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Pain: Chronic - American Family Physician

Dec 1, 2019 - This collection features AFP content on chronic pain and related issues, including end-of-life care, NSAIDs, and opioid therapy. This collection features AFP content on chronic pain and related issues, including end-of-life care, NSAIDs, and opioid therapy.

American Family Physician : AFP By Topic

https://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=61

Acupuncture for Pain - American Family Physician

Jul 15, 2019 - Acupuncture has been increasingly used as an integrative or complementary therapy for pain. It is well-tolerated with little risk of serious adverse effects. Traditional acupuncture and nontraditional techniques, such as electroacupuncture and dry needling, often result in reported pain...

American Family Physician : Article

https://www.aafp.org/afp/2019/0715/p89.html

Manipulative Therapies: What Works - American Family Physician

Feb 15, 2019 - Manipulative therapies include osteopathic manipulative treatment and many other forms of manual therapies used to manage a variety of conditions in adults and children. Spinal manipulative therapy may provide short-term improvement in patients with acute or chronic low back pain, ...

American Family Physician : Article

https://www.aafp.org/afp/2019/0215/p248.html

Treating Painful Diabetic Peripheral Neuropathy: An Update - American Family Physician

Aug 1, 2016 - Painful diabetic peripheral neuropathy occurs in approximately 25% of patients with diabetes mellitus who are treated in the office setting and significantly affects quality of life. It typically causes burning pain, paresthesias, and numbness in a stocking-glove pattern that progresses...

American Family Physician : Article

https://www.aafp.org/afp/2016/0801/p227.html

Pharmacologic Therapy for Acute Pain - American Family Physician

Jun 1, 2013 - The approach to patients with acute pain begins by identifying the underlying cause and a disease-specific treatment. The first-line pharmacologic agent for the symptomatic treatment of mild to moderate pain is acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). The choice ...

American Family Physician : Article

https://www.aafp.org/afp/2013/0601/p766.html

Weighing the Risks and Benefits of Chronic Opioid Therapy - American Family Physician

Jun 15, 2016 - Evidence supports the use of opioids for treating acute pain. However, the evidence is limited for the use of chronic opioid therapy for chronic pain. Furthermore, the risks of chronic therapy are significant and may outweigh any potential benefits. When considering chronic opioid ...

American Family Physician : Article

https://www.aafp.org/afp/2016/0615/p982.html

Common Questions About the Diagnosis and Management of Fibromyalgia - American Family ...

Apr 1, 2015 - Fibromyalgia has a distinct pathophysiology involving central amplification of peripheral sensory signals. Core symptoms are chronic widespread pain, fatigue, and sleep disturbance. Most patients with fibromyalgia have muscle pain and tenderness, forgetfulness or problems concentrating,...

American Family Physician : Article

https://www.aafp.org/afp/2015/0401/p472.html

Pharmacologic Management of Pain at the End of Life - American Family Physician

Jul 1, 2014 - Although many patients experience debilitating pain at the end of life, there are many options to improve analgesia and quality of life. Pain assessment using a validated tool, with attention to patient function and specific goals, helps tailor individual treatment plans. The World ...

American Family Physician : Article

https://www.aafp.org/afp/2014/0701/p26.html

Gabapentinoids for Pain: Potential Unintended Consequences - Editorials - American ...

Dec 1, 2019 - The widespread and often indiscriminate prescribing of gabapentinoids is not supported by robust evidence, and it carries known and unknown risks.

American Family Physician : Editorials

https://www.aafp.org/afp/2019/1201/p672.html

Infiltrative Anesthesia in Office Practice - American Family Physician

Jun 15, 2014 - When choosing an infiltrative anesthetic agent, the type of procedure, the length of time required for anesthesia, and the pharmacodynamics of each medication are important considerations. Distraction techniques and buffering with sodium bicarbonate can be used to decrease the pain ...

