Pain Management, Addiction,
and End‑of‑Life Care
Need CME credit? These articles may be of help in meeting specially designated CME requirements in the areas of pain management, addiction, and end-of-life care. Also available, free CME courses on these topics from NEJM Knowledge + and from the Massachusetts Medical Society.
Pain Management and Addiction
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Bupropion and Naltrexone for Methamphetamine Use
M.H. Trivedi and Others N Engl J Med 2021; 384:140-153
In a randomized trial involving participants with methamphetamine use disorder, the response among those who received bupropion and naltrexone was 11 percentage points higher than that among participants who received placebo. Adverse events included gastrointestinal disorders.
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A Man with Unintentional Opioid Overdose
A.S. Raja and Others N Engl J Med 2017; 377:2181-2188
A 36-year-old man was seen in the emergency department because of opioid overdose. The patient was found unresponsive and cyanotic in a park. Naloxone was administered and his mental status normalized, but hypoxemia persisted. A diagnosis and management decisions were made.
End-of-Life Care
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A Man with Acute Respiratory Failure and Unclear Goals of Care
J.C. Jacobsen and Others N Engl J Med 2020; 382:2450-2457
A 74-year-old man with lymphoma was admitted to the hospital during the Covid-19 pandemic because of rapidly progressive respiratory failure. Several years earlier, when he had been critically ill, he had expressed a desire for “do not resuscitate” status. More recently, he had indicated that he would try all therapies that may be helpful. A consultation was requested.
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Delirium
E.R. Marcantonio N Engl J Med 2017; 377:1456-1466
Delirium, an acute confusional state, is common among hospitalized elders and is associated with poor outcomes. All patients with delirium should be evaluated for reversible causes. Behavioral disturbances should be managed with nonpharmacologic approaches whenever possible.
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