Pain Blogs Pain RSS feedThis is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

Genetics, opioids, and addiction [PODCAST]
Subscribe to The Podcast by KevinMD. Catch up on old episodes! Join Amy Baxter, a clinical associate professor of emergency medicine and CEO of Pain Care Labs, to unravel the complexities of this critical topic. We’ll explore the interconnectedness of pain and reward areas in the brain, genetic factors influencing addiction susceptibility, and the distinct Read more… Genetics, opioids, and addiction [PODCAST] originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - November 18, 2023 Category: General Medicine Authors: Tags: Podcast Pain Management Source Type: blogs

Acute Dyspnea and Right Bundle Branch Block
I was texted this ECG just as I was getting into bed.It is of an elderly woman who complained of shortness of breath and had a recent stent placed.I was told that the Queen of Hearts had called it OMI with high confidence.What do you think? Ken (below) is appropriately worried about pulmonary embolism from the ECG. What I had not told him before he made that judgement is that the patient also had ultrasound B-lines of pulmonary edema.Here is my interpretation:There is sinus rhythm with RBBB.  If you jump to looking at ST segments, you see " coved " ST in V3, V4, V5, with subtle ST Elevation.  This is HIGHLY ...
Source: Dr. Smith's ECG Blog - November 18, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?
A 70-something female with no previous cardiac history presented with acute chest pain.  She  awoke from sleep last night around 4:45 AM (3 hours prior to arrival) with pain that originated in her mid back. She stated the pain was achy/crampy. Over the course of the next hour, this pain turned into a pressure in her chest. She said this was midsternal and felt like a tightness. This originally radiated into her left arm. Over some time and the pain moved into her other arm as well as her jaw. She also had some shortness of breath. She was brought in by ambulance and re...
Source: Dr. Smith's ECG Blog - November 15, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

How important are old ECGs in Non-obvious cases of potential OMI?
Conclusion: As per Dr. Smith — the cath lab was initially activated on the basis of the history of changing symptoms occurring in association with dynamic ST-T wave changes on these 3 serial ECGs shown in Figure-1.BUT — Review of this patient ' s medical chart revealed previous ECGs showing a similar pattern of labile ECG changes. Some patients do this ... that is, show a pattern of labile ST-T wave changes not due to an acute coronary event.Despite the seemingly worrisome ST-T wave changes on serial tracings shown in Figure-1  — an acute event was definitively ruled out b...
Source: Dr. Smith's ECG Blog - November 14, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

Putting people in boxes
I just finished readingThe Invisible Kingdom: Reimagining Chronic Illness, by Meghan O ' Rourke. She lived for many years with a debilitating illness that went undiagnosed. She ultimately concluded that she had chronic sequelae of Lyme disease, likely complicated by autoimmune and other manifestations that may have been triggered by Lyme disease or possibly just co-occurring coincidentally. In her desperation to find relief, or at least answers, she saw innumerable physicians and other practitioners, ultimately resorting to people with, shall we say, unorthodox ideas who many people -- I included -- would classify as quack...
Source: Stayin' Alive - November 13, 2023 Category: American Health Source Type: blogs

Medical and legal aspects of codeine cough syrup [PODCAST]
Subscribe to The Podcast by KevinMD. Catch up on old episodes! Join us for an insightful podcast discussion with L. Joseph Parker, a research physician. In this episode, we delve into the fascinating world of promethazine with codeine cough syrup, its medical applications, diversion risks, and the legal complexities surrounding its prescription. Explore the history, Read more… Medical and legal aspects of codeine cough syrup [PODCAST] originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - November 13, 2023 Category: General Medicine Authors: Tags: Podcast Pain Management Source Type: blogs

How confident are clinicians to deliver pain self-management?
Over the past few weeks I’ve been talking about pain self management from many perspectives. It’s an important topic because most people living with pain will be self managing most of the time. Being able to confidently self manage leads to less disability, distress and lives that look like life, not some endless healthcare regime. A paper by Penlington et al., (2023) explored confidence beliefs of clinicians working in the UK in primary or community settings prior to a training programme that was then delivered to them. The sample included in the survey is therefore a subset of those who might be expected t...
Source: HealthSkills Weblog - November 12, 2023 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping Skills Coping strategies Pain conditions Research Science in practice Health healthcare pain management Therapeutic approaches Source Type: blogs

