pain

Management of Shoulder Pain in Primary Care

Nathan Hinkle — Fri, 09 Oct 2026 05:00:00 +0000

Date Added:

October 9, 2026

Journal/Publication:

JAMA Intern Med

Publisher:

Journal of the American Medical Society

Publication Date:

August 17, 2026

Issue:

Volume:

186

Pages:

1256-1268

URL:

Management of Shoulder Pain in Primary Care A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi:10.1001/jamainternmed.2026.3135

Keywords

Shoulder Pain

primary care

soft-tissue disorders

MeSH

RPR Commentary: Guidance regarding when to refer patients with shoulder pain (and when not to). James W. Mold, MD, MPH

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Importance Shoulder pain is a common and disabling condition most often managed in primary care. This review provides an evidence-based update on the diagnosis and management of shoulder pain to support clinical decision-making and improve patient outcomes.

Observations Shoulder pain arises from benign, self-limiting soft-tissue disorders or rare but serious causes. In primary care, most cases are nontraumatic and involve periarticular soft tissues. The subacromial region is the most frequent source of pain, and the term subacromial pain is preferred over overlapping and inconsistently defined labels such as rotator cuff tendinopathy or tear, impingement syndrome, or subacromial bursitis. Less commonly, pain originates from the glenohumeral joint, as in glenohumeral osteoarthritis or adhesive capsulitis. Assessment should focus on a detailed history and physical examination to assess pain patterns and movement limitation and to exclude serious causes, such as infection, malignant neoplasm, or nonshoulder referred pain. Once these are excluded, first-line treatment is similar for most patients and aligns with recommended care for other regional musculoskeletal concerns: education about the favorable natural history, symptom relief and activity modification if needed, and watchful waiting. Early imaging is not indicated in the absence of significant trauma or suspicious features, such as fever, unexplained weight loss, or history of malignant neoplasm, as structural abnormalities often do not correlate with symptoms, rarely alter management, and may lead to overdiagnosis and overtreatment. Specialist referral should be reserved for suspected serious pathology, such as infection, malignant neoplasm, fracture, or dislocation; significant functional or neurologic deficit; features suggestive of systemic inflammatory disease; or persistent or worsening pain and debility. High-certainty evidence indicates that subacromial pain does not benefit from surgical intervention.

Conclusions and Relevance Shoulder pain is the third most common musculoskeletal presentation in primary care. Although causes vary, the initial management is largely the same once serious conditions have been excluded. Most patients with subacromial pain will fully recover with minimal intervention and can be safely treated with supportive care. Imaging and referral to surgical subspecialists should be reserved for rare and carefully selected cases to avoid unnecessary intervention.

Author/s:

Romi Haas, Thomas Ibounig, Rachelle Buchbinder

Management of Shoulder Pain in Primary Care: A Review

Mary Cervantes — Wed, 19 Aug 2026 17:54:00 +0000

Date Added:

August 19, 2026

Journal/Publication:

JAMA Internal Medicine

Publisher:

JAMA Intern Med

Publication Date:

August 17, 2026

URL:

Management of Shoulder Pain in Primary Care: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2026.3135

Keywords

Internal Medicine

Internal Medicine Practice

MeSH

clinical decision-making

Physical Examination

Physical Examination / methods

Overtreatment

primary health care

referral and consultation

Tendinopathy

A review of the management of patients with shoulder pain. James W. Mold, MD, MPH

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Author/s:

Romi Haas, Thomas Ibounig, MD, Buchbinder, Rachelle

Online Unsupervised Tai Chi Intervention for Knee Pain and Function in People With Knee Osteoarthritis: The RETREAT Randomized Clinical Trial

Megan George — Tue, 11 Nov 2025 14:30:40 +0000

Date Added:

November 11, 2025

Journal/Publication:

JAMA Internal Medicine

Publication Date:

October 27, 2025

URL:

Online Unsupervised Tai Chi Intervention for Knee Pain and Function in People With Knee Osteoarthritis: The RETREAT Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamainternmed.2025.5723

Keywords

Pain Medicine

Tai Chi

Knee osteoarthritis

PMID (1):

41143827

MeSH

This free online Tai Chi program (https://myjoint-taichi.org/) appears to be effective for reducing pain in patients with OA of the knees. James W. Mold, MD, MPH

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Importance: Tai chi is a type of exercise recommended for knee osteoarthritis, but access to in-person tai chi can be limited.

Objective: To evaluate the effects of an unsupervised multimodal online tai chi intervention on knee pain and function for people with knee osteoarthritis.