American Family Physician : Article

https://www.aafp.org/afp/2014/0615/p956.html

Labor Analgesia - American Family Physician

Mar 1, 2012 - Regional analgesia has become the most common method of pain relief used during labor in the United States. Epidural and spinal analgesia are two types of regional analgesia. With epidural analgesia, an indwelling catheter is directed into the epidural space, and the patient receives a ...

American Family Physician : Article

https://www.aafp.org/afp/2012/0301/p447.html

Rational Use of Opioids for Management of Chronic Nonterminal Pain - American Family ...

Aug 1, 2012 - Opioid prescribing for chronic nonterminal pain has increased in recent years, although evidence for its long-term effectiveness is weak and its potential for harm is significant. Nonmedical use of prescription opioids, diversion, and overdose deaths have also increased sharply, ...

American Family Physician : Article

https://www.aafp.org/afp/2012/0801/p252.html

NSAID Prescribing Precautions - American Family Physician

Dec 15, 2009 - Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used, but have risks associated with their use, including significant upper gastrointestinal tract bleeding. Older persons, persons taking anticoagulants, and persons with a history of upper gastrointestinal tract bleeding ...

American Family Physician : Article

https://www.aafp.org/afp/2009/1215/p1371.html

Evidence for the Use of Intramuscular Injections in Outpatient Practice - American ...

Feb 15, 2009 - There are few studies comparing the outcomes of patients who are treated with oral versus intramuscular antibiotics, corticosteroids, nonsteroidal anti-inflammatory drugs, or vitamin B12. This may lead to confusion about when the intramuscular route is indicated. For example, ...

American Family Physician : Article

https://www.aafp.org/afp/2009/0215/p297.html

Ibuprofen Plus Acetaminophen Equals Opioid Plus Acetaminophen for Acute Severe ...

Mar 1, 2018 - In adults presenting to the emergency department with acute extremity pain severe enough to warrant radiologic investigation, ibuprofen plus acetaminophen was equally effective in reducing pain intensity at two hours compared with three different opioid and acetaminophen combination ...

American Family Physician : POEMs

https://www.aafp.org/afp/2018/0301/p348.html

Chronic Neck Pain: Nonpharmacologic Treatment - Implementing AHRQ Effective Health Care...

Aug 1, 2019 - Which noninvasive nonpharmacologic treatments for chronic neck pain improve function or pain for at least one month?

American Family Physician : Implementing AHRQ Effective Health Care Reviews

https://www.aafp.org/afp/2019/0801/p180.html

Management of Common Opioid-Induced Adverse Effects - American Family Physician

Oct 15, 2006 - Opioid analgesics are useful agents for treating pain of various etiologies; however, adverse effects are potential limitations to their use. Strategies to minimize adverse effects of opioids include dose reduction, symptomatic management, opioid rotation, and changing the route of ...

American Family Physician : Article

https://www.aafp.org/afp/2006/1015/p1347.html

Integrating Medical Acupuncture into Family Medicine Practice - Editorials - American ...

Jul 15, 2019 - Acupuncture is an evidence-based therapy to reduce pain that can meet patient demand for nonpharmacologic treatment. Now is the time to offer training in medical acupuncture to more family physicians.

American Family Physician : Editorials

https://www.aafp.org/afp/2019/0715/p76.html

Alternative Interventions for Chronic Prostatitis/Chronic Pelvic Pain Syndrome in Men -...

Jun 1, 2019 - In men with chronic pelvic pain and urinary dysfunction who have not responded to standard medical management, extracorporeal shock wave therapy reduces symptoms and increases quality of life. Acupuncture may also provide benefit to some patients.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2019/0601/p677.html

Chronic Nonmalignant Pain in Primary Care - American Family Physician

Nov 15, 2008 - A systematic approach to chronic nonmalignant pain includes a comprehensive evaluation; a treatment plan determined by the diagnosis and mechanisms underlying the pain; patient education; and realistic goal setting. The main goal of treatment is to improve quality of life while ...

American Family Physician : Article

https://www.aafp.org/afp/2008/1115/p1155.html

Osteopathic Manipulative Treatment: A Primary Care Approach - Editorials - American ...

