Articles related to Pain Medicine

This deep-dive into acromioclavicular joint injuries unpacks everything a physician needs to know about these prevalent injuries. Acromioclavicular joint (ACJ) injuries, mostly traumatic, can occur across all ages but are more frequent in males aged 20-40, often related to contact sports. Patients usually present with vague shoulder pain and swelling, but visible deformity is rare. Two mechanisms contribute to ACJ injuries: direct, resulting from a direct blow or fall onto the shoulder, and indirect, arising from a fall onto an outstretched hand or elbow. Imaging is crucial for diagnosis. The Rockwood system, among others, categorizes these injuries into six types. Plain radiographs, including an axillary view, generally suffice for accurate grading. However, in certain scenarios, CT or MRI might be necessary. In case of an injury suspicion with initial normal radiographs or contemplating surgical intervention on a type III injury, additional weight-bearing stress views can be beneficial. Indications of ACJ injury on a plain radiograph may include soft tissue swelling, acromioclavicular joint widening, increased coracoclavicular distance, and superior displacement of the distal clavicle. The treatment choice hinges largely on the patient’s age, lifestyle, and injury type. Conservative management typically applies to types I and II injuries, surgical treatment to types […]

FDA’s New Approval of Atogepant for Chronic Migraine Prevention is a Breakthrough in Migraine Management A promising breakthrough in migraine management, the FDA’s new approval of atogepant tablets, brings renewed hope for chronic migraine sufferers. According to AbbVie, this endorsement allows the use of atogepant (Qulipta) in the prevention of chronic migraines in adults. Atogepant stands out as the first oral calcitonin gene-related peptide (CGRP) receptor antagonist to receive dual approval for episodic and chronic migraines. It works by blocking CGRP, a molecule involved in transmitting pain signals. Chronic migraines, to clarify, involve enduring headaches for at least 15 days a month, with eight of those days associated with migraines. Before this, in September 2021, the FDA approved atogepant for treating episodic migraines. Patients can take the drug in 10 mg, 30 mg, and 60 mg dosages. The FDA recommends the 60 mg dose for chronic migraine patients. Peter McAllister, MD, from the New England Center for Neurology and Headache, noted that the FDA’s endorsement offers a new, convenient daily treatment for chronic migraine patients. The demonstrated efficacy and functional improvement of atogepant make it an appealing option for neurologists and headache specialists when devising treatment plans for patients. The […]

This case study applies the newly revised CDC Clinical Practice Guideline for Prescribing Opioids for Pain to a patient with chronic neck pain. The patient, Joanna, is a 78-year-old woman who has undergone two neck surgeries and experiences worsening pain. Her pain ranges from 6 to 7 on average and can increase up to 8. She has tried various non-pharmacologic modalities, such as heat, ice, TENS, physical therapy, and massage therapy, but insurance limitations and cost have hindered her access to these treatments. Considering Joanna’s medical history, physical therapy and topical analgesics are identified as potential options. However, due to limitations and contraindications with other medications, the only feasible options for her are low-dose acetaminophen and topical analgesics. As a result, initiating a low-dose opioid therapy is considered appropriate, in addition to low-dose acetaminophen, OTC menthol and methyl salicylate cream, and a referral to physical medicine and rehabilitation. Before initiating opioids, the patient’s risk of side effects, including overdose, addiction, constipation, and hypogonadal axis suppression, should be discussed. Joanna’s Risk Index for Overdose or Serious Opioid-Induced Respiratory Depression (RIOSORD) score indicates a risk class of 4 out of 7, with a 15% estimated probability of an opioid-induced respiratory depression event […]

According to surveys, up to 40% of cancer patients in the United States use cannabis, yet only one-third of doctors are comfortable advising them on it. Now, a small but significant study has found that cancer patients who use cannabis to treat their symptoms had reduced pain, better sleep, and an unexpected benefit: they appear to think more clearly after a few weeks of consistent use. The study, published in the journal Exploration in Medicine, is one of the first to look at how cannabis purchased via dispensaries, rather than government-supplied or synthetic kinds, affects cancer symptoms or chemotherapy side effects. It also sheds light on the large range of drugs used by cancer patients now that marijuana is legal in the majority of states.

According to the FDA, more than 101,000 fatal overdoses were reported during the 12-month period that ended in October 2022. Nearly half of fatal overdoses involve bystanders, but naloxone is only used in a small percentage of those situations. According to medical professionals who support the approval, there would be a critical opportunity to close this gap and lower the number of opioid-related deaths if naloxone were available over-the-counter.

The Food and Drug Administration has approved digital therapeutics, but insurance coverage has remained a problem. Some businesses have pushed for patient pharmacy benefits to pay for their software-based therapies, but AppliedVR is going in a different direction. A new HCPCS (Healthcare Common Procedure Coding System) code that describes the company’s treatment as a virtual reality cognitive behavioral therapy device with pre-programmed therapy software was granted by CMS to the company. The program complied with all five criteria set forth by CMS to qualify as durable medical equipment.