Design, setting, and participants: The RETREAT study was a 2-group superiority randomized clinical trial enrolling participants who met clinical criteria for knee osteoarthritis in Australian communities from August 2023 and November 2024.

Interventions: Participants in the control group received access to a purpose-built website containing information about osteoarthritis and exercise benefits. Participants in the intervention group received the My Joint Tai Chi intervention comprising access to the same website plus tai chi information, a 12-week unsupervised video-based Yang-style tai chi program, and encouragement to use an app to facilitate program adherence.

Main outcomes and measures: Changes in knee pain during walking (Numeric Rating Scale; range 0-10 with higher scores indicating greater pain) and difficulty with physical function (Western Ontario and McMaster Universities Osteoarthritis Index; range 0-68 with higher scores indicating greater dysfunction) during 12 weeks. Secondary outcomes included another knee pain measure, sport and recreation function, quality of life, physical and mental well-being, fear of movement, self-efficacy, balance confidence, positive activated affect, sleep quality, global improvement, and oral medication use.

Results: Of 2106 patients screened, 178 met inclusion criteria and were randomized, 89 (mean [SD] age, 61.0 [8.7] years; 66 female [74%] and 23 [26%] male participants) to the control group and 89 (mean [SD] age, 62.1 [7.3] years; 59 [66%] female and 30 male [34%] participants) to the tai chi intervention. Of the total, 170 (96%) completed both of the primary outcomes at 12 weeks. The tai chi group reported greater improvements in knee pain (control, -1.3; tai chi, -2.7; mean difference, -1.4 [95% CI, -2.1 to -0.7] units; P < .001) and function (control, -6.9; tai chi, -12.0; mean difference, -5.6 [95% CI, -9.0 to -2.3] units; P < .001) compared to the control group. More participants in the tai chi than in the control group achieved a minimal clinically important difference in pain (73% vs 47%; risk difference, 0.3; 95% CI, 0.1 to 0.4; P < .001) and function (72% vs 52%; risk difference, 0.2; 95% CI, 0.1 to 0.3; P = .007). Between-group differences for most secondary outcomes favored tai chi, including another knee pain measure, sport and recreation function, quality of life, physical and mental well-being, global improvement, pain self-efficacy, and balance confidence. No associated serious adverse events were reported.

Conclusions and relevance: This randomized clinical trial found that this unsupervised multimodal online tai chi intervention improved knee pain and function compared with the control at 12 weeks. This free-to-access web-based intervention offers an effective, safe, accessible, and scalable option for guideline-recommended osteoarthritis exercise.

Author/s:

Shiyi Julia Zhu, Rana S. Hinman, Rachel K. Nelligan

Online Unsupervised Tai Chi Intervention for Knee Pain and Function in People With Knee Osteoarthritis: The RETREAT Randomized Clinical Trial

Megan George — Tue, 28 Oct 2025 15:08:17 +0000

Date Added:

October 28, 2025

Journal/Publication:

JAMA Internal Medicine

Publication Date:

October 27, 2025

URL:

Online Unsupervised Tai Chi Intervention for Knee Pain and Function in People With Knee Osteoarthritis: The RETREAT Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamainternmed.2025.5723

Keywords

Knee osteoarthritis

kinesiophobia

Tai Chi

PMID (1):

41143827

MeSH

Minimal Clinically Important Difference

Use of a freely available online Tai Chi coaching app improved function and pain in individuals with osteoarthritis of the knees. James Mold, MD, MPH

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Importance: Tai chi is a type of exercise recommended for knee osteoarthritis, but access to in-person tai chi can be limited.

Objective: To evaluate the effects of an unsupervised multimodal online tai chi intervention on knee pain and function for people with knee osteoarthritis.

Author/s:

Shiyi Julia Zhu, Rana S Hinman, Rachel K Nelligan, Peixuan Li, Anurika P De Silva, Jenny Harrison, Alexander J Kimp, Kim L Bennell

What Do I Need to Know About the Pneumococcal Pneumonia Vaccine?