Feb 15, 2019 - Osteopathic manipulative treatment is a valuable modality that has the potential to decrease cost and improve pain/function in patients.

American Family Physician : Editorials

https://www.aafp.org/afp/2019/0215/p214.html

Complementary and Integrative Treatments for Pain Management in Labor - Cochrane for ...

Feb 1, 2019 - There is evidence that all of the studied interventions have some benefit in labor, but the evidence is of low to very low quality. Massage, thermal interventions (warm and cold packs), relaxation techniques, yoga, and music reduce pain during latent labor, but not during active labor.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2019/0201/p154.html

Acupuncture for Pain - American Family Physician

Sep 1, 2009 - Acupuncture is increasingly used as an alternative or complementary therapy for the treatment of pain. It is well tolerated, with a low risk of serious adverse effects. Traditional and modern acupuncture techniques may result in reported improvement in pain patterns. Research on ...

American Family Physician : Article

https://www.aafp.org/afp/2009/0901/p481.html

Epidural Analgesia and Risk of Cesarean Delivery - FPIN's Help Desk Answers - American ...

Nov 1, 2018 - There is no difference in the risk of cesarean delivery in women who receive epidural analgesia before 4 to 5 cm cervical dilation compared with later dilation.

American Family Physician : FPIN's Help Desk Answers

https://www.aafp.org/afp/2018/1101/od2.html

Fibromyalgia - American Family Physician

Jul 15, 2007 - Fibromyalgia is an idiopathic, chronic, nonarticular pain syndrome with generalized tender points. It is a multisystem disease characterized by sleep disturbance, fatigue, headache, morning stiffness, paresthesias, and anxiety. Nearly 2 percent of the general population in the United ...

American Family Physician : Article

https://www.aafp.org/afp/2007/0715/p247.html

Acupuncture Effective for Chronic Pain Conditions - POEMs - American Family Physician

Nov 15, 2018 - Acupuncture, with its meridians, chi, and other concepts that do not seem to line up with anything physiologic, is vexing to most of us who trained in Western medicine. However, this meta-analysis, based on data from almost 21,000 patients, found it to be more effective than no ...

American Family Physician : POEMs

https://www.aafp.org/afp/2018/1115/od2.html

Cannabinoids Somewhat Helpful for Nausea, Maybe Helpful for Spasticity, Probably Not ...

Oct 15, 2018 - This umbrella review found a modest benefit of cannabinoids for the treatment of neuropathic pain; a greater benefit for the treatment of spasticity and nausea and vomiting; and substantial harms. The studies were extremely heterogeneous in terms of the comparators, dose, duration, and ...

American Family Physician : POEMs

https://www.aafp.org/afp/2018/1015/od3.html

Nonopioids Equivalent to Opioids for Severe Chronic Back, Hip, or Knee Pain with Fewer ...

Sep 1, 2018 - Nonopioid medications were at least as effective as opioid medications for improving pain-related function over 12 months in adults with severe chronic back pain or knee or hip osteoarthritis pain. The evidence that opioids are not superior to nonopioid medications for chronic and acute...

American Family Physician : POEMs

https://www.aafp.org/afp/2018/0901/p316.html

NSAIDs for Postpartum Perineal Pain - FPIN's Help Desk Answers - American Family Physician

Jun 1, 2018 - Women with third- or fourth-degree perineal lacerations or who received an episiotomy can be given oral NSAIDs to reduce perineal pain in the first six hours postpartum.

American Family Physician : FPIN's Help Desk Answers

https://www.aafp.org/afp/2018/0601/od3.html

No Added Benefit with Higher Doses of Ketorolac for Treatment of Acute Pain in the ...

Aug 15, 2017 - A 10-mg dose of ketorolac is as effective as higher doses for the short-term treatment of acute pain for patients in the emergency department.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0815/p262.html

Ibuprofen and Morphine Provide Similar Post-op Pain Relief in Kids; Ibuprofen Has Fewer...

