Pain Features News

Stat Consult: Chronic Low Back Pain

Stat Consult: Chronic Low Back Pain

Chronic low back pain (LBP) defined as persistent or fluctuating musculoskeletal pain of lower back and lumbar spine lasting >3 months.

Hormonal Contraceptives and Migraine: Is It Time to Revisit Stroke Risk?

Hormonal Contraceptives and Migraine: Is It Time to Revisit Stroke Risk?

Current oral contraceptive products contain lower doses of estrogen than those used in the past, prompting reconsideration of risks and benefits.

Managing Pediatric Migraine: Current Therapies and Future Directions

Managing Pediatric Migraine: Current Therapies and Future Directions

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.

Assessing lidocaine efficacy for chronic pain management

Assessing lidocaine efficacy for chronic pain management

Intravenous, patch lidocaine might be effective in treating, preventing chronic pain.

Opioids and naloxone for pain management

Opioids and naloxone for pain management

Co-prescribing naloxone and opioids in primary care is recommended for patients who have a high risk for opioid overdose.

Could disrupted homeostasis cause headaches?

Could disrupted homeostasis cause headaches?

Dysfunction of the endocrine system may lead to various neurologic manifestations, including headaches.

Chest pain in a woman

Chest pain in a woman

A woman has a myocardial infarction after her chest symptoms are misdiagnosed as acid reflux.

Genetic vascular anomaly

Genetic vascular anomaly

A young Caucasian woman presented with complaints of years regarding pain in her feet but did not know the cause.

Suboxone and methadone—our readers weigh in on the pros and cons

Suboxone and methadone—our readers weigh in on the pros and cons

Research has shown that use of suboxone and methadone, in conjunction with counseling, can be effective addiction treatment.

Alternative treatment options for chronic pain

Alternative treatment options for chronic pain

Ice is among alternative recommendations for treatment of chronic pain.

Salivary duct stone

Salivary duct stone

After 36 hours, a patient with a salivary duct stone shows limited improvement.

Slippery elm: an effective anti-inflammatory agent

Slippery elm: an effective anti-inflammatory agent

Slippery elm may be beneficial for patients with GI complaints.

Readers weigh in on non-narcotic treatment options for patients with musculoskeletal pain

Readers weigh in on non-narcotic treatment options for patients with musculoskeletal pain


Readers provide more suggestions for treating musculoskeletal pain.

Osteoarthritis: conservative treatment options

Osteoarthritis: conservative treatment options

Osteoarthritis is one of the most common problems encountered in primary care, and conservative treatment can improve patients' quality of life.

Non-narcotic analgesics for musculoskeletal pain

Non-narcotic analgesics for musculoskeletal pain

Which non-narcotic analgesics are best for treating musculoskeletal pain?

Pharmacotherapy options for noncancer pain: an efficacy review

Pharmacotherapy options for noncancer pain: an efficacy review

Although opioids are often prescribed for noncancer pain, a new review shows that they are no more effective than acetaminophen or NSAIDs.

Management and treatment of peripheral neuropathy

Management and treatment of peripheral neuropathy

An older patient with type 2 diabetes expresses concern about potential peripheral neuropathy.

Intra-articular injections
 for severe osteoarthritis

Intra-articular injections
 for severe osteoarthritis


For patients with severe osteoarthritis, dangling their legs can help with intra-articular injections.

Generic "caine" is effective 
for wound care

Generic "caine" is effective 
for wound care


Most pharmacies have a generic, affordable "caine" medication to relieve pain in wound care.

Integrative and OTC treatment of headache

Integrative and OTC treatment of headache

Headache is one of the most common complaints in outpatient practice. There are 10 things that clinicians need to know to help treat their patients with headache.

Referral misses 
drug-seeking 
behavior

Referral misses 
drug-seeking 
behavior

A patient overdoses when communication breaks down between clinicians.

Understanding Dupuytren disease

Understanding Dupuytren disease

Needle aponeurotomy and collagenase Clostridium histolyticum are both viable options for treating patients with Dupuytren disease.

Reflex sympathetic dystrophy

Reflex sympathetic dystrophy

A man with worsening pain in his right arm is diagnosed with reflex sympathetic dystrophy.

Weighing the pros, cons of craniosacral therapy

Weighing the pros, cons of craniosacral therapy

The benefits of CranioSacral Therapy may not outweigh the intensive training and medical costs associated with the treatment.