Megan George — Tue, 21 Oct 2025 13:35:47 +0000

Date Added:

October 21, 2025

Journal/Publication:

JAMA Internal Medicine Patient Page

Publication Date:

October 20, 2025

URL:

What Do I Need to Know About the Pneumococcal Pneumonia Vaccine?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jamainternmed.2025.5277

Keywords

'Vaccination

Infectious diseases

Patient Information

Pneumococcal Vaccines

PMID (1):

41114997

MeSH

23-valent pneumococcal capsular polysaccharide vaccine

pneumonia

13-valent pneumococcal vaccine

spleen

COVID-19

Streptococcus pneumoniae

Influenza

Pneumococcal Vaccines

Pneumococcal Infections

Hypersensitivity

Herpes Zoster

Information for patients about pneumococcal immunizations. James W. Mold, MD, MPH

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What Is the Pneumococcal Pneumonia Vaccine?
The pneumococcal vaccine protects against infections from a type of bacteria called pneumococcus. Pneumococcus is a common cause of pneumonia (a lung infection), as well as other serious infections. The vaccine prepares your immune system to recognize and fight pneumococcal bacteria. The vaccine is usually given through an injection into the arm. Some versions can also be inhaled. The vaccines do not contain living or dead bacteria. The pneumococcal vaccine does not protect you from other lung infections like the flu (influenza), COVID-19, RSV (respiratory syncytial virus), or other kinds of bacteria that cause pneumonia. It is still important to get your flu shot every year and other vaccines your doctor recommends, even if you already got the pneumococcal vaccine.

What Are Benefits of Pneumococcal Pneumonia Vaccines?
The vaccine substantially lowers your risk of hospitalization or dying from serious pneumococcal infection. Vaccination can reduce the risk of pneumonia-related deaths by almost half.

Why Is There a New Pneumococcal Pneumonia Vaccine, and How Does It Differ From Prior Versions?
There are several types of pneumococcal bacteria that can cause pneumonia. Being vaccinated against one type of pneumococcus may not protect you from other types that could make you sick. Previous pneumococcal pneumonia vaccines like PPSV23 or PCV13 do not protect against all types of the pneumococcal bacteria that cause pneumonia. Newer vaccines were made in 2021 (PCV15 and PCV20) and 2024 (PCV21). These help to prevent infections from types of bacteria not covered by older versions.

What Are the Potential Side Effects?
Side effects are frequent but generally mild. The most common side effect is pain or redness at the site of injection. Less common side effects include fever, feeling tired, muscle ache, and headache. These are less severe than for other vaccines like flu and shingles. These effects can be treated with over-the-counter medications and generally go away within 24 to 48 hours. Life-threatening allergic reactions are extremely rare but possible. Seek immediate medical attention if you experience severe symptoms like difficulty breathing or progressive weakness after vaccination. The pneumonia vaccine cannot cause pneumonia or other bacterial illness.

Who Should Get a New Pneumococcal Pneumonia Vaccine?
All adults 50 years and older who have not been vaccinated should receive one of the new vaccines: PCV21, PCV20, or a sequence of PCV15 followed by PPSV23. People younger than 50 years with certain health problems should also get the new vaccine. These health problems include diabetes; chronic conditions affecting the heart, lungs, liver, or kidneys; current tobacco use or heavy alcohol consumption; a weak immune system from certain health problems or medications; absence or prior removal of the spleen; and a history of spinal fluid leak or a cochlear (inner ear) implant.

Most adults who got either PPSV23 and/or PCV13 should still get a booster with one of the newer vaccines. The different pneumococcal vaccines protect against different types of bacteria. Some types of bacteria are more common in people depending on their age, health, and where they live. Talk to your doctor about which vaccine is best for you.

Author/s:

Jerard Z. Kneifati-Hayek, Michael A. Incze

The effectiveness and safety of methotrexate in the intervention of osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

Megan George — Tue, 14 Oct 2025 13:08:01 +0000

Date Added:

October 14, 2025

Journal/Publication:

Medicine

Publication Date:

October 10, 2025

URL:

The effectiveness and safety of methotrexate in the intervention of osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1097/MD.0000000000044994

Keywords

MeSH

The findings of this meta-analysis suggest that methotrexate is both safe and effective for treatment of pain and joint stiffness in patients with osteoarthritis. James W. Mold, MD, MPH

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Background:
Osteoarthritis (OA) is a prevalent chronic joint disorder among middle-aged and older adults, characterized by progressive cartilage degeneration, subchondral bone remodeling, and osteophyte formation, leading to joint pain, stiffness, dysfunction, and reduced quality of life. With the global aging population, OA imposes a growing socioeconomic burden, yet no disease-modifying therapy is currently available—particularly for moderate-to-severe stages. Emerging evidence implicates synovial inflammation as a central contributor to OA symptoms and progression, raising interest in methotrexate (MTX), a well-established, low-dose anti-inflammatory agent used safely in rheumatoid arthritis. Preliminary studies suggest MTX may alleviate OA-related pain, but findings from randomized controlled trials (RCTs) have been inconsistent and limited in number. Given recent new RCTs and the heterogeneity of existing outcomes, an updated systematic review and meta-analysis is urgently needed to clarify the efficacy and safety of MTX in OA and inform future clinical trial design.

