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Search Results for "chronic back pain management"
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Displaying 61 - 70 of 365 in Policy Library
Displaying 61 - 70 of 1297 in Annals of Internal Medicine
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Chronic Pain Among Suicide Decedents, 2003 to 2014: Findings From the National Violent Death Reporting System
Background: More than 25 million adults in the United States have chronic pain. Chronic pain has been associated with suicidality, but previous studies primarily examined nonfatal suicidal behaviors rather than suicide deaths associated with chronic pain or the characteristics of such deaths. Objective: To estimate the prevalence of chronic pain among suicide decedents in a large multistate sample and to characterize suicide decedents with and without chronic pain. Design: Retrospective analysis of National Violent Death Reporting System (NVDRS) data. The NVDRS links death certificate, coroner or medical examiner, and law enforcement data collected by investigators, who often interview informants who knew the decedent to gather information on precipitating circumstances surrounding the suicide. Information is abstracted by using standard coding guidance developed by the Centers for Disease Control and Prevention. Setting: 18 states participating in the NVDRS. Participants: Suicide decedents with and without chronic pain who died during 1 January 2003 to 31 December 2014. Measurements: Demographic characteristics, mechanism of death, toxicology results, precipitating circumstances (mental health, substance use, interpersonal problems, life stressors), and suicide planning and intent. Results: Of 123 181 suicide decedents included in the study, 10 789 (8.8%) had evidence of chronic pain, and the percentage increased from 7.4% in 2003 to 10.2% in 2014. More than half (53.6%) of suicide decedents with chronic pain died of firearm-related injuries and 16.2% by opioid overdose. Limitation: The results probably underrepresent the true percentage of suicide decedents who had chronic pain, given the nature of the data and how they were captured. Conclusion: Chronic pain may be an important contributor to suicide. Access to quality, comprehensive pain care and adherence to clinical guidelines may help improve pain management and patient safety. Primary Funding Source: None.
Cannabis-Based Products for Chronic Pain: An Updated Systematic Review: Annals of Internal Medicine: Vol 179, No 2
Background: Benefits and harms of cannabinoids for chronic pain are uncertain. Purpose: To update an evidence synthesis on cannabinoids for chronic pain. Data Sources: Ovid MEDLINE, PsycINFO, Embase, the Cochrane Library, and Scopus to 28 July 2025. Study Selection: Randomized placebo-controlled trials. Data Extraction: Data extraction, risk of bias, and strength of evidence were dually reviewed. Cannabinoids were categorized by tetrahydrocannabinol (THC)-to-cannabidiol (CBD) ratio (high, comparable, or low), source (synthetic, purified, extracted), and administration method. Data Synthesis: 25 short-term (1 to 6 months) randomized controlled trials (n = 2303; 64% neuropathic pain) assessed cannabinoids. Oral synthetic/purified high THC-to-CBD (THC only) may slightly reduce and oromucosal, extracted, comparable THC-to-CBD ratio products probably slightly reduce pain severity (pooled differences, −0.78 and −0.54 points, respectively, [0 to 10 scale]), with moderate or large increased dizziness, sedation, and nausea. Among THC-only products, nabilone moderately reduced pain severity but dronabinol did not (pooled differences, −1.59 and −0.23 points, respectively). Low THC-to-CBD interventions may not improve outcomes. Although low THC-to-CBD mixed THC/CBD products may increase dizziness, sedation, and nausea, CBD alone may not increase harms. Limitation: Variability within categories; lack of product details; unclear U.S. availability of studied products; restricted to English-language studies. Conclusion: Comparable and high THC-to-CBD ratio cannabinoid products may result in small improvements in pain and increased common adverse events during short-term treatment of primarily neuropathic pain; among high-ratio THC-only products, nabilone (but not dronabinol) reduced pain. Low THC-to-CBD products may not improve outcomes. Studies are needed on long-term outcomes and other cannabis product types. Primary Funding Source: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services (PROSPERO: CRD42021229579).
Quality Indicators for Pain in Adults: A Review of Performance Measures by the American College of Physicians
Pain is a debilitating symptom generally caused by injuries or various conditions. It can be acute, subacute, or chronic and can have a significant impact on a patient’s quality of life. The goal of managing pain is to relieve or reduce suffering and improve patient functioning. Several performance measures that address the treatment of pain are used in payment, public reporting, or accountability programs. The American College of Physicians (ACP) embraces performance measurement as a means to improve quality of care. ACP believes that a performance measure must be methodologically sound and evidence-based to be considered for inclusion in payment, accountability, or reporting programs. However, a plethora of performance measures that provide minimal or no value to patient care have inundated physicians, practices, and systems with the burden of collecting and reporting data. ACP’s Performance Measurement Committee (PMC) reviews performance measures using a validated process to recognize high-quality performance measures, address gaps and areas for improvement in performance measures, and help reduce reporting burden. There is a need for a higher standard for a performance measure when reputation and reimbursement are on the line. This paper aims to present a review of current performance measures for pain to inform physicians, payers, and policymakers in their selection and use of performance measures. The PMC reviewed 6 performance measures for pain relevant to internal medicine physicians, of which 3 were considered valid at their intended levels of attribution (“Use of Imaging for Low Back Pain,” “Use of Opioids at High Dosage in Persons Without Cancer,” and “Use of Opioids From Multiple Providers in Persons Without Cancer”). This paper also proposes a performance measure concept to address a quality-of-care gap based on the current clinical guideline from ACP and the American Academy of Family Physicians, “Nonpharmacologic and Pharmacologic Management of Acute Pain From Non–low Back, Musculoskeletal Injuries in Adults.”
