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Search Results for "chronic back pain management"
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Displaying 31 - 40 of 365 in Policy Library
Displaying 31 - 40 of 1297 in Annals of Internal Medicine
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Effectiveness of Nonpharmacologic Treatments for Chronic Low Back Pain: A Sequential, Multiple-Assignment, Randomized Trial: Annals of Internal Medicine: Vol 0, No 0
Background: Many treatments are recommended for chronic low back pain (cLBP), but comparative effectiveness and adaptive interventions have not been adequately studied. Objective: To compare the effectiveness of physical therapy (PT) and cognitive behavioral therapy (CBT) as first-stage treatment and switching treatments versus mindfulness as second-stage treatment. Design: Multisite sequential, multiple-assignment, randomized trial with 52-week follow-up. (ClinicalTrials.gov: NCT03859713) Setting: Three health care systems. Participants: Adults with cLBP. Intervention: Eight weeks of PT or CBT in stage I. Nonresponders were randomly assigned again to 8 weeks of stage II treatment. Measurements: Co-primary outcomes were function measured with the Oswestry Disability Index (ODI; range, 0 to 100) and pain intensity (range, 0 to 10) at 10 (stage I), 26, and 52 (stage II) weeks. Results: The sample comprised 749 participants. After 10 weeks, there was greater improvement in function in the PT group (adjusted mean ODI difference, 2.8 [96% CI, 0.38 to 5.1]) and no difference in pain intensity (adjusted mean difference, 0.32 [99% CI, −0.07 to 0.71]). The mean difference in ODI was below the minimum important difference of 6. After 52 weeks, there were no differences in stage II treatments for nonresponders for either function (adjusted mean ODI difference, 0.43 [96% CI, −0.29 to 2.4]) or pain intensity (adjusted mean difference, −0.05 [96% CI, −0.58 to 0.48]). Limitations: Treatment initiation was lower than expected, particularly for CBT and for nonresponders. Participants were not blinded. Sample size was reduced due to the COVID-19 pandemic. Conclusion: Patients with cLBP may benefit from PT as first-line treatment. Among nonresponders, there were no differences in second-stage treatment with mindfulness or switching. Primary Funding Source: Patient-Centered Outcomes Research Institute (PCORI).
Stable Supportive Footwear for Self-managing Hip Osteoarthritis Pain: A Randomized Clinical Trial: Annals of Internal Medicine: Vol 179, No 4
Background: Few effective nonsurgical treatments exist for hip osteoarthritis. Footwear influences hip forces and may be a promising novel approach. Objective: To evaluate whether stable supportive shoes are more effective than flat flexible shoes for hip pain. Design: 2-group, pragmatic, comparative effectiveness, superiority randomized trial. (Australian New Zealand Clinical Trials Registry: ACTRN12621001532897) Setting: Community. Participants: 120 people with hip osteoarthritis pain. Intervention: Off-the-shelf stable supportive (n = 60) or flat flexible (n = 60) shoes that met prespecified criteria. Participants chose from options in their randomly assigned shoe group and were instructed to wear selected shoes at least 6 hours per day for 6 months. Measurements: The primary outcome was 6-month change in average hip pain on walking in the previous week (11-point scale; range, 0 to 10, with higher scores indicating worse pain). Secondary outcomes included other measures of pain, symptoms, function in daily living, function in sport and recreation, quality of life, physical activity, global improvement, and adverse events. Results: A total of 120 participants were randomly assigned, and 116 (97%) completed 6-month primary outcomes. Stable supportive shoes did not differ from flat flexible shoes in improving hip pain (mean difference [MD], −0.5 point [95% CI, −1.3 to 0.2 point]; P = 0.163). Few secondary outcomes differed by shoe type, but flat flexible shoes showed greater improvement in the Hip Disability and Osteoarthritis Outcome Score symptom subscale (MD, 6.6 points [CI, 1.4 to 11.7 points]) and quality-of-life subscale (MD, 7.8 points [CI, 1.1 to 14.4 points]), whereas stable supportive shoes showed more improvement in contralateral foot or ankle pain (MD, 0.8 point [CI, 0.0 to 1.5 points]). There were fewer adverse events in the stable supportive shoe group (n = 7 [12%]) than the flat flexible shoe group (n = 18 [31%]; relative risk, 0.39 [CI, 0.18 to 0.86]). Limitation: Unblinded participants. Conclusion: Stable supportive shoes were not superior to flat flexible shoes for improving hip osteoarthritis pain while walking. Primary Funding Source: National Health and Medical Research Council.