Mar 15, 2018 - This carefully designed and adequately powered study found no difference in pain reduction between ibuprofen and oral morphine in children with postoperative pain. Adverse effects, however, were much more likely with morphine.

American Family Physician : POEMs

https://www.aafp.org/afp/2018/0315/p408a.html

Low Back Pain: American College of Physicians Practice Guideline on Noninvasive ...

Sep 15, 2017 - The American College of Physicians has released a guideline, which partially updates its 2007 guideline, to provide recommendations for noninvasive treatment of acute (duration less than four weeks), subacute (duration of four to 12 weeks), and chronic (duration longer than 12 weeks) ...

American Family Physician : Practice Guidelines

https://www.aafp.org/afp/2017/0915/p407.html

Effectiveness of Skin-to-Skin Care for Procedure-Related Pain in Newborns - Cochrane ...

Feb 1, 2018 - Skin-to-skin care, also known as kangaroo care, effectively reduces physiologic and behavioral measures of pain in neonates during painful procedures and has no identified adverse effects. Infants who received skin-to-skin care during painful procedures had a heart rate of 10.8 beats ...

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2018/0201/p170.html

Topical Capsaicin for Treatment of Chronic Neuropathic Pain in Adults - Medicine by the...

Dec 1, 2017 - Based on low-quality evidence, high-concentration capsaicin patches reduce neuropathic pain from herpes and human immunodeficiency virus infection by 30% to 50% compared with the low-concentration capsaicin control group.

American Family Physician : Medicine by the Numbers

https://www.aafp.org/afp/2017/1201/od1.html

Use of Mindfulness or Self-Hypnosis Provides Immediate Pain Relief to Hospitalized ...

Nov 15, 2017 - Compared with psychoeducation, a single 15-minute session of training in mindfulness or self-hypnosis leads to greater immediate pain relief for hospitalized patients with at least moderate pain at baseline.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/1115/od6.html

How Family Physicians Can Combat the Opioid Epidemic - Editorials - American Family ...

Sep 15, 2017 - Family physicians must commit to responsible prescribing of opioid medications. The decision to initiate opioid therapy should be a careful and deliberate one, especially in patients who are at risk of addiction.

American Family Physician : Editorials

https://www.aafp.org/afp/2017/0915/p357.html

Pregabalin for Fibromyalgia Pain in Adults - Cochrane for Clinicians - American Family ...

Sep 1, 2017 - There is high-quality evidence that pregabalin in daily dosages of 300 mg, 450 mg, and 600 mg reduces pain associated with fibromyalgia. The most effective dosage seems to be 450 mg daily; this dosage is more effective than placebo at reducing pain by at least 50% (number needed to ...

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2017/0901/p291.html

Antipsychotics for Fibromyalgia in Adults - Medicine by the Numbers - American Family ...

Aug 1, 2017 - Quetiapine may be considered for a limited period (less than 12 weeks) to improve pain, sleep, and depression in fibromyalgia, while considering the potential for weight gain.

American Family Physician : Medicine by the Numbers

https://www.aafp.org/afp/2017/0801/od1.html

Management of Chronic Pain and Opioid Misuse: A Position Paper from the AAFP - Practice...

Apr 1, 2017 - Overprescribing, misuse, diversion, and dependence on opioids have occurred as a result of external pressures, physician behavior, inadequate evidence, and pharmacologic development. Family physicians could play an important role in alleviating these problems; therefore, the American ...

American Family Physician : Practice Guidelines

https://www.aafp.org/afp/2017/0401/p458.html

Pregabalin Does Not Decrease the Pain of Sciatica - POEMs - American Family Physician

Aug 15, 2017 - Pregabalin does not relieve pain in patients with sciatica.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0815/p260.html

Methadone Treatment for Pain States - American Family Physician

Apr 1, 2005 - Methadone is a synthetic opioid with potent analgesic effects. Although it is associated commonly with the treatment of opioid addiction, it may be prescribed by licensed family physicians for analgesia. Methadone's unique pharmacokinetics and pharmacodynamics make it a valuable option ...