How Would You Manage This Patient With Recurrent Diverticulitis?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center: Annals of Internal Medicine: Vol 176, No 6
Acute diverticulitis, which refers to inflammation or infection, or both, of a colonic diverticulum, is a common medical condition that may occur repeatedly in some persons. It most often manifests with left-sided abdominal pain, which may be associated with low-grade fever and other gastrointestinal symptoms. Complications may include abscess, fistula formation, perforation, and bowel obstruction. The American College of Physicians recently published practice guidelines on the diagnosis and management of acute diverticulitis, the role of colonoscopy after resolution, and interventions to prevent recurrence of this condition. Among the recommendations were the use of abdominal computed tomography (CT) scanning in cases where there was diagnostic uncertainty, initial management of uncomplicated cases in the outpatient setting without antibiotics, referral for colonoscopy after an initial episode if not performed recently, and discussion of elective surgery to prevent recurrent disease in patients with complicated diverticulitis or frequent episodes of uncomplicated disease. Here, 2 gastroenterologists with expertise in acute diverticulitis debate CT scanning for diagnosis, antibiotics for treatment, colonoscopy to screen for underlying malignancy, and elective surgery to prevent recurrent disease.
How Would You Manage This Patient With Benign Prostatic Hyperplasia?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center: Annals of Internal Medicine: Vol 176, No 4
Lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) are common in older patients assigned male sex at birth, regardless of gender identity, and treatment of these symptoms is therefore common in primary care practice. In 2021, the American Urological Association published guidelines for management of BPH. They recommend using a standardized scoring system such as the International Prostate Symptom Score to help establish a diagnosis and to monitor the efficacy of interventions, α-blockers as the first-choice pharmacotherapy option, and 5α-reductase inhibitors for patients with prostate size estimated to be at least 30 cc. Tadalafil is another option regardless of erectile dysfunction. Combination therapies with α-blockers and 5α-reductase inhibitors, anticholinergic agents, or β3-agonists are effective options. A surgical referral is warranted if the BPH results in chronic kidney disease, refractory urinary retention, or recurrent urinary tract infections; if there is concern for bladder or prostate cancer; or if symptoms do not respond to medical therapy. In this article, a general internal medicine physician and a urologist discuss the treatment options and how they would apply their recommendations to a patient who wishes to learn more about his options.
Displaying 61 - 70 of 90 in Annals of Internal Medicine: Clinical Cases
Unusual Extra-intestinal Manifestations of Crohn Disease Complicated by Incidentally Diagnosed Pancreatic Neuroendocrine Tumor | Annals of Internal Medicine: Clinical Cases
Crohn disease is associated with nonnecrotizing epithelioid granulomas, which rarely involve extra-intestinal solid organs. Management of moderate-to-severe Crohn disease, especially with extra-intestinal manifestations, relies on biologic therapies and small molecules which suppress the immune system and potentially increase cancer risk. We present the diagnosis and management of a rare case of Crohn disease with nonnecrotizing epithelioid granulomas in the sacral spine, pancreas, and peripancreatic soft tissue, complicated by an incidentally diagnosed pancreatic neuroendocrine tumor.
Biopsy-Proven Anticoagulant-Related Nephropathy: A Case Report and Review of the Literature | Annals of Internal Medicine: Clinical Cases
Anticoagulant-related nephropathy is a type of acute kidney injury that may follow warfarin and other anticoagulants. Anticoagulant-related nephropathy has been shown to be associated with irreversible kidney injury and increased risk for morbidity. Accurate diagnosis and management remain to be challenging. We describe a case of a 62-year-old man with significant cardiac history who presented with impaired kidney function associated with supratherapeutic international normalized ratio. Kidney biopsy findings suggested anticoagulant-related nephropathy.
A Case Report of Systemic Lupus Erythematosus With IgA Nephropathy and Crescentic Nephritis | Annals of Internal Medicine: Clinical Cases
We report a case of systemic lupus erythematosus with IgA nephropathy and acute progressive glomerulonephritis. Renal function failed to recover after the administration of glucocorticoid and cyclophosphamide pulse therapy, which shows that systemic lupus erythematosus and IgA nephropathy may coexist at the same time.
