Search Results for "chronic back pain management"
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Displaying 1 - 1 of 1 in Online Learning Center
Back Pain: Get Your Patient Back in the Game
Obidiugwu Kenrik Duru, MD, MSHS, discusses the prevalence, assessment and treatment of acute and chronic low back pain. This session was originally presented at IMM 2019. The 2024 rerelease of ACP's modules within the Pain Management Learning Series includes updated information and provides additional learning and credit earning opportunity for learners who claimed credit for earlier versions. CME/MOC credit are free to ACP Members. Nonmembers may purchase access to claim CME/MOC credit for $25.
Displaying 1 - 10 of 362 in Policy Library
Displaying 1 - 2 of 2 in Performance Measures
Use of Opioids from Multiple Providers in Persons without Cancer
The proportion (XX out of 1,000) of individuals without cancer receiving prescriptions for opioids from four (4) or more prescribers AND four (4) or more pharmacies.
Use of Opioids at High Dosage in Persons Without Cancer
The proportion (XX out of 1,000) of individuals without cancer receiving prescriptions for opioids with a daily dosage greater than 120mg morphine equivalent dose (MED) for 90 consecutive days or longer
Displaying 1 - 10 of 1295 in Annals of Internal Medicine
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Guideline: In low back pain, nonpharmacologic treatments are recommended
Source Citation Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166:514-30. 28192789
Nonopioids and opioids gave similar relief for back pain or osteoarthritis but nonopioids had fewer adverse effects
Source Citation Krebs EE, Gravely A, Nugent S, et al. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA. 2018;319:872-82. 29509867
Reporting of Sex Effects by Systematic Reviews on Interventions for Depression, Diabetes, and Chronic Pain
Systematic reviews (SRs) have the potential to contribute uniquely to the evaluation of sex and gender differences (termed “sex effects”). This article describes the reporting of sex effects by SRs on interventions for depression, type 2 diabetes mellitus, and chronic pain conditions (chronic low back pain, knee osteoarthritis, and fibromyalgia). It includes SRs published since 1 October 2009 that evaluate medications, behavioral interventions, exercise, quality improvement, and some condition-specific treatments. The reporting of sex effects by primary randomized, controlled trials is also examined. Of 313 eligible SRs (86 for depression, 159 for type 2 diabetes mellitus, and 68 for chronic pain), few (n = 29) reported sex effects. Most SRs reporting sex effects used metaregression, whereas 9 SRs used subgroup analysis or individual-patient data meta-analysis. The proportion of SRs reporting the sex distribution of primary studies varied from a low of 31% (n = 8) for low back pain to a high of 68% (n = 23) for fibromyalgia. Primary randomized, controlled trials also infrequently reported sex effects, and most lacked an adequate sample size to examine them. Therefore, all SRs should report the proportion of women enrolled in primary studies and evaluate sex effects using appropriate methods whenever power is adequate.
Displaying 1 - 10 of 92 in Annals of Internal Medicine: Clinical Cases
Insidious Spinal Brucellosis and Psoas Abscess in a 67-Year-Old Patient: A Case Report | Annals of Internal Medicine: Clinical Cases
A 67-year-old man presented with chronic low-back pain, unintentional weight loss, and intermittent fevers in the setting of a recent trip to Mexico. Imaging showed discitis and osteomyelitis, and epidural cultures confirmed brucellosis. Brucellosis is a zoonotic infection endemic to Eurasia and South America but has a low incidence in the United States. Although the vast majority of cases of vertebral osteomyelitis are due to common bacterial organisms, a thorough history can prompt earlier consideration of atypical infections. This case highlights brucellosis as an etiologic consideration in cases of unexplained osteomyelitis and how expanded history-taking can help clinicians more readily identify risk factors for less common infections.
Cirrhosis Caused by Nilotinib in Dose-Dependent Hepatotoxicity: Role of Gamma-Glutamyl Transferase in Management | Annals of Internal Medicine: Clinical Cases
We report nilotinib hepatotoxicity in a patient with chronic myeloid leukemia (CML) who presented with isolated elevations of gamma-glutamyl transferase (GGT). Cirrhosis was confirmed by clinical, radiologic, and histologic findings. Therapy for CML was continued, guided by monitoring BCR-ABL1 levels and declining GGT levels. Cirrhosis regression was evaluated using liver stiffness measurements and histology. Isolated GGT elevations in diagnosis and improvement in hepatotoxicity with dose reduction have not been previously reported. Treatment continuation while monitoring GGT and BCR-ABL1 levels resulted in disease remission and regression of cirrhosis. Our report will be useful to clinicians managing patients treated with nilotinib.
A Rare Case of Severe Vitamin D Deficiency Presenting as Diffuse Osteosclerosis | Annals of Internal Medicine: Clinical Cases
Maintaining calcium homeostasis is essential for various physiologic processes, with vitamin D playing a key role. Hyperparathyroidism typically causes fragility fractures and osteolytic lesions but rare cases can present with osteosclerosis. We report a 64-year-old woman with a history of gastric bypass presenting with back pain who was found to have diffuse osteosclerosis and hyperparathyroidism due to severe vitamin D deficiency. Nutritional supplementation led to symptom resolution. This case underscores the importance of considering bone-mineral pathology in patients with unexplained pain and highlights the need for close follow-up in postoperative care after bariatric surgery.