In moderate-to-severe sciatica, pregabalin did not reduce leg pain intensity or improve quality of life
Source Citation Mathieson S, Maher CG, McLachlan AJ, et al. Trial of pregabalin for acute and chronic sciatica. N Engl J Med. 2017;376:1111-20. 28328324
Long-acting opioids for chronic noncancer pain were linked to mortality
Source Citation Ray WA, Chung CP, Murray KT, Hall K, Stein CM. Prescription of long-acting opioids and mortality in patients with chronic noncancer pain. JAMA. 2016;315:2415-23. 27299617
Telemedicine Versus In-Person Primary Care: Treatment and Follow-up Visits
Background: Beyond initial COVID-19 pandemic emergency expansions of telemedicine use, it is unclear how well primary care telemedicine addresses patients’ needs. Objective: To compare treatment and follow-up visits (office, emergency department, hospitalization) between primary care video or telephone telemedicine and in-person office visits. Design: Retrospective design based on administrative and electronic health record (EHR) data. Setting: Large, integrated health care delivery system with more than 1300 primary care providers, between April 2021 and December 2021 (including the COVID-19 pandemic Delta wave). Patients: 1 589 014 adult patients; 26.5% were aged 65 years or older, 54.9% were female, 22.2% were Asian, 7.4% were Black, 22.3% were Hispanic, 46.5% were White, 21.5% lived in neighborhoods with lower socioeconomic status, and 31.8% had a chronic health condition. Measurements: Treatment outcomes included medication or antibiotic prescribing and laboratory or imaging ordering. Follow-up visits included in-person visits to the primary care office or emergency department or hospitalization within 7 days. Outcomes were adjusted for sociodemographic and clinical characteristics overall and stratified by clinical area (abdominal pain, gastrointestinal concerns, back pain, dermatologic concerns, musculoskeletal pain, routine care, hypertension or diabetes, and mental health). Results: Of 2 357 598 primary care visits, 50.8% used telemedicine (19.5% video and 31.3% telephone). After adjustment, medications were prescribed in 46.8% of office visits, 38.4% of video visits, and 34.6% of telephone visits. After the visit, 1.3% of in-person visits, 6.2% of video visits, and 7.6% of telephone visits had a 7-day return in-person primary care visit; 1.6% of in-person visits, 1.8% of video visits, and 2.1% of telephone visits were followed by an emergency department visit. Differences in follow-up office visits were largest after index office versus telephone visits for acute pain conditions and smallest for mental health. Limitations: In the study setting, telemedicine is fully integrated with ongoing EHRs and with clinicians, and the study examines an insured population during the late COVID-19 pandemic period. Observational comparison lacks detailed severity or symptom measures. Follow-up was limited to 7 days. Clinical area categorization uses diagnosis code rather than symptom. Conclusion: In-person return visits were somewhat higher after telemedicine compared with in-person primary care visits but varied by specific clinical condition. Primary Funding Source: Agency for Healthcare Research and Quality.
Displaying 31 - 40 of 90 in Annals of Internal Medicine: Clinical Cases
A Case of Steroid-Responsive Multisystem Inflammatory Syndrome in Adults With SARS-CoV-2 | Annals of Internal Medicine: Clinical Cases
While the COVID-19 pandemic continues to evolve, different phenotypic variants of the disease are being recognized. Multisystem inflammatory syndrome in adults is an emerging entity that has yet to be fully characterized. The syndrome involves extrapulmonary multiorgan failure with hyperinflammation that typically affects young healthy males, approximately 2 to 12 weeks after infection with SARS-CoV-2. There are no formal guidelines for management, although the syndrome appears responsive to immunomodulators and supportive care. Clinicians should be aware of this unusual and severe clinical entity and the general principles of its management.
Immune-Mediated Necrotizing Myopathy Associated With Myelodysplastic Syndrome | Annals of Internal Medicine: Clinical Cases
Autoimmune diseases can often be diagnosed in patients with myelodysplastic syndrome (MDS). Here, we review the emerging literature linking MDS and rare presentations of autoimmunity, including myositis. We report a patient case that underscores the consideration of myositis as an autoimmune manifestation of MDS: initial presentation included shoulder pain and fevers, and after concurrent diagnoses of MDS and autoimmune myositis, the patient continued to present periodically with recurrent flares despite immunosuppressive treatment. Timely diagnosis of MDS-associated myositis may be challenging due to concurrent fever and hemolytic anemia. Furthermore, accurate diagnosis must exclude statin-induced myopathy, effect of toxins, or infectious etiologies.
Chronic Pulmonary Aspergillosis: Bronchoscopic Visualization of a Cavitary Aspergilloma | Annals of Internal Medicine: Clinical Cases
Chronic pulmonary aspergillosis is a common condition seen in immunocompetent patients with lung structural damage. Sometimes, a fungal ball-like mass forms inside a lesion, leading to recurrent hemoptysis. Direct visualization of the aspergilloma inside the cavity is rarely possible; however, this case highlights this unusual presentation.