Spontaneous Resolution of Myocardial Inflammation in Cardiac Sarcoidosis: A Case Report | Annals of Internal Medicine: Clinical Cases
Sarcoidosis is a multisystem disease characterized by granulomatous inflammation of virtually any organ or tissue. Atrioventricular block, arrhythmias, cardiomyopathies, and sudden cardiac death are known manifestations of cardiac sarcoidosis (CS), and, thus, diagnosis of CS is considered an absolute indication to initiate treatment of sarcoidosis with disease-modifying anti-inflammatory immunosuppressives. To our knowledge, spontaneous resolution of CS has not been documented. Here, we report what we believe is the first documented case of spontaneous-resolution CS-related myocardial inflammation without corticosteroid or other immunosuppressive therapy for nearly 5 years following initial presentation.
A Confirmed Case of Ignatzschineria larvae Bacteremia From a Myiatic Wound Infection in Kentucky | Annals of Internal Medicine: Clinical Cases
Myiasis, or the infection of a fly larva (maggot) in a human tissue is a rare occurrence in the United States. Rarer yet is bacteremia arising from such infection. In this case report, we discuss a case of Ignatzschineria larvae bacteremia that we believe is only the second of its kind reported in the United States, both being from the state of Kentucky. We provide more information regarding exposure, risk factors, and clinical manifestations of the disease, along with insight into the pharmacologic approach to treatment based on known susceptibilities.
Refractory Iron Deficiency Anemia Secondary to Angiodysplasia-Related Gastrointestinal Bleeding Successfully Treated With Bevacizumab | Annals of Internal Medicine: Clinical Cases
Rapidly recurrent iron deficiency anemia secondary to angiodysplasia-related gastrointestinal hemorrhage is usually difficult to treat. Management is limited to endoscopic techniques such as argon plasma coagulation, blood product transfusion, parenteral iron replacement, and elimination of drugs that predispose to bleeding. We describe 2 patients with gastrointestinal angiodysplasia and rapidly recurrent iron deficiency anemia secondary to chronic gastrointestinal bleeding who continued to be symptomatic despite multiple pharmacologic and supportive interventions. They both experienced a dramatic, rapid, and sustained response to bevacizumab. Clear guidelines on the use of bevacizumab in this setting are lacking.
Apathetic Thyrotoxicosis Presenting With New-Onset Pulmonary Hypertension | Annals of Internal Medicine: Clinical Cases
Apathetic thyrotoxicosis is a distinct clinical entity of hyperthyroidism that occurs in elderly patients. Manifestations include depression, weight loss, mild tachycardia, and symptoms of heart failure. Noteworthy is the absence of typical hyperkinetic motor symptoms. Pulmonary hypertension is an often-overlooked manifestation of thyrotoxicosis. Here, we present a case of a 67-year-old woman who presented to the clinic with complaints of dyspnea on exertion, orthopnea, leg edema, and 20-lb weight loss. Further work-up revealed pulmonary hypertension with thyrotoxicosis, without the typical sympathetic symptoms. After achieving a euthyroid state with methimazole therapy, she experienced resolution of her symptoms, and her pulmonary artery pressures normalized.
Page Kidney From Ruptured Mycotic Pseudoaneurysm of Renal Artery: An Unusual Complication of Infective Endocarditis | Annals of Internal Medicine: Clinical Cases
Page kidney is an uncommon but potentially reversible cause of secondary hypertension characterized by external compressive force leading to renal hypoperfusion and elevated renin level. Renal artery mycotic aneurysms from infective endocarditis are exceedingly rare. The most feared complication is rupture, which can result in subcapsular hematoma and Page kidney. Early recognition and treatment are crucial to preserving renal function. Imaging and clinical findings aid diagnosis. Angiotensin-converting enzyme inhibitors are usually the first-line treatment of hypertension. Here, we present a rare patient case of ruptured mycotic pseudoaneurysm of the renal artery that complicated infective endocarditis and resulted in Page kidney.
A Case of Pseudo-Pseudo Meigs Syndrome as the Initial Presentation of Systemic Lupus Erythematosus | Annals of Internal Medicine: Clinical Cases
Systemic lupus erythematosus (SLE) is a multigenic disease leading to chronic inflammatory states within organ systems. When associated with ascites, pleural effusions, and elevated CA-125 levels, it is known as pseudo-pseudo Meigs syndrome. It is a clinical diagnosis without findings of benign or malignant ovarian tumors in patients with SLE. We present a patient case of a 42-year-old woman who presented with episodic and progressively worsening ascites, bilateral pleural effusions, and elevated CA-125 levels without any evidence of benign or malignant tumors as the initial manifestation of SLE.
When Community-Acquired Pneumonia Guidelines Provide Misguided Guidance | Annals of Internal Medicine: Clinical Cases
Limited diagnostic testing and empirical antimicrobial therapy are recommended in practice guidelines for adults with community-acquired pneumonia (CAP). Although following CAP guidelines is cost-effective with high cure rates, consideration should be given to the possibility that CAP is caused by pathogens not effectively treated by the recommended antibiotic regimens. Expanding the differential diagnosis based on potential pathogen exposures and comorbid conditions can prevent delays in diagnosis and appropriate treatment. As an example, mucormycosis should be considered in a patient presenting with pneumonia in the setting of diabetic ketoacidosis.