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The opioid crisis is real. But so is pain.
“I’m not impressed with his pain.”“I only give Norco if I see a bone sticking out.”“She says her pain is a 10/10 but…” On any given shift in the emergency room, I hear some version of these said by residents or fellow attendings. And whenever I hear these phrases, I think to […]Find jobs at  Careers by KevinMD.com.  Search thousands of physician, PA, NP, and CRNA jobs now.  Learn more.
Source: Kevin, M.D. - Medical Weblog - March 18, 2020 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/jessica-badwards" rel="tag" > Jessica Badwards, MD < /a > < /span > Tags: Conditions Emergency Medicine Pain Management Source Type: blogs

COVID19 and Finding Effective Medical Therapies
This post introduces a column I wrote over at TheHeart.org | Medscape Cardiology — The good news is that most people infected with coronavirus don’t need a hospital or doctor. But some do. Some get very ill. The maddening thing is that doctors don’t have an effective treatment for the virus. There are no cures. The Worldmeter today shows nearly 5 million infections and more than 300,000 deaths. And no effective therapy. Excluding a possibly modest effect of Remdesivir, our care is supportive, which is medical jargon for giving simple things like oxygen, acetaminophen, IV fluids and letting ...
Source: Dr John M - May 16, 2020 Category: Cardiology Authors: Dr John Source Type: blogs

Perioperative Analgesia for Patients Undergoing Thyroidectomy and Parathyroidectomy: An Evidence-Based Review.
CONCLUSION: There is significant evidence supporting the use of NSAIDs and local anesthetics in the perioperative period for pain management for thyroid and parathyroid surgeries. Acetaminophen, gabapentinoid and ketamine have some supporting evidence and may serve as adequate alternatives. Further multi-institutional RCTs are warranted to delineate optimal analgesic regimens. LEVEL OF EVIDENCE: NA. PMID: 32436727 [PubMed - as supplied by publisher]
Source: The Annals of Otology, Rhinology, and Laryngology - May 20, 2020 Category: ENT & OMF Authors: Nguyen BK, Stathakios J, Quan D, Pinto J, Lin H, Pashkova AA, Svider PF Tags: Ann Otol Rhinol Laryngol Source Type: research

Management of postoperative pain in ophthalmic plastic surgery: a major review.
CONCLUSIONS: Several medications may prevent and treat pain after ophthalmic plastic surgery. These agents are well-tolerated, and many decrease the requirement for opioid analgesics. Clinicians should be aware of these therapies when considering non-narcotic pain management. PMID: 32669009 [PubMed - as supplied by publisher]
Source: Orbit - July 15, 2020 Category: Opthalmology Authors: Wladis EJ, Rothschild MI, Rubinstein TJ Tags: Orbit Source Type: research

Aspirin (single dose) for perineal pain in the early postpartum period.
CONCLUSIONS: Single dose aspirin may increase adequate pain relief in women with perineal pain post-episiotomy compared with placebo. It is uncertain whether aspirin has an effect on the need for additional analgesia, or on maternal adverse effects, compared with placebo. We downgraded the certainty of the evidence because of study limitations (risk of bias), imprecision, and publication bias. Aspirin may be considered for use in non-breastfeeding women with post-episiotomy perineal pain. Included RCTs excluded breastfeeding women, so there was no evidence to assess the effects of aspirin on neonatal adverse effects or bre...
Source: Cochrane Database of Systematic Reviews - July 23, 2020 Category: General Medicine Authors: Shepherd E, Grivell RM Tags: Cochrane Database Syst Rev Source Type: research

A Comprehensive Review of Over the Counter Treatment for Chronic Low Back Pain
AbstractPurpose of the ReviewChronic low back pain (CLBP) is a major contributor to societal disease burden and years lived with disability. Nonspecific low back pain (LBP) is attributed to physical and psychosocial factors, including lifestyle factors, obesity, and depression. Mechanical low back pain occurs related to repeated trauma to or overuse of the spine, intervertebral disks, and surrounding tissues. This causes disc herniation, vertebral compression fractures, lumbar spondylosis, spondylolisthesis, and lumbosacral muscle strain.Recent FindingsA systematic review of relevant literature was conducted. CENTRAL, MEDL...
Source: Pain and Therapy - November 4, 2020 Category: Anesthesiology Source Type: research

A Comprehensive Review of Over the Counter Treatment for Chronic Low Back Pain.
Abstract PURPOSE OF THE REVIEW: Chronic low back pain (CLBP) is a major contributor to societal disease burden and years lived with disability. Nonspecific low back pain (LBP) is attributed to physical and psychosocial factors, including lifestyle factors, obesity, and depression. Mechanical low back pain occurs related to repeated trauma to or overuse of the spine, intervertebral disks, and surrounding tissues. This causes disc herniation, vertebral compression fractures, lumbar spondylosis, spondylolisthesis, and lumbosacral muscle strain. RECENT FINDINGS: A systematic review of relevant literature was cond...
Source: Pain Physician - November 4, 2020 Category: Anesthesiology Authors: Peck J, Urits I, Peoples S, Foster L, Malla A, Berger AA, Cornett EM, Kassem H, Herman J, Kaye AD, Viswanath O Tags: Pain Ther Source Type: research