Methods:
PubMed, ClinicalTrials, Web of Science, Cochrane Library and other databases were searched to find randomized controlled trials (RCT) of MTX treatment of OA. Methodological quality was assessed using the Cochrane "risk of bias" assessment tool, and the meta-analysis was conducted using Review Manager (RevMan) version 5.3 (The Cochrane Collaboration, London, UK).

Results:
Fifteen RCTs involving 1591 participants were included in this review. The meta-analysis results showed that the ineffective rate in the experimental group was lower [RR: 0.40 (0.24, 0.67), P = .004]; the VAS in the experimental group was lower [WMD: −0.66 (−1.08, −0.24), P = .002]; the WOMAC score-stiffness in the experimental group was lower [WMD: −0.72 (−1.04, −0.41), P < .00001]; the WOMAC score-function in the experimental group was lower [WMD: −7.72 (−13.56, −1.87), P = .01]. The adverse events in the experimental group were not statistically significant compared with the control group [RR: 1.04 (0.77, 1.42), P = .78].

Conclusion:
MTX demonstrates potential in effectively alleviating pain, improving joint function, and slowing disease progression in patients with OA. Its safety profile is comparable to that of control treatments, making it a viable and reliable therapeutic option worthy of broader clinical application.

Author/s:

Wan, Lifei, Yang, Qianyue, Yang, Kailin, Zeng, Liuting, Sun, Lingyun

Acupuncture vs Sham Acupuncture for Chronic Sciatica From Herniated Disk: A Randomized Clinical Trial

Alex Haga — Wed, 23 Oct 2024 15:22:30 +0000

Date Added:

October 23, 2024

Journal/Publication:

JAMA Internal Medicine

Publication Date:

October 14, 2024

URL:

Acupuncture vs Sham Acupuncture for Chronic Sciatica From Herniated Disk: A Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamainternmed.2024.5463

Keywords

Acupuncture Therapy

acupunture

Sciatica

PMID (1):

39401008

MeSH

Sciatica

Intervertebral Disc Displacement

pain

Acupuncture Therapy*

Acupuncture was significantly more effective for relieving the symptoms of sciatica compared to sham acupuncture. James W. Mold, MD, MPH

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Importance: Sciatica is commonly caused by herniated lumbar disc and contributes to severe pain and prolonged disability. Although acupuncture is widely used by patients with chronic sciatica, the evidence of its efficacy is scarce.

Objective: To investigate the efficacy and safety of acupuncture compared with sham acupuncture in patients with chronic sciatica from herniated disk.

Design, settings, and participants: This was a multicenter 2-arm randomized clinical trial conducted in 6 tertiary-level hospitals in China of patients with chronic sciatica from herniated disk. Participants were recruited from March 25, 2021, to September 23, 2021, with a final follow-up through September 22, 2022. Data analyses were performed from December 2022 to March 2023.

Interventions: Participants were randomly assigned to receive 10 sessions of acupuncture (n = 110) or sham acupuncture (n = 110) over 4 weeks. Participants, outcome assessors, and statisticians were blinded.

Main outcomes and measures: The 2 coprimary outcomes were changes in visual analog scale (VAS) for leg pain and Oswestry Disability Index (ODI) from baseline to week 4. Secondary outcomes were adverse events.

Results: A total of 216 patients (mean [SD] age, 51.3 [15.2] years; 147 females [68.1%] and 69 males [31.9%]) were included in the analyses. The VAS for leg pain decreased 30.8 mm in the acupuncture group and 14.9 mm in the sham acupuncture group at week 4 (mean difference, -16.0; 95% CI, -21.3 to -10.6; P < .001). The ODI decreased 13.0 points in the acupuncture group and 4.9 points in the sham acupuncture group at week 4 (mean difference, -8.1; 95% CI, -11.1 to -5.1; P < .001). For both VAS and ODI, the between-group difference became apparent starting in week 2 (mean difference, -7.8; 95% CI, -13.0 to -2.5; P = .004 and -5.3; 95% CI, -8.4 to -2.3; P = .001, respectively) and persisted through week 52 (mean difference, -10.8; [95% CI, -16.3 to -5.2; P < .001; and -4.8; 95% CI, -7.8 to -1.7; P = .003, respectively). No serious adverse events occurred.

