication to treat it. Participants completed either the Rejoyn app’s 6-week course or a sham app course. Although the difference in Montgomery-Åsberg Depression Rating Scale (MADRS) score change between groups was statistically significant, the average between group difference was only 2.12 points.

A randomized, open-label trial assigned more than 5,000 patients with an acute MI and preserved left ventricular ejection fraction of at least 50% to long-term therapy with metoprolol or bisoprolol or no treatment. After a median of 3.5 years, there was no difference between the groups in the primary composite outcome of death from any cause or new MI.

Although the long-term benefits of outpatient BP control are well established, it is not clear whether initiating or intensifying antihypertensive therapy in the hospital is necessary or beneficial. In fact, two large cohort studies have suggested that such therapy may cause more harm than good.

Treatments promising “fat dissolving” aren’t the only ones with risks. Chemical peels offered at many med spas can cause burns if not appropriately applied. Intravenous treatments touted to cure hangovers or boost energy can cause dangerous electrolyte imbalances.