Jul 062014
 
Related Articles

Acute and Chronic Low Back Pain.

Med Clin North Am. 2014 Jul;98(4):777-789

Authors: Patrick N, Emanski E, Knaub MA

Abstract
Low back pain is an extremely common presenting complaint that occurs in upward of 80% of persons. Treatment of an acute episode of back pain includes relative rest, activity modification, nonsteroidal anti-inflammatories, and physical therapy. Patient education is also imperative, as these patients are at risk for further future episodes of back pain. Chronic back pain (>6 months' duration) develops in a small percentage of patients. Clinicians' ability to diagnose the exact pathologic source of these symptoms is severely limited, making a cure unlikely. Treatment of these patients should be supportive, the goal being to improve pain and function.

PMID: 24994051 [PubMed - as supplied by publisher]

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Apr 252014
 
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Medically Unexplained Symptoms.

Med Clin North Am. 2014 May;98(3):663-672

Authors: Isaac ML, Paauw DS

Abstract
Medically unexplained symptoms (MUS) are common in the primary care setting and lead to high medical resource use. Diagnostic criteria for somatic symptom disorder focus on the psychological impact of symptoms. Patients with MUS may present with a myriad of symptoms, with pain being the most common, and several named disorders with specific symptoms are included under the broad heading of MUS. Treatment of MUS is challenging, and cognitive behavior therapy is the best studied and validated specific treatment modality. In the primary care setting, a specific 6-step approach can help clinicians provide the best care for patients.

PMID: 24758967 [PubMed - as supplied by publisher]

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Apr 252014
 
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Evaluation and Treatment of Chronic Cough.

Med Clin North Am. 2014 May;98(3):391-403

Authors: Terasaki G, Paauw DS

Abstract
Chronic cough is a common and frustrating problem for patients and health care providers that can result in a range of physical and psychological complications including exhaustion, urinary incontinence, vomiting, depression, and social isolation. A step-wise empiric approach to treatment will increase the likelihood of a successful resolution of the cough. Even with current treatment protocols, a subset of patients will continue to have chronic cough without a diagnosis. As understanding of the pathophysiology of chronic cough evolves particularly around the concept of cough reflex hypersensitivity, future research should lead to new diagnostic and therapeutic modalities for this challenging problem.

PMID: 24758953 [PubMed - as supplied by publisher]

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Apr 252014
 
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Low Back Pain.

Med Clin North Am. 2014 May;98(3):405-428

Authors: Golob AL, Wipf JE

Abstract
Low back pain is one of the most frequent complaints for which patients are seen in primary care. Low back pain has a substantial economic impact, estimated at $100 billion per year including direct and indirect costs. The evaluation of low back pain involves a thorough history and physical examination. Imaging is only indicated when a more serious underlying cause or neurologic abnormality is suspected. Abnormalities detected on imaging do not strongly correlate with symptoms. Generally, a specific underlying cause for low back pain is not identified. Treatment consists of a multidisciplinary approach with goal to maintain function and minimize disability.

PMID: 24758954 [PubMed - as supplied by publisher]

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Apr 252014
 
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Involuntary Weight Loss.

Med Clin North Am. 2014 May;98(3):625-643

Authors: Wong CJ

Abstract
Involuntary weight loss, defined as 5% or greater weight loss occurring within 6 to 12 months, may have a prevalence as high as 7% in the adult population. In case series, malignant, gastrointestinal, and psychiatric conditions were common, although unidentified causes were still prevalent after evaluation. Patients without malignancy are more likely to have normal physical examination, and normal laboratory and imaging studies. Treatment is directed at identifying and treating the causative illness. This article reviews the syndrome of involuntary weight loss and its diagnostic etiologies, and provides an approach to the treatment of patients presenting with this condition.

PMID: 24758965 [PubMed - as supplied by publisher]

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Apr 252014
 
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Diagnosing and Treating Dizziness.

Med Clin North Am. 2014 May;98(3):583-596

Authors: Molnar A, McGee S

Abstract
Dizziness is a common presenting concern in primary care practice. The most useful diagnostic approach in distinguishing different types of dizziness is a thorough history and physical examination; additional tests are rarely necessary. Effective treatments exist for many causes of dizziness, and these treatments are often accomplished in the clinic or at home without the need for medication.

PMID: 24758962 [PubMed - as supplied by publisher]

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