Physical medicine and rehabilitation clinics of North America
-
Injuries to the hip and pelvis among runners can be among the most challenging to treat. Advances in the understanding of running biomechanics as it pertains to the lumbopelvic and hip regions have improved the management of these conditions. Conservative management with an emphasis on activity modification and neuromuscular exercises should comprise the initial plan of care, with injection therapies used in a supportive manner.
-
Phys Med Rehabil Clin N Am · Aug 2015
ReviewGuideline for Prescribing Opioids to Treat Pain in Injured Workers.
Recently, there has been a dramatic increase in the use of opioids to treat chronic noncancer pain. Opioids are also being prescribed in stronger potencies and larger doses for musculoskeletal injuries. ⋯ The risk of dependence and addiction is much more common than previously thought. This guideline provides recommendations for prudent opioid prescribing and addresses issues critical to the care and rehabilitation of injured workers.
-
Phys Med Rehabil Clin N Am · Aug 2015
ReviewWork-Related Complex Regional Pain Syndrome: Diagnosis and Treatment.
Complex regional pain syndrome can be a debilitating disorder, which, in its earliest stages, can be prevented by aggressive rehabilitation based on reactivation. It is critical to follow international criteria on making the diagnosis; overdiagnosis can lead to inappropriate interventions and further disability. ⋯ This article presents a phased approach to treatment that suggests movements of nonresponders quickly to more integrated levels of care. Some commonly used invasive interventions, such as sympathectomy and spinal cord stimulation, have not been proved effective; these unproven and potentially harmful therapies should be avoided.
-
Opioids remain the strongest and most effective analgesics available. The downside is that they are addictive and potentially dangerous. Throughout history, although recognizing the value of opioids in treating serious pain, especially acute pain and pain at the end of life, there has been caution about using opioids to treat chronic pain. This article presents how opioids should be used to treat chronic pain considering recent concerns about their efficacy and safety.
-
Phys Med Rehabil Clin N Am · May 2015
ReviewCentral hypersensitivity in chronic musculoskeletal pain.
Clinical research has consistently detected alteration in central pain processing leading to hypersensitivity. Most methods used in humans are reliable and have face validity to detect widespread central hypersensitivity. However, construct validity is difficult to investigate due to lack of gold standards. ⋯ Research on pain biomarkers that reflect specific central hypersensitivity processes is warranted. Few studies have analyzed the prognostic value of central hypersensitivity. Most medications acting at central level and some non-pharmacological approaches, including psychological interventions, are likely to attenuate central hypersensitivity.