Conclusions and relevance: This randomized clinical trial found that in patients with chronic sciatica from herniated disk, acupuncture resulted in less pain and better function compared with sham acupuncture at week 4, and these benefits persisted through week 52. Acupuncture should be considered as a potential treatment option for patients with chronic sciatica from a herniated disk.

Author/s:

Jian-Feng Tu, Guang-Xia Shi, Shi-Yan Yan, Guang-Xia Ni

Common Painful Foot and Ankle Conditions: A Review

Erin Blanchette — Wed, 03 Jan 2024 19:56:23 +0000

Date Added:

January 3, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

December 19, 2024

Issue:

Volume:

330

Pages:

2285-2294

URL:

Common Painful Foot and Ankle Conditions: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2023.23906

Keywords

PMID (1):

38112812

MeSH

A review of common painful foot and ankle problems. James W. Mold, MD, MPH

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Importance: Morton neuroma, plantar fasciitis, and Achilles tendinopathy are foot and ankle conditions that are associated with pain and disability, but they can respond to nonoperative treatment.

Observations: Morton neuroma, consisting of interdigital neuronal thickening and fibrosis, is characterized by burning pain in the ball of the foot and numbness or burning pain that may radiate to the affected toes (commonly the third and fourth toes). First-line nonoperative therapy consists of reducing activities that cause pain, orthotics, and interdigital corticosteroid injection; however, approximately 30% of patients may not respond to conservative treatment. Plantar fasciitis accounts for more than 1 million patient visits per year in the US and typically presents with plantar heel pain. Fifteen years after diagnosis, approximately 44% of patients continue to have pain. First-line nonoperative therapy includes stretching of the plantar fascia and foot orthotics, followed by extracorporeal shockwave therapy, corticosteroid injection, or platelet-rich plasma injection. Midportion Achilles tendinopathy presents with pain approximately 2 to 6 cm proximal to the Achilles insertion on the heel. The primary nonoperative treatment involves eccentric strengthening exercises, but extracorporeal shockwave therapy may be used.

Conclusions and relevance: Morton neuroma, plantar fasciitis, and Achilles tendinopathy are painful foot and ankle conditions. First-line therapies are activity restriction, orthotics, and corticosteroid injection for Morton neuroma; stretching and foot orthotics for plantar fasciitis; and eccentric strengthening exercises for Achilles tendinopathy.

Author/s:

Minton Truitt Cooper

Topical Nonprescription Pain Medications for Adults

Erin Blanchette — Tue, 14 Nov 2023 20:48:41 +0000

Date Added:

November 14, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

November 3, 2023

URL:

Topical Nonprescription Pain Medications for Adults

Type:

Patient Education Materials

Format:

Article

DOI (1):

doi:10.1001/jama.2023.13813

Keywords

clinical pharmacy and pharmacology

PMID (1):

37921785

MeSH

Anti-Inflammatory Agents

Anti-Inflammatory Agents, Non-Steroidal

Nonprescription Drugs

Information for patients on three types of nonprescription topical analgesics. James W. Mold, MD, MPH

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This JAMA Patient Page describes the types of topical nonprescription pain medications and tips for using them.

Topical nonprescription pain medications are over-the-counter drugs applied to the skin to treat pain.

Topical pain medications can effectively treat pain caused by several acute and chronic conditions. Because they are applied directly to the skin, topical pain medications are easy to use and less likely to cause side effects or interact with other medications than oral pain medications. Pain relief typically occurs within several days of starting a topical pain medication.

Author/s:

Sarah E. Vordenberg

Management of de Quervain Tenosynovitis: A Systematic Review and Network Meta-Analysis

Erin Blanchette — Mon, 13 Nov 2023 16:38:32 +0000

Date Added:

November 14, 2023

Journal/Publication:

JAMA Network Open

Publisher:

American Medical Association

Publication Date:

October 27, 2023

Issue:

Volume:

URL:

Management of de Quervain Tenosynovitis: A Systematic Review and Network Meta-Analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2023.37001

Keywords

de Quervain tenosynovitis

corticosteroid injection

CSI

ultrasonography

tendonitis

PMID (1):

37889490

MeSH

Tenosynovitis* / therapy

pain

bias

Network Meta-Analysis

Tenosynovitis

Visual Analog Scale

Results of a systematic review and meta-analysis of interventions for treatment of DeQuervain tendonitis. Yet another reason to become proficient at ultrasonography. James W. Mold, MD, MPH

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Importance: There is a plethora of treatment options for patients with de Quervain tenosynovitis (DQT), but there are limited data on their effectiveness and no definitive management guidelines.

