ABSTRACT
Treatment of chronic noncancer pain (CNCP) with high-dose opioids (HDOs) has burgeoned over the past 2 decades in the United States. Characteristic domains and features of the failed CNCP management patient using long-term HDOs are described herein as the/an opioid syndrome (Schreiber AL, personal communication. 2013). Reversing or even modulating HDO use in patients with CNCP requires a paradigm shift on the part of physician, patient, and the societal "quick fix" medical culture. This review offers measures, agents, and strategies to consider in management of this pervasive, erosive medical and societal challenge.
Subject(s)
Analgesics, Opioid/adverse effects , Chronic Pain/drug therapy , Opioid-Related Disorders/epidemiology , Pain, Intractable/drug therapy , Analgesics, Opioid/therapeutic use , Chronic Pain/diagnosis , Female , Humans , Incidence , Male , Neoplasms , Opioid-Related Disorders/etiology , Opioid-Related Disorders/physiopathology , Pain, Intractable/diagnosis , Prognosis , Risk Assessment , Severity of Illness Index , Syndrome , Treatment Failure , United States/epidemiologyABSTRACT
UNLABELLED: This self-directed learning module highlights a clinical vignette of a female patient with osteoporosis and addresses the clinical presentation, assessment, medical management, and rehabilitation approaches to a patient with an acute vertebral fracture. It is part of the study guide on osteoporosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This chapter emphasizes the differential diagnosis, clinical diagnostic considerations, current pharmacotherapy, invasive procedure options, and orthotic and exercise interventions for a patient with postmenopausal osteoporosis. OVERALL ARTICLE OBJECTIVE: To summarize the clinical evaluation, medical management, and rehabilitation strategies in women with postmenopausal osteoporosis and acute vertebral fracture presentation.
Subject(s)
Osteoporosis/diagnosis , Osteoporosis/therapy , Alendronate/therapeutic use , Analgesics, Opioid/therapeutic use , Cyclooxygenase Inhibitors/therapeutic use , Diagnosis, Differential , Humans , Osteoporosis/drug therapy , Osteoporosis/rehabilitation , Osteoporosis, Postmenopausal/diagnosis , Osteoporosis, Postmenopausal/drug therapy , Osteoporosis, Postmenopausal/rehabilitation , Osteoporosis, Postmenopausal/therapy , Pain/drug therapy , Risk Factors , Spinal Fractures/diagnosis , Spinal Fractures/therapy , Tramadol/therapeutic useABSTRACT
UNLABELLED: This self-directed learning module discusses a patient with knee osteoarthritis and addresses the clinical presentation, assessment, medical management, rehabilitation approaches, and surgical options. It is part of the chapter on osteoarthritis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This chapter emphasizes the differential diagnosis, clinical diagnostic considerations, current pharmacology, orthotics, exercise interventions, and surgical procedure options for a patient with knee osteoarthritis. OVERALL ARTICLE OBJECTIVE: To summarize diagnostic considerations and management of knee osteoarthritis.
Subject(s)
Osteoarthritis, Knee/diagnosis , Osteoarthritis, Knee/therapy , Acute Kidney Injury/chemically induced , Aged , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Arthroplasty, Replacement, Knee/rehabilitation , Diagnosis, Differential , Disease Management , Exercise Therapy , Gastrointestinal Hemorrhage/chemically induced , Humans , Male , Orthotic Devices , Osteoarthritis, Knee/rehabilitation , Risk FactorsABSTRACT
UNLABELLED: This self-directed learning module highlights a clinical vignette of a female patient who had a total hip arthroplasty. The module addresses the medical management and rehabilitation interventions necessary to direct the postacute care needs of this patient. It is part of the study guide on rehabilitation of the joint replacement patient in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This chapter emphasizes planning for discharge from the acute care hospital, postacute care medical complications, and rehabilitation program elements germane to the patient with hip joint replacement. OVERALL ARTICLE OBJECTIVE: To summarize the postacute care planning, medical complications, and rehabilitation needs of the patient with hip joint replacement.
Subject(s)
Arthroplasty, Replacement, Hip/rehabilitation , Aged , Bandages , Female , Humans , Length of Stay , Thromboembolism/prevention & control , Thrombolytic Therapy , Transportation of PatientsABSTRACT
UNLABELLED: This self-directed learning module highlights a clinical vignette of 2 patients: (1) a woman with bilateral, distal, upper-limb pain assessed by differential diagnosis, laboratory work-up, and treatment of rheumatologic disorders frequently seen in the physiatric practice setting and (2) a 57-year-old man with an acute recurring monoarthritis of the knee and addresses clinical presentation, assessment, medical management, and rehabilitation approaches. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on 2 aspects: (1) the differential diagnosis of polyarthralgia, distal upper-limb pain, criteria for classification of rheumatoid arthritis, synovial fluid analysis, and comprehensive treatment of rheumatoid arthritis, both pharmacologic and nonpharmacologic and (2) the differential diagnosis, clinical diagnostic considerations, current pharmacotherapy, invasive procedure options, and orthotic and exercise interventions for a patient with calcium pyrophosphate dehydrate-induced monoarthritis of the knee. OVERALL ARTICLE OBJECTIVES: (a) Clinical evaluation, diagnosis, management, and rehabilitation strategies in persons with initial presentations of inflammatory distal upper-limb pain and (b) clinical evaluation of an individual with crystal-induced monoarthritis and differentiation of the pathophysiology, assessment, and treatment of chondrocalcinosis.
Subject(s)
Arthritis, Rheumatoid/rehabilitation , Chondrocalcinosis/rehabilitation , Adult , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , Chondrocalcinosis/diagnosis , Diagnosis, Differential , Exercise Therapy , Female , Humans , Knee Joint/diagnostic imaging , Male , Middle Aged , Musculoskeletal Diseases/diagnosis , Radiography , Synovial Fluid/chemistry , Wrist Joint/diagnostic imagingABSTRACT
UNLABELLED: This self-directed learning module highlights the pathoanatomy and pathogenesis of lumbar spinal stenosis. The areas covered include assessment and therapeutic options in the rehabilitation of patients with degenerative lumbar spinal stenosis. It is part of the study guide on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. OVERALL ARTICLE OBJECTIVES: (a) To summarize the evaluation and management of lumbar spinal stenosis and (b) to review the pathoanatomy and pathogenesis of lumbar degenerative spinal stenosis.
