- N Engl J Med 2022; 386:1732-1740
Nonspecific low back pain is diagnosed by ruling out other causes, usually by means of history taking and physical examination; imaging is not routinely indicated. Patients with acute nonspecific low back pain should receive education about the condition and advice to remain active; most recover within weeks. Exercise therapy and...
- N Engl J Med 2022; 386:1742-1749
An 82-year-old woman presented to the emergency department with a 3-week history of severe low back pain, rigors, anorexia, difficulty ambulating, and a sensation of incomplete urination. She had no numbness, tingling, weakness, saddle anesthesia, or fecal incontinence.
- N Engl J Med 2022; 386:611-613
Patients who have taken opioids for years for chronic pain must be treated differently from those who have not because such therapies cause profound physiological and neurologic changes. Reflexive approaches to tapering or discontinuing opioids should be avoided.
- N Engl J Med 2021; 385:1640-1641
“Everything hurts,” the elderly woman reports through the Tigrinya interpreter. When the physician begins examining her back for the source of the pain, the patient responds to her touch with delight, and the two begin forging a deep and mutually therapeutic bond.
- N Engl J Med 2021; 385:1448-1449
The promise of the “good death” was one of the outcomes that had inspired the physician to pursue a career in palliative care. But not all patients’ stories play out according to this script, and we need to admit that for some patients, death can be difficult to tame.
- N Engl J Med 2021; 385:342-351
This analysis of 2016 and 2017 claims data for disabled Medicare beneficiaries compared filled opioid prescriptions between Black and White patients treated within the same health systems. The mean annual opioid dose was 36% lower among Black patients than White patients. In 75% of the 310 health systems studied, the...
- N Engl J Med 2021; 384:97-99
Over the objections of numerous members of Congress, state attorneys general, and families of people killed by opioid products, the company was permitted to resolve all federal criminal and civil charges and its owners, members of the Sackler family, were permitted to settle all federal civil claims against them.
- N Engl J Med 2020; 383:1866-1876
The trigeminal nerve and its projections to the intracranial vasculature — the trigeminovascular system — are at the nexus of migraine. Identification of the mechanisms that trigger signals in this system have led to targeted treatments and preventive therapies for migraine.
- N Engl J Med 2020; 383:1657-1662
Sensory ganglionopathy is characterized by sensory loss without weakness. A common pathophysiological mechanism is autoimmunity. This review focuses on acquired sensory ganglionopathies, most commonly seen in patients with an autoimmune disease or a paraneoplastic disorder.
- N Engl J Med 2020; 383:e68
The onus of advocacy for suffering Black patients has been placed almost solely on this country’s disproportionately few Black clinicians — an unsustainable situation, particularly since they are already shouldering the effects of systemic racism on their own lives.
- N Engl J Med 2020; 383:754-762
Trigeminal neuralgia is manifested by severe, paroxysmal facial pain. The classical type involves compression of the trigeminal nerve root. Sodium-channel blockers are the first-choice treatment; if they are unsuccessful, vascular decompression or ablative procedures may be used.
- N Engl J Med 2019; 381:2067-2069
A forward genetic screen using the worm Caenorhabditis elegans implicated the G protein–coupled receptor 139 in suppressing signaling by the mu opioid receptor. Further experiments in mouse models suggest that antagonizing this receptor could enhance the analgesic efficacy of medicinal opioids.
- N Engl J Med 2019; 381:680-682
To improve opioid prescribing after surgery, the Michigan Surgical Quality Collaborative developed evidence-based prescribing guidelines for nine operations. After introduction of the guidelines, prescription size decreased from 26 to 18 pills, with no clinically important changes in pain scores.
- N Engl J Med 2019; 381:132-141
In a trial of galcanezumab, an antibody to calcitonin gene–related peptide, for the treatment of cluster headache, a subcutaneous dose reduced the mean weekly frequency of cluster attacks from 17.8 to 9.1, as compared with 17.3 to 12.1 in the placebo group. Injection-site reactions occurred in 8% of the patients...
- N Engl J Med 2019; 381:142-149
Treatment with the oral calcitonin gene–related peptide receptor antagonist rimegepant resulted in freedom from migraine pain 2 hours after the dose in 20% of patients; 12% of the patients who received placebo were pain-free. Freedom from the most bothersome migraine symptom aside from pain 2 hours after the dose was...
- N Engl J Med 2019; 380:2440-2448
Narcotic treatment of pain can lead to addiction, dependence, and tolerance, underscoring the need for alternative treatments. The roles of NSAIDs, antidepressants, antiepileptic drugs, local agents, and complementary therapies are summarized in this review.
- N Engl J Med 2019; 380:2285-2287
The CDC’s 2016 Guideline for Prescribing Opioids for Chronic Pain has largely been embraced by the medical and health policy communities. Unfortunately, some policies and practices purportedly derived from the guideline have been inconsistent with its recommendations.
Preying on Prescribers (and Their Patients) — Pharmaceutical Marketing, Iatrogenic Epidemics, and the Sackler LegacyN Engl J Med 2019; 380:1785-1787
Though the Sackler family did not invent the practice of selling drugs to physicians, they were pioneers whose story illustrates the ways marketers developed, naturalized, and monetized the interface between the pharmaceutical industry and prescribing physicians.
- N Engl J Med 2019; 380:701-704
When he gets tangled in new restrictive policies on opioid prescribing, a factory worker with severe rheumatoid arthritis, whose pain must be managed for him to perform his job, ends up buying oxycodone from a friend.
- N Engl J Med 2019; 380:365-378
This review describes the indications for opioid therapy in patients in the intensive care unit, mechanisms of opioid tolerance, and current and potential mitigation strategies for opioid tolerance.