Objective: To assess and compare the effectiveness associated with available treatment options for DQT to guide musculoskeletal practitioners and inform guidelines.

Data sources: Medline, Embase, PubMed, Cochrane Central, Scopus, OpenGrey.eu, and WorldCat.org were searched for published studies, and the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, The European Union Clinical Trials Register, and the ISRCTN registry were searched for unpublished and ongoing studies from inception to August 2022.

Study selection: All randomized clinical trials assessing the effectiveness of any intervention for the management of DQT.

Data extraction and synthesis: This study was prospectively registered on PROSPERO and conducted and reported per Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions (PRISMA-NMA) and PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science (PERSIST) guidance. The Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluations tool were used for risk of bias and certainty of evidence assessment for each outcome.

Main outcomes and measures: Pairwise and network meta-analyses were performed for patient-reported pain using a visual analogue scale (VAS) and for function using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale. Mean differences (MD) with their 95% CIs were calculated for the pairwise meta-analyses.

Results: A total of 30 studies with 1663 patients (mean [SD] age, 46 [7] years; 80% female) were included, of which 19 studies were included in quantitative analyses. From the pairwise meta-analyses, based on evidence of moderate certainty, adding thumb spica immobilization for 3 to 4 weeks to a corticosteroid injection (CSI) was associated with statistically but not clinically significant functional benefits in the short-term (MD, 10.5 [95% CI, 6.8-14.1] points) and mid-term (MD, 9.4 [95% CI, 7.0-11.9] points). In the network meta-analysis, interventions that included ultrasonography-guided CSI ranked at the top for pain. CSI with thumb spica immobilization had the highest probability of being the most effective intervention for short- and mid-term function.

Conclusions and relevance: This network meta-analysis found that adding a short period of thumb spica immobilization to CSI was associated with statistically but not clinically significant short- and mid-term benefits. These findings suggest that administration of CSI followed by 3 to 4 weeks immobilization should be considered as a first-line treatment for patients with DQT.

Author/s:

Dimitris Challoumas, Rohan Ramasubbu, Elliot Rooney, Emily Seymour-Jackson, Amit Putti, Neal L. Millar

Chronic anal pain: A review of causes, diagnosis, and treatment

Saige Blanchard — Tue, 14 Jun 2022 05:00:00 +0000

Date Added:

June 14, 2022

Journal/Publication:

Cleveland Clinic Journal of Medicine

Publisher:

Cleveland Clinic Journal of Medicine

Publication Date:

June 1, 2022

Issue:

Volume:

Pages:

336-343

URL:

Chronic anal pain: A review of causes, diagnosis, and treatment

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.3949/ccjm.89a.21102

Keywords

PMID (1):

35649568

MeSH

Levator syndrome

Pudendal Neuralgia

diagnostic tests, routine

Syndrome

pain

A nice review of the causes of chronic anal pain. James W. Mold, MD, MPH

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Chronic anal pain is diffi cult to diagnose and treat, especially with no obvious anorectal cause apparent on clinical examination. This review identifi es 3 main diagnostic
categories for chronic anal pain: local causes, functional
anorectal pain, and neuropathic pain syndromes. Conditions covered within these categories include proctalgia
fugax, levator ani syndrome, pudendal neuralgia, and coccygodynia. The signs, symptoms, relevant diagnostic tests,
and main treatments for each condition are reviewed.

Author/s:

Knowles, C. H., Cohen, R. C.

Efficacy and Safety of Nonantibiotic Outpatient Treatment in Mild Acute Diverticulitis (DINAMO-study): A Multicentre, Randomised, Open-label, Noninferiority Trial

Bethie Seay — Tue, 02 Nov 2021 05:00:00 +0000

Date Added:

November 2, 2021

Journal/Publication:

Annals of Surgery

Publication Date:

November 1, 2021

Issue:

Volume:

274

Pages:

e435-e442

Type:

Clinical Research Results

DOI (1):

10.1097/SLA.0000000000005031

PMID (1):

34183510

MeSH

Humans

Amoxicillin-potassium clavulanate combination

anti-bacterial agents

prospective studies

outpatients

Anti-Inflammatory Agents

Ambulatory Care

hospitalization

pain management

Emergency Service, hospital

hospitals

tomography

pain

Apparently it isn’t necessary to treat patients with mild diverticulitis with antibiotics.

