Pain

This month's issue of Internal Medicine World Report (IMWR) features another collection of studies selected by our physician editor for their potential impact on clinical practice.

For patients diagnosed with knee osteoarthritis the pain associated not only with the condition but also the potential knee replacement surgery can be excruciating. A recent study looked at ways to minimize the pain after the operation to get people back on their feet as quickly as possible.

A commonly asked question by physicians pertains to the ideal frequency of urine drug testing. The answer is an unequivocal "it depends".

For smokers and other users of nicotine, the rewarding effects of the substance had been associated with activation of nicotine receptors. But studies have found evidence that the endogenous opioid system is also involved in creating this sense of pleasure.

Investigators believe they may have identified a potential "off switch" for pain, according to study results published in the journal Brain.

In a rat study, Brazilian researchers looked at the connections between exercise, opioid receptors (OR) and myocardial ischemia-reperfusion (IR) injuries.

Diabetics often experience peripheral neuropathy. In an estimated 30% to 50% of patients, this condition results in pain. The most common painful neuropathy is distal symmetric sensorimotor polyneuropathy.

Microvascular disease is a concern in patients with diabetes, and follows hyperglycemia-induced endothelial damage or endothelial dysfunction. Diabetic neuropathy is the most prominent microvascular consequence of diabetes, and often, the foot is involved.

Many clinicians and academicians believe that stipulation for random urine drug testing should be a part of any opioid agreement, with UDT serving the dual purposes of ensuring compliance with prescribed opioids as well as monitoring use of illicit drugs and non-prescribed medications.

As electronic health records become more or less mandatory, the question moves from how widely they are adopted by practices across the country to whether the new versions are more effective than the old pen-and-paper way of doing business.

A 28 year-old commercial realtor comes to your office on Monday morning after spraining his right ankle in a basketball game with friends the preceding Saturday afternoon. He has a swollen right ankle with tenderness inferior and anterior to the lateral malleolus. He is limping but able to apply weight to the injured extremity.

Dronabinol, commonly used as a nausea treatment, could be effective treatment for non-cardiac chest pain patients.

The current issue of The Lancet takes a deep dive into the World War I treatment of phantom limb pain and amputated limb patients.

Intra-articular injection of two widely used plant and mineral extract-based formulations provide long-lasting pain relief in patients with moderate to severe pain from knee osteoarthritis, according to the first-ever double-blind trial of the treatments.

Hysingla ER (hydrocodone bitartrate) is a single-entity oral hydrocodone tablet that is administered to treat pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.

When surgical patients have tumors that secrete adrenal hormonal, the anesthesiologist needs to thoroughly address preoperative evaluation, perioperative hemodynamic control, electrolytes, and metabolic abnormalities

Almost everyone has episodes of low back pain (LBP) from time to time. Fortunately, most episodes of LBP are considered acute, and resolve within 6 to 12 weeks. When LBP pain persists and becomes chronic, treatment is considerably more complicated and often leads the patient to the surgical suite.

Running does not increase the risk for knee osteoarthritis (OA), according to study results presented at the 2014 annual meeting of the American College of Rheumatology. No increase in knee OA or knee pain was associated with habitual running in any age group in a study of over 600 individuals who reported running as a regular activity at some point in their lives.

Administration of the varicella zoster vaccine is safe in patients with rheumatoid arthritis or other rheumatic conditions who are taking biologic disease-modifying anti-rheumatic drugs, according to study results presented at the 2014 American College of Rheumatology annual meeting.

Monitoring injured workers by testing urine samples can increase prescription consistencies, according to a recent study.

Attempting to catch up with bacteria's resistance to drugs, University of California, Los Angeles, CA (UCLA) researchers have manufactured an antibiotic that they believe will counteract bacterial antibiotic resistance.

After a period of 6 months from post herpetic neuralgia onset, patients often report chronic pain, according to a study conducted in Rome, Italy.

White blood cells may be the cause of rheumatoid arthritis, according to a study from Northwestern Medicine.

Even as Electronic Health Record (EHR) systems become more commonplace in the medical community there is still a large knowledge gap between health care professionals and their patients regarding the availability and use of these systems, according to a recent survey.

As the workload for doctors increases some practices and hospitals are turning to scribes to help with some of the duties. What they should be doing and how much involvement they should have remains a topic of discussion.

The third part in a series looking at the risk associated with the prescribing of opioid medications.

Chronic exertional compartment syndrome (CECS), a common condition among individuals who served in the military, is disproportionately untreated and misunderstood, according to research in Clinics in Sports Medicine, which aimed to highlight viable treatments.

From 2000 to 2007, medications to treat nonmalignant chronic pain (NMCP) came with a price tag of $17.8 billion annually in the US, a Journal of Managed Care & Specialty Pharmacy study found.

A new technique makes it possible to quickly detect the presence of drugs or to monitor certain medical conditions using only a single drop of blood or urine, representing a potential tool for clinicians and law enforcement.

Carpal tunnel syndrome pain is effectively reduced using topical menthol gel, according to a study from Denmark.