Vertigo, then headache: what is 
the diagnosis?

Vertigo, then headache: what is 
the diagnosis?


A man, aged 56, presented with complaints about episodes of vertigo and disabling headaches.

Craniosacral therapy may be helpful, but not curative

Craniosacral therapy may be helpful, but not curative

Due to the limited amount of high-quality human studies, craniosacral therapy should not be suggested as a first-line treatment.

Steroids no use in spinal stenosis

Steroids no use in spinal stenosis

Epidural injections of anesthetic without corticosteroids do not relieve the pain associated lumbar spinal stenosis.

Unusual use of radiation therapy for pelvic pain

Unusual use of radiation therapy for pelvic pain

A woman suffers cyclic pain after multiple abdominal and pelvic surgeries.

Numbness, tingling, weakness, and coolness in a 'jammed' hand

Numbness, tingling, weakness, and coolness in a 'jammed' hand

A man tells the orthopedics clinic staff about odd sensations in his hand a week after a car accident.

Numbing a wound on infected skin

Numbing a wound on infected skin 


Incision and drainage on already infected skin structures can always be uncomfortable for the patient.

Comments in chart lead to a lawsuit

Comments in chart lead to a lawsuit

A clinician's opinions about a patient, noted in the patient's chart, become grounds for charges of defamation.

The safe use of opioids in the treatment of pain

The safe use of opioids in the treatment of pain

To minimize the risk of abuse and addiction, evidence-based prescribing practices must be used when treating acute and chronic pain with opioids.

Involve parents when 
suturing a child

Involve parents when 
suturing a child


Enlisting a parent's help can provide comfort without a scary needle or painful injection.

Relieving the pain of epiploic appendagitis

Relieving the pain of epiploic appendagitis

What treatments are recommended for pain from epiploic appendagitis?

Magnet therapy for pain and muscle spasms

Magnet therapy for pain and muscle spasms

When a magnet is placed on the skin, capillary walls relax, allowing for increased blood flow and oxygenation and removal of accumulated pain-producing prostaglandins.

Quick relief of oral mucositis

Quick relief of oral mucositis

A simple way to achieve oral cryotherapy to immediately relieve acutely painful symptoms.

What you should know about medical marijuana

What you should know about medical marijuana

Federal criminalization of this drug—most commonly used in the treatment
of HIV, pain and glaucoma—has limited research into its effectiveness.

Does red wine ease menstrual cramps?

Does red wine ease menstrual cramps?

Does evidence support red wine for menstrual cramp prevention?

Questioning the doctor's orders

Questioning the doctor's orders

A strong dose of an opioid administered to a woman recovering from surgery causes permanent damage.

No increased delirium with hydromorphone after hip surgery

No increased delirium with hydromorphone after hip surgery

Hydromorphone for postoperative pain does not appear to increase delirium in elderly patients having hip fracture surgery.

Should fatty liver be considered in spontaneous bleeding?

Should fatty liver be considered in spontaneous bleeding?

A who takes acetaminophen for chronic neck and back pain awakens to a bloody nose and blood-soaked pillow. Could liver disease be to blame?

Reflexology for managing pain and anxiety

Reflexology for managing pain and anxiety

Reflexology uses subtle pressure on specific muscle areas of the feet or hands to stimulate blood flow and nerve impulses that then trigger the release of endorphins and retained toxins.

Rosemary boasts cognitive and anti-inflammatory benefits

Rosemary boasts cognitive and anti-inflammatory benefits

Rosmarinus officinalis is rich in iron, calcium and vitamin B6, and has been credited with improving cognition and memory.

Painful skin ulcer ­develops in older woman on dialysis

Painful skin ulcer ­develops in older woman on dialysis

Metastatic calcification of the left 
breast in a patient with renal failure 
raises suspicion.

Acupuncture best for chronic low back pain and osteoarthritis management

Acupuncture best for chronic low back pain and osteoarthritis management

The National Institutes of Health noted that there is enough scientific evidence of acupuncture's efficacy to warrant its use in certain clinical situations.

Tart cherry: A superfruit with antiinflammatory and cardiac benefits

Tart cherry: A superfruit with antiinflammatory and cardiac benefits

A growing body of evidence has linked the tart cherry to substantial anti-inflammatory benefits, including reduced arthritic and gout pain, and several cardiac benefits.

The role of vitamin D in post-fracture symptoms

Can vitamin D deficiency play a role in post-fracture pain?