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Objective:
Mild AD can be treated safely and effectively on an outpatient basis without antibiotics.

Summary of Background Data:
In recent years, it has shown no benefit of antibiotics in the treatment of uncomplicated AD in hospitalized patients. Also, outpatient treatment of uncomplicated AD has been shown to be safe and effective.

Methods:
A Prospective, multicentre, open-label, noninferiority, randomized controlled trial, in 15 hospitals of patients consulting the emergency department with symptoms compatible with AD.

The Participants were patients with mild AD diagnosed by Computed Tomography meeting the inclusion criteria were randomly assigned to control arm (ATB-Group): classical treatment (875/125 mg/8 h amoxicillin/clavulanic acid apart from anti-inflammatory and symptomatic treatment) or experimental arm (Non-ATB-Group): experimental treatment (antiinflammatory and symptomatic treatment). Clinical controls were performed at 2, 7, 30, and 90 days.

The primary endpoint was hospital admission. Secondary endpoints included number of emergency department revisits, pain control and emergency surgery in the different arms.

Results:
Four hundred and eighty patients meeting the inclusion criteria were randomly assigned to Non-ATB-Group (n = 242) or ATB-Group (n = 238). Hospitalization rates were: ATB-Group 14/238 (5.8%) and Non-ATB-Group 8/242 (3.3%) [mean difference 2.58%, 95% confidence interval (CI) 6.32 to -1.17], confirming noninferiority margin. Revisits: ATB-Group 16/238 (6.7%) and Non-ATB-Group 17/242 (7%) (mean difference -0.3, 95% CI 4.22 to -4.83). Poor pain control at 2 days follow up: ATB-Group 13/230 (5.7%), Non-ATB-Group 5/221 (2.3%) (mean difference 3.39, 95% CI 6.96 to -0.18).

Conclusions:
Nonantibiotic outpatient treatment of mild AD is safe and effective and is not inferior to current standard treatment.

Trial registration:
ClinicalTrials.gov (NCT02785549); EU Clinical Trials Register (2016-001596-75)

Author/s:

Mora-López, L., Ruiz-Edo, N., Estrada-Ferrer, O., Piñana-Campón, M. L., Labró-Ciurans, M., Escuder-Perez, J., Sales-Mallafré, R., Rebasa-Cladera, P., Navarro-Soto, S., Serra-Aracil, X.

Extended follow-up of local steroid injection for carpal tunnel syndrome: A randomized clinical trial

Bethie Seay — Tue, 26 Oct 2021 05:00:00 +0000

Date Added:

October 26, 2021

Journal/Publication:

JAMA

Publication Date:

October 22, 2021

Issue:

Volume:

Pages:

e2130753

Type:

Clinical Research Results

DOI (1):

10.1001/jamanetworkopen.2021.30753

MeSH

carpal tunnel syndrome

double-blind method

Shoulder

Kaplan-Meier Estimate

Anti-Inflammatory Agents

Carpal tunnel injections with methylprednisolone appear to reduce or delay surgery but symptoms are no different at 5 years than with a placebo injection.

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Importance Local steroid injection is commonly used in treating patients with idiopathic carpal tunnel syndrome, but evidence regarding long-term efficacy is lacking.

Objective To assess the long-term treatment effects of local steroid injection for carpal tunnel syndrome.

Design, Setting, and Participants This exploratory 5-year extended follow-up of a double-blind, placebo-controlled randomized clinical trial was conducted from November 2008 to March 2012 at a university hospital orthopedic department. Participants included patients aged 22 to 69 years with primary idiopathic carpal tunnel syndrome and no prior treatment with local steroid injections. Data were analyzed from May 2018 to August 2018.

Interventions Patients were randomized to injection of 80 mg methylprednisolone, 40 mg methylprednisolone, or saline.

Main Outcomes and Measures The coprimary outcomes were the symptom severity score and rate of subsequent carpal tunnel release surgery on the study hand at 5 years. Secondary outcomes were time from injection to surgical treatment, SF-36 bodily pain score, and score on the 11-item disabilities of the arm, shoulder, and hand scale.