American Family Physician : Article

https://www.aafp.org/afp/2005/0401/p1353.html

Chronic Musculoskeletal Pain in Children: Part I. Initial Evaluation - American Family ...

Jul 1, 2006 - Musculoskeletal pain can be difficult for children to characterize. Primary care physicians must determine whether the pain may be caused by a systemic disease. Change in activity, constitutional symptoms such as fevers and fatigue, or abnormal examination findings without obvious ...

American Family Physician : Article

https://www.aafp.org/afp/2006/0701/p115.html

Cyclobenzaprine in the Treatment of Low Back Pain - Medicine by the Numbers - American ...

Feb 1, 2016 - Studies show that 1 in 3 patients experiences global improvement in back pain symptoms at 10 days, while 1 in 4 patients experiences medication adverse effects. Read more.

American Family Physician : Medicine by the Numbers

https://www.aafp.org/afp/2016/0201/od2.html

Chronic Pain Management and Opioid Misuse: Guidance for Family Physicians - Editorials ...

Apr 1, 2017 - Family physicians are committed to advancing population and community health, and we must take the lead in reducing opioid misuse and overdose before outside entities mandate practice strategies that may not be patient-centered.

American Family Physician : Editorials

https://www.aafp.org/afp/2017/0401/p420.html

Alpha-adrenergic Agonists for the Management of Opioid Withdrawal - Medicine by the ...

Jan 1, 2017 - Alpha-adrenergic agonists were more efficacious than placebo in the management of opioid withdrawal, but are best reserved as an alternative to methadone.

American Family Physician : Medicine by the Numbers

https://www.aafp.org/afp/2017/0101/od1.html

Low-Dose Morphine Less Effective Than Diclofenac or Acetaminophen for Renal Colic - ...

Oct 15, 2016 - This is a good example of how a well-done study can lead to erroneous conclusions. The comparator most likely to be effective here—titrated morphine—was used at a low dose and found to be less effective than intramuscular diclofenac or intravenous paracetamol (acetaminophen).

American Family Physician : POEMs

https://www.aafp.org/afp/2016/1015/p665.html

Selective Serotonin Reuptake Inhibitors for Fibromyalgia - Cochrane for Clinicians - ...

Oct 1, 2016 - SSRIs may have a small to moderate effect on pain (number needed to treat [NNT] = 10), global improvement (NNT = 7), and depression (NNT = 13) in patients with fibromyalgia, but the quality of evidence is very low because of bias and small studies. SSRIs do not reduce fatigue related to...

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2016/1001/p548.html

Acetaminophen for the Treatment of Pain in Newborns - Cochrane for Clinicians - ...

Aug 1, 2016 - Acetaminophen does not significantly reduce pain associated with heel lance, eye examinations, or assisted vaginal births in newborns. Acetaminophen may reduce the total amount of morphine a newborn needs in the first 48 hours following major abdominal or thoracic surgery.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2016/0801/p216.html

Rural Opioid Use Disorder Treatment Depends on Family Physicians - Graham Center Policy...

Oct 1, 2016 - The nation's growing opioid use disorder epidemic disproportionately impacts rural areas, where physicians who can prescribe buprenorphine are scarcest. Among physicians approved to prescribe buprenorphine, family physicians (FPs) are the most likely to work in rural areas.

American Family Physician : Graham Center Policy One-Pagers

https://www.aafp.org/afp/2016/1001/p546.html

Family Medicine: An Underutilized Resource in Addressing the Opioid Epidemic? - Graham ...

Sep 1, 2016 - Opioid overdose rates have tripled since 2000, and although overprescribing of opioids by physicians is widely accepted as a causal factor, the physician's role in providing medication-assisted treatment for opioid use disorder is less appreciated. Despite a clear willingness to ...

American Family Physician : Graham Center Policy One-Pagers

https://www.aafp.org/afp/2016/0901/p350.html

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