The special challenge of chronic pain

The special challenge of chronic pain

Failure to properly treat patients suffering legitimate chronic pain syndromes can result in a compounding of prescription pain-medication abuse.

Pain management: Lessons from patients

Pain management: Lessons from patients

These women experienced debilitating pain episodes that challenged even the most knowledgeable clinicians. You can learn from their case histories.

Hypnosis for pain management, anxiety and behavioral disorders

Hypnosis for pain management, anxiety and behavioral disorders

Medical hypnotherapy today is most commonly used for pain management, treatment of anxiety or psychosomatic illness, and treatment of behavioral disorders.

Check for flat feet in young patients with shin splints

Ruling out pes planus can help avoid unnecessary prescriptions and referrals.

Halting migraine in someone with coronary artery disease

What treatment would you recommend for aborting a migraine in a patient with known coronary artery disease?

Which radiologic test to use for abdominal pain

How do I know which radiologic tests to choose when evaluating abdominal pain?

Managing post-herpetic neuralgia

A 55-year-old woman who had herpes zoster and takes morphine for post-herpetic neuralgia pain, no longer wants to be on heavy-duty pain medication. What are her alternatives?

An algorithm for managing breast pain

An algorithm for managing breast pain

Breast pain can be an frightening experience, but the primary-care provider can often allay the patient's fears and capably manage the condition.

Serotonin syndrome in depressed patients with migraine

How concerned should clinicians be about serotonin syndrome when prescribing a triptan with a selective serotonin reuptake inhibitor (SSRI)?

Is there one pill to treat hypertension and migraine?

A hypertensive patient with migraines experienced undesirable side effects (irritability and weight gain) while taking the nonselective beta-blockers nadolol (Corgard) and propranolol (Inderal).

Are iodine preparations safe for treating pressure sore eschar formations?

The use of povidine-iodine in wound care is controversial. Several experimental studies have demonstrated concerns regarding its safety and effect on wound healing.

Plantar fasciitis

Chronic inflammation can lead to a calcaneal spur at the base of the heel bone.

Willow bark relieves pain and inflammation

Willow bark relieves pain and inflammation

Willow bark contains the chemical salicin, which is the precursor to aspirin.The active salicin in white willow bark acts primarily as both an analgesic and an antipyretic. The actual mechanism of action of salicin is very similar to that of modern prescription medications in the cyclo-oxygenase-1 and 2 (COX-1, COX-2) pathways.

Is a patient in pain or seeking drugs?

How should a clinician treat a patient with recurring migraines, that also has a history of drug seeking behavior?

Gouty arthritis: How to make the diagnosis

Gouty arthritis: How to make the diagnosis

This painful disease greatly impacts the daily lives of those who suffer from it. Diagnosis, treatment, and lifestyle modification can ease long-term effects

GI side effects of pain medication

What are the side effects of fentanyl?

Managing diabetic neuropathic pain

Managing diabetic neuropathic pain

Neuropathy is one of the most common diabetic comorbidities — affecting about 60% to 70% of patients. Managing glucose levels is the most direct way to prevent nerve damage and alleviate pain.

The role of myofascial trigger points in migraine therapy

What is the relationship between myofascial trigger points and migraine headaches?

Unexplained low-back pain in an adolescent with scoliosis

Unexplained low-back pain in an adolescent with scoliosis

Nothing offered more than temporary relief for the aching, constant pain, which was unaccompanied by other symptoms.

Easing costochondritis pain

What do you recommend to speed healing or to treat the pain of costochondritis?

Cancer missed because patient lacked health insurance

Nurse commits to dedicating more time to free clinics.

Nurse trusts instincts, diagnoses colleague's potentially life-threatening condition

Early experience in the medical ICU helped a nurse choose the appropriate test.

Chest pain: When should I be worried?

Chest pain: When should I be worried?

Many sources of chest pain have nothing to do with the heart. Whether the pain is cardiac or noncardiac in nature dictates the next steps.

Off-label anticonvulsant relieves neuropathic pain

The antiseizure medication tiagabine (Gabitril) has been used off-label to manage neuropathic pain, either diabetic or spinal in nature.

Pain-clinic referral

When is it appropriate to refer patients to a pain clinic?

Outdated warning against using epinephrine in digital blocks

Do the benefits now outweigh the risks of using lidocaine with epinephrine in digital blocks?

