Primary care
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Chronic pain is a common presenting problem in primary care offices. Primary pain disorders and chronic pain secondary to another underlying medical problem can significantly impact a patient's function and quality of life. ⋯ Through thorough patient interview, physical examination, diagnostics, and standardized assessment tools, primary care clinicians can create a robust care plan for patients with chronic pain. Given the multifaceted nature of chronic pain, it is a diagnosis that fits into chronic disease model of care managed appropriately in the primary care setting.
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Chronic pain interventions in the primary care setting can provide temporal relief and are best used as part of a comprehensive treatment plan. Interventional therapies may use steroids, local anesthetic, saline, prolotherapy, no medication at all (dry needling), acupuncture, or transcutaneous electrical nerve stimulation. These interventions may include adjuvant modalities, such as ultrasound, to improve precision and accuracy of injection. Choice of interventional therapy for chronic pain in the primary care setting is highly dependent on the clinician, location, and cause of the pain as well as a multitude of patient factors, which are discussed in this article.
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The management of diabetes in clinical practice has many challenges: quickly interpreting a large volume of self-monitoring of blood glucose data, ensuring safe and accurate titration of basal insulin, managing patients on insulin pump therapy, and synthesizing glycemic data into actionable reports to improve patient outcomes. Technological advancements are emerging as a solution to some of these challenges. This article reviews mobile applications for insulin dosing, continuous glucose monitoring, insulin pump therapy, and smart insulin pens available for patients with type 1 and type 2 diabetes.