The Journal of the American Board of Family Practice / American Board of Family Practice
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J Am Board Fam Pract · May 1996
CommentChronic opioids for chronic low back pain--solution or problem?
The article by Brown et al does not provide data to justify long-term opioid use but does suggest a treatment option for the many patients who have chronic back pain and who want the help that our medical delivery system often does not provide. Having worked in a tertiary referral pain clinic that serves many low back pain patients who have demonstrated the ineffectiveness of chronic opiate therapy, I am strongly ambivalent about recommending prescribing ongoing opioiod therapy for chronic pain patients. The caveats about prescribing opioids for such patients are most appropriate (i.e., do not prescribe opioids for those who have a history of problems with opioid therapy or for whom increased intake is associated with decreased function); however, for patients who do not display these problems (and there could be many out there), I am sympathetic with the sentiments expressed by Brown et al. ⋯ If pain complaints are reduced and if function is improved according to the record (eg, patient is working) and the relatives' report, and if you, the prescribing physician, are happy, then a long-term regimen of opioid therapy is probably fine. Further controlled trials are needed to see whether this therapy works, and if so, what are the optimal agent(s) and dosages, what is optimal monitoring, and most important of all, who is the optimal patient who might derive not only analgesia but also functional benefit rather than compromise from this therapy. If we cannot make patients better, we must not make them worse.
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J Am Board Fam Pract · Nov 1995
Patients' attitudes about gifts to physicians from pharmaceutical companies.
Little is known about patients' awareness of and attitudes about gifts to physicians from pharmaceutical companies. ⋯ Respondents distinguished between particular gifts; approval rates were high for gifts generally considered to be trivial or that have potential value to patient care; disapproval rates were relatively high for gifts that have some monetary value but have little or no benefit for patients. Opinions about gifts were related to perceptions of their effects on prescribing behavior and costs.
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J Am Board Fam Pract · Nov 1995
Comparative StudyPerinatal outcomes: a comparison between family physicians and obstetricians.
This retrospective study compared obstetrician and family physician patient population demographics, obstetric outcomes, delivery methods, and medical risk factors. ⋯ These findings support the high-quality outcomes of perinatal care provided by family physicians. They also provide evidence for training and privileging family physicians to perform their own Cesarean sections.