Migraine medication concerns

Is it okay to combine promethazine with migraine medications?

Clinician trusts instincts and diagnoses an unlikely heart attack

Patient treated despite EKG results devoid of Q waves, ST depression or elevation.

Abdominal pain in a posthysterectomy patient

Ms. L, 34 years old and para 1 gravida 2, presented to the emergency room one evening following a four-day battle with "the flu." She became concerned after experiencing increasing pain in her left flank and pelvic area. On questioning, she recounted being constipated and very nauseated.

Opioids for chronic pain: Striking a balance

Opioids for chronic pain: Striking a balance

Misconceptions surround the use of opioids for chronic pain. For optimal management, clinicians and patients need to be armed with the facts.

Sniffing out phony back pain

What is the best way to differentiate between a patient who has legitimate back pain and someone who is looking for a drug prescription or workers' compensation?

Tai Chi beneficial for fibromyalgia

A randomized trial of 66 patients with fibromyalgia suggests that Tai Chi might be helpful for both pain and sleep disturbance symptoms.

Slip and fall ends in more than a simple muscle strain

Slip and fall ends in more than a simple muscle strain

Four weeks after the accident, the patient was still in severe pain and reported urinary frequency.

An effective natural remedy for migraine and allergies

An effective natural remedy for migraine and allergies

Butterbur, once discouraged because of its potential to cause liver damage, is now widely used in Europe to combat allergic rhinitis, asthma, and migraine.

Nonpharmacologic treatment of pain from sickle-cell disease

Are there any nonpharmacologic treatment measures that have been effective in managing pain associated with sickle-cell disease?

Does fibromyalgia require sleep testing?

Should all patients with fibromyalgia undergo sleep studies?

Mixing NSAIDs with antiplatelet therapy

Mixing NSAIDs with antiplatelet therapy

Combining these agents may compound GI complications. New guidelines help primary-care clinicians identify and protect patients most at risk.

Severe arm pain following radiation

Mr. C, 58 years old, presented for a routine primary-care appointment with the complaint of "right arm pain" of two months' duration. He rated the severity of his pain as a 10/10 and described it as gradual in onset from the shoulder down. The pain was keeping him awake at night. He had had no correlative injury except for a rotator cuff tear and repair 20 years ago.

Diagnosing and treating generalized anxiety disorder

In order to meet diagnostic criteria for generalized anxiety disorder, a patient must worry excessively about everyday problems for at least six months.

Low back pain: Steps you may be overlooking

Your main challenge is to pinpoint the true cause and limit invasive interventions. A leading rheumatologist tells how to achieve these goals.

Carpal tunnel syndrome

Carpal tunnel syndrome

A review of the diagnosis, treatment, and testing of carpal tunnel syndrome.

Independent exam seems to blur roles

Independent exam seems to blur roles

If an insurance company hires you to evaluate disability claims, are you functioning as its agent or as the patient's clinician?

Assessing knee pain in the primary-care clinic

Assessing knee pain in the primary-care clinic

Not all knee complaints require orthopedic referral. This review of basic testing and exam techniques will help you arrive at an accurate diagnosis.

Coalition of Pain Experts Offers Guidance on Measures to Prevent Misuse and Abuse of Pain Medications

An ad hoc coalition of leading pain specialists and representatives from key clinical and patient advocacy organizations convened in November 2008 to address the growing problem of misuse and abuse of pain medications.

Late-night call leads to nightmare

Late-night call leads to nightmare

A faulty dermal patch causes a fatal overdose, but if she didn't prescribe it, why is this NP in court?

Difficult-to-treat chronic pain syndromes

Difficult-to-treat chronic pain syndromes

Learn which pain complaints call for medication management only and which are more time-intensive and require multimodal regimens.

New pain drug approved

Keep low back pain patients out of surgery

Education, self-management, and pharmacologic as well as nonpharmacologic therapies take center stage in this latest, jointly issued guideline.

Self-care can relieve back pain

Clinicians may be able to help patients with chronic back pain overcome discomfort by employing a self-care program known as the Alexander technique...

DEXAMETHASONE MAY REDUCE MIGRAINE RECURRENCE WITHIN 72 HOURS

A systematic review of seven randomized placebo-controlled trials evaluated the...

A comprehensive look at kidney stones

A comprehensive look at kidney stones

Some risk factors are unavoidable, but adjusting your patient's diet and addressing comorbidities can prevent excruciating episodes.

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