Paraneoplastic Leukemoid Reaction in High-Grade Lung Adenocarcinoma Complicated by Triple Co-Mutations | Annals of Internal Medicine: Clinical Cases
Paraneoplastic leukemoid reaction occurs secondary to cytokine-secreting tumors or cancers with high tumor burden. We report a case of extreme leukocytosis in a 58-year-old man presenting with a clavicular mass. Biopsy revealed a high-grade, non–small cell carcinoma of unknown origin, and genetic studies identified a lung adenocarcinoma with triple mutations in STK11, KRAS, and TP53 along with programmed death-ligand 1 positivity. Leukocytosis persisted despite treatment, so the diagnosis of paraneoplastic leukemoid reaction was made. Treatment of underlying malignancy is imperative in management, but this case was complicated by tumor mutations that rendered the most optimal treatments less effective.
Recurrent Abdominal Aortic Aneurysm After Aortoiliac Endograft Stent Placement | Annals of Internal Medicine: Clinical Cases
We report a case of a 59-year-old man with multiple comorbid conditions who had endovascular aortic repair for an abdominal aortic aneurysm (AAA). Despite the procedure's initial success, the patient later presented with recurrent AAA as the result of an enlarged aneurysmal sac and a 90-degree angle kink at the midportion of the endograft stent, necessitating emergent open surgery. This case underscores the challenges in managing AAA post endovascular aortic repair and the potential for serious complications. Our experience highlights the importance of close surveillance and prompt intervention for optimal patient outcomes.
Nonserogroup-1 Legionella pneumophila Pneumonia: Navigating Diagnostic Challenges | Annals of Internal Medicine: Clinical Cases
A 59-year-old woman with newly diagnosed immune thrombocytopenia treated with steroids and rituximab presented with a cavitary lung lesion. Extensive work-up, including bronchoalveolar lavage and transthoracic lung biopsy, were unrevealing. Molecular testing on lung tissue ultimately diagnosed nonserogroup-1 Legionella pneumophila, underscoring the utility of advanced diagnostics in clinical conundrums.
Meningitis Caused by Campylobacter jejuni in a Patient With Immunodeficiency Due to Bispecific Antibody Therapy | Annals of Internal Medicine: Clinical Cases
Bispecific antibodies, such as talquetamab and teclistamab, offer promising treatment options for refractory multiple myeloma but are associated with significant immunosuppression and susceptibility to atypical infections. We report a case of recurrent Campylobacter jejuni meningitis in a 44-year-old man undergoing talquetamab and teclistamab therapy, highlighting the role of hypogammaglobulinemia in disease recurrence. Diagnosis was confirmed using molecular tools, emphasizing their value in detecting pathogens with low bacterial loads. This case underscores the need for vigilance, advanced diagnostics, and tailored prophylaxis to mitigate infection risks in immunocompromised patients receiving novel therapies.
When Palpitations and Hand Weakness Point to the Aorta: An Atypical Case of Aortic Dissection | Annals of Internal Medicine: Clinical Cases
Aortic dissection (AD) is a life-threatening condition often presenting with varied symptoms, complicating early diagnosis. We present a case of a 58-year-old woman with untreated hypertension and a remote history of cardiac ablation who presented with persistent palpitations and transient left-hand weakness, but without chest or back pain. An incidental AD was identified during imaging for a suspected transient ischemic attack. Effective blood pressure management and prompt cardiothoracic intervention, with successful surgical repair, enabled favorable outcomes. This case underscores the diagnostic challenges posed by atypical AD presentations, highlighting the importance of maintaining high index of suspicion in at-risk population.
The Unregulated Opioid: Neurologic and Electrolyte Imbalance From Long-Term Kratom Use | Annals of Internal Medicine: Clinical Cases
Mitragyna speciosa, commonly known as kratom, is a Southeast Asian herb gaining popularity as an alternative to opioids for chronic pain and opioid withdrawal treatment. The U.S. Food and Drug Administration classifies it as a “new dietary ingredient” with the potential to damage the kidneys, liver, and heart. Despite this, kratom is widely available in drug stores and online. We present a case of a patient with long-term daily use of kratom who exhibited altered mental status and focal neurologic deficits with hyponatremia 1 week after abruptly discontinuing kratom use. This case underscores the necessity of obtaining a comprehensive history of all regularly consumed medications and supplements, whether prescribed or otherwise.
A Case of Combined Baclofen and Carisoprodol Withdrawal: The Hidden Dangers of Muscle Relaxants | Annals of Internal Medicine: Clinical Cases
Muscle relaxant prescriptions are on the rise for the treatment of chronic pain, although physician education about the effects of overdose, medication interactions, and withdrawal is limited. Simultaneous use of the muscle relaxants baclofen and carisoprodol can result in withdrawal at relatively low doses, possibly because of their synergistic effect. Prior case reports have described withdrawal from either of these muscle relaxants. However, this case report describes the course of a patient who was experiencing withdrawal from both baclofen and carisoprodol. To address such scenarios appropriately, it is important for prescribers to be aware of the withdrawal syndromes associated with these medications.