Current rheumatology reports
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Chronic widespread pain (CWP) is very prevalent in the general population (5%-10%) and is characterized by pain in all four body quadrants, the neck, and back. CWP differs from localized pain not only in its distribution but also in the way it affects lives. Multiple pain sites are associated with higher pain intensity, longer pain duration, and greater disability. ⋯ FM has been found in 2% to 4% of community subjects and represents the extreme of CWP. This article compares pain characteristics, quality of life, consequences for daily living, and psychosocial status between FM patients and individuals with CWP. Available evidence shows that FM is associated with more severe symptoms and consequences for daily life and higher pain-severity compared with CWP.
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Patients with systemic lupus erythematosus (SLE) have a significantly increased risk of atherosclerotic coronary events. Traditional risk factors, such as hypertension and hypercholesterolemia, only partly account for the increased risk of coronary disease in SLE. Other important risk factors include disease and treatment-related factors. ⋯ Among these, scintigraphic myocardial perfusion defects have been shown to be predictive of subsequent coronary events, independent of traditional Framingham risk factors. Although the aggressive treatment of reversible risk factors, such as lipids and blood pressure, is advocated by many, no published studies have yet demonstrated a clear reduction in risk of coronary events with this approach. Elucidation of risk factors and preventive strategies for accelerated atherosclerosis in SLE is the subject of ongoing research.
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Calcifying tendonitis of the shoulder is a common, acute or chronic, painful disorder characterized by calcifications in the rotator cuff tendons. A natural cycle exists during which the tendon repairs itself. ⋯ Surgery is recommended when conservative treatment fails. This article discusses advances in imaging and medical, physical, and surgical management, as well as current evidence for the treatment of calcifying tendonitis of the shoulder.
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As life expectancy increases every decade, the incidence and prevalence of osteoarthritis (OA) also will increase. Despite progress in our knowledge of the pathophysiology of OA, the management of OA-mediated pain continues to challenge physicians. Concern regarding the cardiovascular effects of cyclooxygenase-2 inhibitors and the gastrointestinal and renal side effects of nonsteroidal anti-inflammatory drugs (NSAIDs) in general has limited the use of these medications in the management of chronic non-cancer pain. ⋯ When used as part of a multimodal approach to pain control, opioids are a safe and effective treatment for joint pain, including that of OA. Patients for whom NSAIDs are contraindicated, or for whom combined acetaminophen, tramadol, and NSAID therapy is ineffective, may be started on low-dose opioids and titrated as needed and tolerated. Patient education and informed consent, exercise, complementary medicine, and the use of a controlled substance agreement increases the likelihood of patient compliance with treatment guidelines, improving functional capacity and quality of life.
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Review
Effectiveness of transcutaneous electrical nerve stimulation for treatment of hyperalgesia and pain.
Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacologic treatment for pain relief. TENS has been used to treat a variety of painful conditions. This review updates the basic and clinical science regarding the use of TENS that has been published in the past 3 years (ie, 2005-2008). ⋯ This review also highlights data from recent randomized, placebo-controlled trials and current systematic reviews. Clinical trials suggest that adequate dosing, particularly intensity, is critical to obtaining pain relief with TENS. Thus, evidence continues to emerge from both basic science and clinical trials supporting the use of TENS for the treatment of a variety of painful conditions while identifying strategies to increase TENS effectiveness.