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 89 in Annals of Internal Medicine: Clinical Cases
Vasculitis After a Vaccine: Rare Adverse Reaction Following a COVID-19 Vaccine | Annals of Internal Medicine: Clinical Cases
Fatigue, fever, localized soreness, urticaria, and rash are common adverse reactions of COVID-19 vaccines. However, the occurrence of serious autoimmune reactions is quite rare. Cutaneous small-vessel vasculitis is an autoimmune disorder that manifests with palpable purpura and petechiae involving extremities. It results from neutrophilic inflammation within and around dermal vessels and is usually self-limited. We report a 55-year-old woman presenting with a rash 48 hours after receiving the third (Moderna) COVID-19 vaccine dose. Blood investigations and a skin punch biopsy confirmed the diagnosis of COVID-19 vaccine–induced cutaneous small-vessel vasculitis. The patient ultimately improved after inpatient treatment with systemic steroids.
Symptomatic Methemoglobinemia at Low Levels in a Patient With Obstructive Sleep Apnea | Annals of Internal Medicine: Clinical Cases
Previously reported cases of hypoxemia secondary to methemoglobinemia usually had measured methemoglobin percentages of around 20% or greater. We report an unusual case of methemoglobinemia secondary to dapsone use in a 66-year-old man with obstructive sleep apnea who presented with dyspnea and hypoxia with a methemoglobin percentage of less than 10%.
Infectious Aortitis Secondary to Gastrointestinal Pathogens: A Case Series and Syndromic Review | Annals of Internal Medicine: Clinical Cases
Aortitis is a rare but serious complication of infection that results in high morbidity and mortality. The most common location is in preexisting aneurysmal disease in a patient with multiple chronic comorbidities. The pathogens often reflect gastrointestinal bacteria, the classic example being Salmonella spp., but also include other enteric flora, Staphylococcus aureus, Streptococcus spp., and more. Herein, we describe 2 cases of aortitis caused by gastrointestinal bacteria and review management of this complex syndrome.
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.
An Unusual Case of an Incidentally Detected Angioplasty Wire in the Aorta | Annals of Internal Medicine: Clinical Cases
A retained angioplasty wire is rarely described, and there are no guidelines as to how it should be managed. Thus the management of this complication remains highly individualized. In the present instance, a 74-year-old woman was found on routine transthoracic echocardiography to have a linear echogenic structure that was initially concerning for a dissection flap. A computed tomography angiogram of the aorta revealed a linear density that followed the curvature of the aortic arch, which was concerning for a retained angioplasty wire from a percutaneous coronary intervention done 11 years earlier. Because the patient had not reported any symptoms, a multidisciplinary decision was made to defer any surgical intervention.
Upper Thoracic Back Pain Due to Acute Calcific Tendinitis of the Longus Colli | Annals of Internal Medicine: Clinical Cases
A 56-year-old woman presented with acute left upper back pain and odynophagia. By thoracic computed tomography, she was diagnosed with acute calcific tendinitis of the longus colli and treated with nonsteroidal anti-inflammatory drugs.
The Search for Diagnosis: Pericardial Tamponade in a Patient With Autoimmune Polyglandular Syndrome Type 1 | Annals of Internal Medicine: Clinical Cases
This case report describes a 28-year-old man with autoimmune polyglandular syndrome (APS) type 1 who presented with pericardial tamponade complicated by pulseless electric activity cardiac arrest. After 59 minutes of cardiopulmonary resuscitation and pericardiocentesis, spontaneous circulation returned. Although pericardial tamponade has been rarely associated with APS type 2, to the best of our knowledge, it has never been reported in APS-1. This unique case highlights the importance of recognizing autoimmune pathology as a potential cause of pericardial effusion in patients with APS.
Maggots: Antimicrobial Stewards and Life Savers | Annals of Internal Medicine: Clinical Cases
Maggots have been used in wound care for centuries. Their larvae secrete digestive enzymes and antimicrobial compounds that reduce the bacterial load within a wound and promote the growth of new, healthy tissue. We will discuss a series of patients with complex, nonhealing and life-threatening sacral wounds who developed multidrug-resistant sacral osteomyelitis. These wounds had failed to respond to standard and advanced strategies. Medicinal maggots were offered as a last-ditch effort in each case. In addition to saving the patients’ lives, these maggots demonstrated their underappreciated and underused role as antimicrobial stewards.
Cachexia and Diffuse “Fish-Scale” Skin | Annals of Internal Medicine: Clinical Cases
Ichthyosis is marked by dry, thickened, scaly skin. It may be genetic or acquired. Importantly, it may be a cutaneous manifestation of an underlying malignancy. Here, we present a striking case of paraneoplastic ichthyosis.
Infectious Proctitis From Cytomegalovirus in an Immunocompetent Patient | Annals of Internal Medicine: Clinical Cases
Cytomegalovirus colitis typically causes immunocompromised patients to present with hematochezia, abdominal pain, fever, or diarrhea and rarely as perforation. Here we report an 83-year-old woman with no other traditional immunocompromising risk factors who presented with cytomegalovirus proctitis. Providers should be aware of the potential for this severity of presentation even in immunocompetent patients.