Results A total of 111 participants (mean [SD] age at follow-up, 52.9 [11.6] years; 81 [73.0%] women and 30 [27.0%] men) were randomized, with 37 in the 80 mg methylprednisolone group, 37 in the 40 mg methylprednisolone group, and 37 in the saline placebo group. Complete 5-year follow-up data were obtained from all 111 participants with no dropouts (100% follow-up). At baseline, mean (SD) symptom severity scores were 2.93 (0.85) in the 80 mg methylprednisolone group, 3.13 (0.70) in the 40 mg methylprednisolone group, and 3.18 (0.75) in the placebo group, and at the 5-year follow up, mean (SD) symptom severity scores were 1.51 (0.66) in the 80 mg methylprednisolone group, 1.59 (0.63) in the 40 mg methylprednisolone group, and 1.67 (0.74) in the placebo group. Compared with placebo, there was no significant difference in mean change in symptom severity score from baseline to 5 years for the 80 mg methylprednisolone group (0.14 [95%CI, −0.17 to 0.45]) or the 40 mg methylprednisolone group (0.12 [95%CI, −0.19 to 0.43]). After injection, subsequent surgical treatment on the study hand was performed in 31 participants (83.8%) in the 80 mg methylprednisolone group, 34 participants (91.9%) in the 40 mg methylprednisolone group, and 36 participants (97.3%) in the placebo group; the number of participants who underwent surgical treatment between the 1-year and 5-year follow-ups was 4 participants (10.8%) in the 80 mg methylprednisolone group, 4 participants (10.8%) in the 40 mg methylprednisolone group, and 2 participants (5.4%) in the placebo group. All surgical procedures were conducted while participants and investigators were blinded to type of injection received. The mean (SD) time from injection to surgery was 180 (121) days in the 80 mg methylprednisolone group, 185 (125) days in the 40 mg methylprednisolone group, and 121 (88) days in the placebo group. Kaplan-Meier survival curves showed statistically significant difference in time to surgical treatment (log-rank test: 80 mg methylprednisolone vs placebo, P = .002 ; 40 mg methylprednisolone vs placebo, P = .02; methylprednisolone 80 mg vs 40 mg, P = .37).

Conclusions and Relevance These findings suggest that in idiopathic carpal tunnel syndrome, local methylprednisolone injection resulted in statistically significant reduction in surgery rates and delay in need for surgery.

Trial Registration ClinicalTrials.gov Identifiers: NCT00806871 and NCT02652390

Author/s:

Hofer, M., Ranstam, J., Atroshi, I.

Geographic Tongue

Bethie Seay — Mon, 13 Sep 2021 05:00:00 +0000

Date Added:

September 13, 2021

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1503/cmaj.202855

MeSH

Glossitis, Benign Migratory

A good picture and quick summary about geographic tongue.

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A 37-year-old woman presented to the outpatient ear, nose and throat department with a 1-year history of intermittent burning and changes in appearance of her tongue. The patient had no history of bleeding, pain or concurrent skin or genital lesions, and she had no dermatologic history. A course of clotrimazole and vitamin B supplementation had been ineffective. On examination, she had well-defined annular lesions with central erythema and a raised white serpentine border involving the dorsal anterior two-thirds of her tongue (Figure 1). There was no fissuring. Based on her history, the appearance of her tongue and an otherwise normal physical examination, we diagnosed geographic tongue. We prescribed topical benzydamine, as required, for symptomatic relief of burning. At 6-month follow-up, she was free of symptoms, with patchy tongue changes.

Author/s:

Prasanth, V. J., Singh, A.

Treatment-induced neuropathy of diabetes related to abrupt glycemic control

Bethie Seay — Tue, 20 Jul 2021 05:00:00 +0000

Date Added:

July 20, 2021

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1503/cmaj.202091

MeSH

female

glycated hemoglobin a

diabetes mellitus, type 1

Autonomic nervous system diseases

blood glucose

neuropathy, painful

Peripheral nervous system diseases

pain

Retinal diseases

Humans

Aggressive management of blood glucose levels can sometimes precipitate painful peripheral neuropathy, which is usually temporary but may require treatment.

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KEY POINTS
Rapid correction of glycemic control (i.e., > 2 percentage points of hemoglobin A1c) over 3 months may lead to treatment-induced neuropathy of diabetes.

Symptoms include painful neuropathy, autonomic dysfunction, gastroparesis, early worsening of retinopathy and microalbuminuria.

Women and people with type 1 diabetes are at elevated risk of treatment-induced neuropathy of diabetes.

Management of the condition may include involvement of a dietitian, adjustment of insulin dose and use of medications to improve symptoms such as painful neuropathy, postural hypotension and gastroparesis.

Author/s:

Stainforth-Dubois, M., Mcdonald, E. G.