A 90-something with acute stroke. She has no chest symptoms. What is the diagnosis?
A 90-something year old woman presented with an acute mild stroke.She had a routine ECG as part of her workup:What do you think?This was shown to me in real time.I thought it had to be an inferior-lateral-posterior OMI.  But the patient had no symptoms.  Later, she did admit to some vague chest discomfort, but that could be due to the power of suggestion.The one strange thing that I noted at the time is that there is no reciprocal ST depression in aVL.  This is extremely unusual in inferior OMI, even if there is simultaneous STE in V5-6.We studied this: In this paper on the importance of lead aVL f...
Source: Dr. Smith's ECG Blog - November 11, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

Case of the Week 730
 This week ' s case is generously donated by Idzi Potters and theInstitute of Tropical Medicine, Antwerp.The following were seen in used contact lens solution from a young woman with complaints of eye pain and blurry vision. The first two images are taken with light microscopy, and the third with phase-contrast microscopy. What is your diagnosis? Please describe the forms you are seeing. (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - November 9, 2023 Category: Parasitology Source Type: blogs

A doctor ’ s thoughts on The Retrievals podcast
I recently listened to the podcast mini-series The Retrievals. It was fascinating and absolutely worth a listen. It’s the story of a Yale infertility clinic where a nurse was stealing fentanyl and replacing it with normal saline. As a result, women ended up getting egg retrievals with only midazolam, no pain control. There were interviews Read more… A doctor’s thoughts on The Retrievals podcast originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - November 9, 2023 Category: General Medicine Authors: Tags: Physician Medications Source Type: blogs

Explain this ECG in the context of active chest pain, slightly elevated troponin without a delta, RCA culprit, and previous with LBBB
A 60-something yo female presented w/ exertional chest pain for 3 days. She had a recent positive stress test about one week ago. Pain was 8/10 and constant. She has been experiencing progressively worsening exertional dyspnea and chest tightness mostly when climbing up flights of stairs since early September.  She underwent exercise echocardiogram in mid October where she exercised for nearly 7 minutes on the standard Bruce protocol and had typical anginal pain and shortness of breath.  Baseline echocardiogram showed moderate LV systolic dysfunction with no wall motion abnormalities. Over the last...
Source: Dr. Smith's ECG Blog - November 9, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs

Physicians can write their way to increased empathy
“When and how much?” I tried to recall the list of questions for intoxicated patients. A middle-aged man, much older than the demographics printed on the documents I hold, was writhing in pain, vomiting, and sobbing. The paper stated: chief complaint – mouse poison pellet ingestion, attempting suicide. “How and why?” I kept asking. I Read more… Physicians can write their way to increased empathy originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - November 8, 2023 Category: General Medicine Authors: Tags: Physician Emergency Medicine Source Type: blogs

Do clinicians know how to help people develop pain self management?
In recent posts I’ve been discussing pain self management and why it’s not only necessary, but inevitable for people living with pain. Today I turn my gaze to health professionals, and the skills needed to support developing self management – because it’s not the same as ‘telling’, or ‘educating’, or even ‘advising’. Firstly, let’s check out what people with pain want in self management. Lim and colleagues (2019) conducted a systematic review examining studies identifying ‘health information needs’ of people with low back pain. I put that tit...
Source: HealthSkills Weblog - November 5, 2023 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping Skills Low back pain Professional topics Science in practice Clinical reasoning healthcare pain management self-management Therapeutic approaches Source Type: blogs

Wide complex and apparent hyperacute T-waves. Does absence of change from previous ECG mean that it is not New?
By Magnus Nossen, edits by Grauer and SmithThe patient is a 70-something female with DMII, HTN and an extensive prior history of coronary artery disease and myocardial infarctions. She ' s had multiple PCI procedures. She also has sick sinus syndrome (SSS) and intermittent high grade AV block for which she had a dual chamber pacemaker implanted. On the day of presentation she complained of typical chest pain, and stated it feels like prior MI. Just from the medical hx and clinical presentation this patient is very likely to be having an MI. The question is, does she need to go urgently to the cath lab or can she wait....
Source: Dr. Smith's ECG Blog - November 5, 2023 Category: Cardiology Authors: Magnus Nossen Source Type: blogs

Exploring changing definitions of addiction [PODCAST]
Subscribe to The Podcast by KevinMD. Catch up on old episodes! Join L. Joseph Parker, a research physician, as we delve into the evolving definitions of addiction, particularly in the context of chronic pain management. Explore the historical shifts in diagnostic criteria, the challenges faced by chronic pain patients, and the potential impact on their Read more… Exploring changing definitions of addiction [PODCAST] originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - November 3, 2023 Category: General Medicine Authors: Tags: Podcast Psychiatry Source Type: blogs