Pain Management

There is no doubt that because the number of cases of diabetes is rapidly growing in this country, so is the number of patients with diabetic neuropathic pain. Thus any new recommendations for improving treatment of DNP are welcome. However. . .

Antidepressants are often referred to as “adjuvant analgesics.” Although the name suggests that these agents don’t provide direct pain relief in the same way as opioids or NSAIDs, it is well established that antidepressants provide excellent analgesia for many pain conditions.

We have long known that many adolescents have chronic pain. A new study highlights just how widespread it is-and the significant impact it can have.

Pain is a subjective complaint. We can’t measure it as we can, for example, hematocrit, blood pressure, or blood glucose. If a patient doesn’t complain of pain, we generally assume that he or she isn’t experiencing it. But what about patients who have pain but who are physically or mentally unable to tell anyone about it?

For the past 2 weeks, this 46-year-old woman had had malaise, myalgia, and hand and elbow arthralgia. Twelve hours before she was hospitalized, red spots started to appear on her shins and thighs. Soon afterward, her left ankle became increasingly painful, tender, and warm.

A variety of effective treatments are available for diabetic peripheral neuropathic pain (DPNP), including topical agents, oral medications, and nondrug approaches. The lidocaine patch 5% is recommended for relatively localized pain.

A 53-year-old woman presented with sudden onset of left upper quadrant abdominal pain. She had a history of atrial fibrillation, hypertension, and congestive heart failure.

Chronic fatigue syndrome (CFS) is a distinct disorder characterized by debilitating and often recurrent fatigue that lasts at least 6 months but more frequently lasts for longer periods. Patients with CFS experience overall physical, social, and mental impairments and may subsequently qualify for medical disability.

Here, a simple option to help relieve a painful symptom.

The diagnosis of many serious infectious diseases relies heavily on clinical suspicion, particularly in the early stages of the illness. In this 3-part series, we provide useful clues to the triage and diagnosis of these diseases. Here we discuss staphylococcal toxic shock syndrome (TSS) and streptococcal TSS.

Will you recognize these potentially life-threatening infections when you see them? Inside: clues to early diagnosis.

How to determine whether opioids are appropriate, what to do about breakthrough pain, and how frequently to monitor.

I enjoyed Dr D. Brady Pregerson's Practical Pointer, "Heat Therapy 'On the Go'".

Dr Schneider addresses myths and misunderstandings about the long-term use of opioids to treat noncancer pain.

Prevent disruptive movements when administering a digital block.

Children with lacerations that require suturing are typically afraid and uncooperative. The pain of a local lidocaine injection will increase their fear and lack of cooperation.

A 43-year-old white man presented to the emergency department with dyspnea, abdominal bloating, fever with chills, night sweats, decreased oral intake, and myalgia of 1 week's duration. He was found to have heart failure caused by systolic dysfunction. Viral myocarditis was the presumptive diagnosis after investigation for other causes.

Tell patients that cotton swabs dipped in water and frozen in individual plastic bags provide quick relief for a burned tongue or lip or a tooth that is almost out.

A 68-year-old woman complains of diffuse, severe myalgia. She reports stiffness, heaviness, and cramping, which are most marked in her thighs and calves. The heaviness and discomfort result in a sensation of weakness as well.

A 42-year-old woman had a "life-long" history of mild to moderate low back pain, without radiation, anesthesia, weakness, or incontinence. She denied recent trauma or an inciting event. The pain was constant and worse at the end of the day and with prolonged activity. Physical therapy, NSAIDs, tramadol, opioids, and manipulation provided minimal relief.

The CDC’s Advisory Committee on Immunization Practices recommends that children aged 6 months to 9 years receive 2 doses of influenza A (H1N1) 2009 monovalent vaccine; the doses should be given about 4 weeks apart.

For 2 weeks, a 52-year-old man had progressive fatigue and myalgias. On the morning of presentation, he could not walk. He took no medications but reported chronic, intermittent use of alcohol, intranasal cocaine, and marijuana. He had ingested alcohol 2 weeks earlier and had used cocaine 3 days earlier. Vital signs were normal. The patient had bilateral upper and lower extremity weakness. The proximal muscle groups were affected to a greater degree, with 2/5 strength in the shoulder and hip girdles bilaterally compared with 4/5 strength distally. He had significant difficulty in raising himself to a seated position and when attempting to stand. Results of a complete blood cell count and basic chemistry panel were normal. Serum creatine kinase (CK) was mildly elevated at 9030 U/L. Urinalysis showed 3+ blood, with coarse granular casts but no red blood cells.

Palpitations and dizziness prompted a previously healthy 21-year-old cable lineman from southeastern Pennsylvania to seek medical attention. An ECG showed first-degree heart block. The young man was scheduled for outpatient cardiology consultation, but his symptoms worsened and he presented to an emergency department with chest pain and fever 2 days later. Further evaluation revealed that for the past 3 weeks he had myalgia; arthralgia; fatigue; and an expanding, erythematous, nonpruritic rash on his trunk and extremities. He did not recall any tick bites.

Right upper quadrant pain of 24 hours’ duration prompted a 20-year-old man with a history of gastritis to seek medical attention. The pain was sharp and nonradiating, with no alleviating or aggravating factors. The patient occasionally consumed alcohol and regularly smoked cigarettes (tobacco and marijuana). He denied nausea, vomiting, diarrhea, and diaphoresis. Right upper quadrant pain of 24 hours’ duration prompted a 20-year-old man with a history of gastritis to seek medical attention. The pain was sharp and nonradiating, with no alleviating or aggravating factors.

A 36-year-old man presented with persistent right shoulder weakness and pain (4 out of 10 on the visual analog scale). He also had an “odd pulling sensation” with arm adduction. During a wrestling match 2 years earlier, his arm was abducted and extended, after which he heard a popping noise and felt burning pain in his shoulder.

Acute gouty arthritis is frequently misdiagnosed or diagnosed late in its clinical course, and therapy is often suboptimal. Because the treatment of gout as a chronic, progressive disease has not been standardized, optimal disease management remains a challenge.

A 21-year-old man presented for evaluation after he sprained his right ankle while hiking. Radiographs of the ankle showed no fractures but revealed diffuse sclerotic lesions in most of the visualized bones.

Patients almost always believe that their anorectal problems are caused by hemorrhoids, regardless of the nature of their symptoms. They are often dismayed when we insist that they must come to the office for an examination before we can prescribe any treatment.

Establishing the cause of chronic pain is crucial because treatment based on the mechanism of the pain is most likely to be successful.

Pain is a significant public health concern. In a prevalence study conducted in Australia, 17% of men and 20% of women reported chronic daily pain. A US study found that 13% of the total workforce had lost productive time during a 2-week period because of a pain condition. Headache, back pain, and arthritis pain headed the list of causes.