N-acetylcysteine for non-paracetamol (acetaminophen)-related acute liver failure.
CONCLUSIONS: The available evidence is inconclusive regarding the effect of N-acetylcysteine compared with placebo or no N-acetylcysteine, as an adjunct to usual care, on mortality or transplant rate in non-paracetamol-induced acute liver failure. Current evidence does not support the guideline suggestion to use N-acetylcysteine in adults with non-paracetamol-related acute liver failure, nor the rising use observed in clinical practice. The uncertainty based on current scanty evidence warrants additional randomised clinical trials with non-paracetamol-related acute liver failure evaluating N-acetylcysteine versus placebo, ...
Source: Cochrane Database of Systematic Reviews - December 9, 2020 Category: General Medicine Authors: Siu JT, Nguyen T, Turgeon RD Tags: Cochrane Database Syst Rev Source Type: research

PEER systematic review of randomized controlled trials: Management of chronic low back pain in primary care.
CONCLUSION: Exercise, oral NSAIDs, and SNRIs (duloxetine) provide a clinically meaningful reduction in pain, with exercise being the only intervention that demonstrated sustained benefit after the intervention ended. Future high-quality trials that report responder analyses are required to provide a better understanding of the benefits and harms of interventions for patients with chronic low back pain. PMID: 33483410 [PubMed - as supplied by publisher]
Source: Canadian Family Physician Medecin de Famille Canadien - January 1, 2021 Category: Primary Care Authors: Kolber MR, Ton J, Thomas B, Kirkwood J, Moe S, Dugré N, Chan K, Lindblad AJ, McCormack J, Garrison S, Allan GM, Korownyk CS, Craig R, Sept L, Rouble AN, Perry D Tags: Can Fam Physician Source Type: research

Cannabidiol Interactions with Medications, Illicit Substances, and Alcohol: a Comprehensive Review
AbstractCannabidiol, a non-intoxicating phytocannabinoid, has potential therapeutic effects over a broad range of disorders. Recently, there has been increased interest in CBD, as several studies showed promising anticonvulsant efficacy with few side effects. In 2018, a CBD-based oral solution, Epidiolex ®, was approved by the FDA to treat two severe forms of pediatric epilepsy, Dravet syndrome, and Lennox-Gastaut syndrome. Although only these two syndromes are recognized indications for CBD, it has been consumed in an unregulated fashion for a variety of indications including chronic pain, muscle stiffness, inflammation,...
Source: Journal of General Internal Medicine - January 29, 2021 Category: Internal Medicine Source Type: research

Genetic Susceptibility to Drug Teratogenicity: A Systematic Literature Review
Since the 1960s, drugs have been known to cause teratogenic effects in humans. Such teratogenicity has been postulated to be influenced by genetics. The aim of this review was to provide an overview of the current knowledge on genetic susceptibility to drug teratogenicity in humans and reflect on future directions within the field of genetic teratology. We focused on 12 drugs and drug classes with evidence of teratogenic action, as well as 29 drugs and drug classes with conflicting evidence of fetal safety in humans. An extensive literature search was performed in the PubMed and EMBASE databases using terms related to the ...
Source: Frontiers in Genetics - April 26, 2021 Category: Genetics & Stem Cells Source Type: research

Pain management in people with hemophilia in childhood and young adulthood
Expert Rev Hematol. 2021 May 27. doi: 10.1080/17474086.2021.1935852. Online ahead of print.ABSTRACTINTRODUCTION: People with hemophilia (PWH) commonly experience acute and chronic musculoskeletal pain during childhood and young adulthood, but their treatment is often inadequate.AREAS COVERED: From September 1, 2020 to April 15, 2021, authors performed a literature search in PubMed and the Cochrane Library using "hemophilia AND pain" as keywords. Authors found 1082 articles, 51 of which were chosen because we considered them to be intimately connected with the topic of this report. Multimodal pain treatment, including multi...
Source: Expert Review of Hematology - May 27, 2021 Category: Hematology Authors: E Carlos Rodriguez-Merchan Hortensia De la Corte-Rodriguez Source Type: research

A review of alternative intravenous acetylcysteine regimens for acetaminophen overdose
This article reviews these alternative treatment regimens and intends to offer a detailed assessment of the available options to assist providers in managing cases of acetaminophen overdose.AREAS COVERED: This review article covers observational and experimental studies that assessed the efficacy and safety of alternative intravenous acetylcysteine regimens for acetaminophen overdose. A literature search was conducted using PubMed, ProQuest, and Scopus to identify the studies, which included results through April 2021. The assessment of alternative regimens consists of a discussion on the limitations and benefits, barriers...
Source: Expert Review of Clinical Pharmacology - June 30, 2021 Category: Drugs & Pharmacology Authors: Kevin Burnham Tianrui Yang Haleigh Smith Steven Knight Source Type: research