Abdominal Pain, Conjunctival Icterus, and Melena in a Man With Recent Endocarditis | Annals of Internal Medicine: Clinical Cases
Gastrointestinal bleeding is a common clinical entity associated with substantial morbidity and mortality. Upper gastrointestinal hemorrhage in particular requires swift recognition and management, and additionally engenders a broad differential diagnosis. Although rare, hemobilia, bleeding from or into the biliary tract, is an important diagnosis to consider at the bedside because of its unique risk factors, as well as diagnostic and therapeutic considerations. Here, we describe the clinical presentation of a man with hemobilia, highlighting key contemporary risk factors, diagnostic modalities, and therapeutic interventions.
Successful Management of Spontaneous Pneumatocele and Pneumothorax Formation After COVID-19 Infection | Annals of Internal Medicine: Clinical Cases
Pneumatoceles are rarely encountered in the clinical setting. Very few cases have been documented that involved COVID-19 pneumonia as a cause. Furthermore, even fewer cases document spontaneous pneumothorax complicating the pneumatocele that required urgent intervention. We present a case of a patient who developed a pneumatocele as a complication of symptomatic COVID-19 infection. The patient's clinical course was further complicated by spontaneous pneumothorax formation. The patient had thoracostomy and video-assisted thoracoscopic surgery. Here we describe the patient's clinical course in detail.
Unexpected Therapeutic Effect of GLP-1 Receptor Agonists in Patients With Refractory IBS-D: A Case Series | Annals of Internal Medicine: Clinical Cases
Irritable bowel syndrome with diarrhea (IBS-D) is a common functional gastrointestinal disorder. It is primarily caused by increased intestinal transit. GLP-1 receptor agonists (GLP-1 RAs) are widely used for obesity and diabetes management. They have been shown to decrease intestinal motility as a side effect. We present a 67-year-old woman and a 23-year-old woman, both with long-standing, debilitating IBS-D. Both achieved a 22.7-kg weight loss with GLP-1 RA use. They also reported resolution of diarrhea and improved quality of life. This case series suggests potential therapeutic benefits of GLP-1 RA use in hypermotility associated with IBS-D.
When Sarcoidosis Looks Like Myeloma: A Diagnostic Pitfall | Annals of Internal Medicine: Clinical Cases
Multiple myeloma (MM) is a plasma cell malignant disorder with variable clinical presentations. Because MM is the most prevalent hematologic malignancy among Black patients, a high index of suspicion is often applied in this population. However, premature diagnostic closure may occur when initial findings appear consistent with MM, while conflicting information is overlooked. This case describes a 46-year-old Black man initially diagnosed with active MM but ultimately found to have active sarcoidosis and smoldering myeloma. This case illustrates the importance of recognizing cognitive bias and considering granulomatous disease in the differential diagnosis of hypercalcemia, lytic lesions, and systemic abnormalities.
Fecal Transplant Sustained Colitis Remission on Immunotherapy Resumption | Annals of Internal Medicine: Clinical Cases
Immune checkpoint inhibitors are increasingly used to treat various cancers, but they can cause immune-related adverse events that lead to treatment cessation. Here we report 2 cases of immune-mediated colitis that were treated with fecal microbiota transplant. Both cases had sustained colitis remission, which allowed resumption of immunotherapy.
Euglycemic Diabetic Ketoacidosis Related to SGLT2 Inhibitor Use in a Patient With Cobalamin C Deficiency and Diabetes | Annals of Internal Medicine: Clinical Cases
A 24-year-old woman with cobalamin C deficiency (CblCD), autoimmune thyroiditis, and recently diagnosed diabetes mellitus presented with weight loss, emesis, and abdominal pain. She had been placed on sodium-glucose cotransporter inhibitor (SGLT2i) therapy because of metformin intolerance, with the addition of a dipeptidyl peptidase-4 inhibitor. Biochemical analyses demonstrated severe acidosis, initially attributed to CblC-associated metabolic decompensation. Subsequent evaluation led to the diagnosis of SGLT2i-induced euglycemic diabetic ketoacidosis in a patient with type 1 diabetes mellitus. This case highlights the importance of assessing for insulin deficiency when evaluating acidosis and the management challenges of common diseases in adults with inherited metabolic disorders.
Abdominal Epilepsy as Sequelae of COVID-19 in a Patient With Granulomatosis and Polyangiitis | Annals of Internal Medicine: Clinical Cases
Abdominal epilepsy is characterized by chronic abdominal pain, and an epileptogenic focus in the temporal lobe is found in most patients. Here, we present a patient case of a 60-year-old woman hospitalized because of several episodes of epigastric pain preceded by visual and auditory hallucinations 1 month after having had COVID-19. The electroencephalogram obtained during an episode of pain showed temporo-occipital epileptiform activity. Infection by SARS-CoV-2 has been associated with neurologic disorders including epilepsy and, in this case, abdominal epilepsy.