By Dr. Meghan M. Kiefer MD, Dr. Curtis R. Chong MD PhD MPhil
Help your medical determination making and get ready for daily demanding situations within the fundamental care surroundings with Pocket basic Care, a new, pocket-sized loose-leaf source that gives the most up-tp-date, evidence-based techniques to offering caliber care within the outpatient setting.
Representing the efforts of a committed staff of basic care and expert physicians on the Massachusetts normal health facility, this functional source presents the major scientific facts you want to deal with your sufferers successfully and quick.
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Morphine, opium) • Efficacy: For chronic, nonmalignant pain, opioids no better than other analgesics in↓pain, & somewhat worse at↑functioning; however, in some individuals can safely→long-term pain relief (Cochrane Database Syst Rev 2010;1:CD006605) • Side effects: Nausea, constipation, somnolence,↑fall risk in elderly, hyperalgesia (paradoxical↓in pain tolerance), hypogonadism, medication misuse, addiction (Ann Intern Med 2007;146:116; AFP 2012;85:49) • Misuse: 5% of US adults have used opioid Rx either for nonmedical reasons, in excessive dose, or via unauthorized routes; pts who misuse opiates more likely to have panic d/o or social phobia, report fair/poor health (Drug Alcohol Depend 2008;94:38); Risk factors: Personal or FHx substance use, younger, men, Ψ hx • Overdose: Prescription opioids most common cause of drug O/D, involved in 75% of fatal O/Ds; most O/Ds unintentional; highest rates in middle-aged men • Treatment disparities: Evidence that nonwhite pts may receive↓analgesics,↓pain specialist referrals, & have↓PCP trust even when similar rates of opioid misuse/illicit drug use (Pain 2013;154:36; JGIM 2011;26:846) Evaluation • Should a trial of chronic opiates be initiated?
Smart, MD, DMD Chief Resident, Oral & Maxillofacial Surgery, Massachusetts General Hospital (Jaw & Dental Pain) Arthur J. Sober, MD Attending Physician, Department of Dermatology, Massachusetts General Hospital; Professor of Dermatology, Harvard Medical School (Melanoma) Jacob Soumerai, MD Internal Medicine Resident, Massachusetts General Hospital (Lymphadenopathy & Splenic Disorders) MGH ’14 Kyle D. Staller, MD Gastroenterology Fellow, Massachusetts General Hospital (Constipation, Irritable Bowel Syndrome) MGH ’12 Nikolaos Stathatos, MD Attending Physician, Thyroid Unit, Massachusetts General Hospital; Instructor in Medicine, Harvard Medical School (Adrenal Nodules, Thyroid Disorders) Ada Stefanescu, MD, CM Cardiology Fellow, Massachusetts General Hospital (Cardiology Section Co36 Editor, Sports and Exercise Clearance) MGH ’13 Theodore A.
Shah, MD Internal Medicine Resident, Massachusetts General Hospital (Bites & Infestations, Knee Pain) MGH ’14 Meghan Shea, MD Attending Physician, Department of Medicine, Massachusetts General Hospital; Instructor in Medicine, Harvard Medical School (Polycythemia, Bleeding Disorders) MGH ’13 Stephanie V. Sherman, MD Internal Medicine Resident, Massachusetts General Hospital (Anemia) MGH ’14 Derri Shtasel, MD, MPH Attending Physician, Department of Psychiatry, Massachusetts General Hospital; Michele and Howard J.
