Opioids
Balancing the Risks and Benefits of Opioid Therapy: The Pill and the Pendulum
Over the past 20 years, the medicinal use of opioids has swung back and forth like a pendulum. However, unlike Edgar Allan Poe's classic short story, the likelihood of a last-second rescue seems remote. In the 1990s, a confluence of economic, medical, and governmental factors coalesced into a mutual driver of widespread prescription opioid use for chronic pain.1 The havoc wrought by this shift in prescribing practices ushered in the most devastating addiction crisis in US history. The ramifications of indiscriminate opioid prescribing are ubiquitous across the United States, and the statistics are grim.Evaluation and Treatment of Low Back Pain: A Clinically Focused Review for Primary Care Specialists
Low back pain (LBP) is a leading cause of disability worldwide. In the absence of a classification system for pain syndromes, classification of LBP on the basis of the distribution of pain as axial (pain generally localized to the low back) or radicular neuropathic (pain radiating to the lower extremities) is relevant to clinical practice because the distribution of pain is often a corollary of frequently occurring disease processes involving the lumbar spine. Common sources of axial LBP include the intervertebral disc, facet joint, sacroiliac joint, and paraspinal musculature, whereas common sources of radicular pain include a herniated intervertebral disc and spinal stenosis.
