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Dr. Stacey reviews the key guidelines for treating migraine and neuropathic pain and evaluates their strengths and weaknesses in providing direction for clinical decision making.
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Until recently there has been scant evidence on which to base treatment for complex regional pain syndrome (CRPS), leaving an empirical approach as the required alternative. Dr. Harden discusses what may be changing in that landscape, where the evidence gaps still exist, and where providers should...
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With advancing age, the risk for comorbid sleep disturbance and chronic pain has been shown to increase. Where opioids are prescribed for pain, impairments to sleep can worsen. But the use of benzodiazepines for better sleep is contraindicated in combination with opioids. What to do? Dr. Raffa...
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New discoveries in pain management have been slow to emerge, but there have been recent advances in existing medications and analgesic devices, as well as promising new molecules and formulations on the horizon. Dr. Gudin sounds a hopeful note for the future of pain practice.
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There are some common rules that private and governmental agencies use to score prescribing patterns, and that can be referred to various law enforcement agencies for follow-up. Dr. Gonzalez, with the National Association of Drug Diversion Investigators, outlines how these algorithms are used, and...
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Providers who do not understand medical necessity for drug testing, controlled medication prescribing, and substance abuse treatment are at risk as payers increasingly scrutinize these areas. Attorney Jennifer Bolen outlines some "pearls and pitfalls" for clinicians. Watch for important tools you...
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Up to 40% of patients who undero spinal surgery for lower back pain will develop postlaminectomy syndrome, or failed back surgery syndrome (FBSS). Dr. Josihi outlines the pathology, causes, diagnosis, and treatment options that primary care should know about.
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With respect to long-term opioid therapy, prescribing clinicians are faced with a miasma of data, a chorus of regulatory dictates, and the needs of their patients for better pain management. Dr. Clark examines the dilemma confronting providers, and offers practical insight to frontline practitioners...
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Dr. Cheatle reviews some medication and non-medication treatment options for addressing substance use disorder. The message to primary care: a multimodal approach works best, and treatment of the SUD without attention to management of the patient's underlying pain is the likely route to relapse.
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Patients with chronic pain and substance use disorders often have accompanying psychiatric and medical disorders that place them at elevated risk for suicide. Dr. Cheatle, a professor of psychiatry, discusses the epidemiology of suicidal ideation in this population and offers some guidance in...