Advertisement

Advertisement

treatment

Understanding Myofascial Pain Syndrome: Causes, Diagnosis, and Treatment

Teaser: 

Eugene K. Wai MD, MSc, CIP, FRCSC, 1 Ted Findlay, DO, CCFP, FCFP,2

1Associate Professor, Division of Orthopaedic Surgery, Cross Appointment to School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON.
2Clinical Associate Professor, Program Director, Family Medicine Chronic Pain Enhanced Skills R3, Department of Family Medicine, University of Calgary, Calgary, AB.

CLINICAL TOOLS

Abstract: Myofascial Pain Syndrome (MPS) is a chronic pain disorder characterized by localized pain originating from myofascial trigger points (MTrPs) within the skeletal muscle of the spine and should be included in the differential diagnosis for non-surgical back pain. The etiology of MPS is multifactorial, involving trauma, repetitive strain, and postural dysfunction, leading to the formation of hyperirritable nodules that cause both local and referred pain. Diagnosis is primarily clinical, relying on the identification of MTrPs through physical examination. Treatment approaches include pharmacological interventions, manual therapies, and needling techniques. Evidence for long-term efficacy remains limited. Future research is essential to establish reliable diagnostic criteria and effective treatment modalities for MPS.
Key Words: Myofascial pain syndrome, trigger points, diagnosis, treatment, chronic pain, musculoskeletal disorders, manual therapy, pharmacological interventions.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
1. Myofascial Pain Syndrome (MPS) is characterized by the presence of hyperirritable nodules, or myofascial trigger points, within taut bands of skeletal muscle, leading to localized and referred pain.
2. MPS can be caused by factors such as trauma, repetitive strain, poor posture, and muscle deconditioning, with theories suggesting muscle fiber energy crises or neurogenic inflammation as the main contributors.
3. The diagnosis of MPS is primarily clinical, relying on physical examination including palpable nodules, local twitch responses, and reproduction of the patient’s pain with trigger point palpation. There are no standard imaging or lab tests.
4. Treatment includes a combination of exercise, manual therapy, pharmacological interventions, trigger point injections and dry needling. Dry needling has shown the most promise.
5. There is no established Clinical Practice Guideline for MPS, and high-quality evidence supporting the long- term efficacy of current treatments is lacking. Further research into pathophysiology and treatment strategies is needed.
1. Trigger points are active or latent—active points cause spontaneous pain and limit muscle function, while latent points are asymptomatic until palpated.
2. MPS involves localized pain and trigger points; fibromyalgia presents with widespread pain and central sensitization. Conditions may coexist but require different management strategies.
3. A multimodal approach, combining dry needling with other physical therapies, yields better outcomes compared to single-modality treatments.
4. Opioids have limited evidence of efficacy and the potential to delay recovery. Use non-opioid and non-invasive interventions.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, Myofascial Pain Syndrome, Trigger Points, diagnosis, treatment, chronic pain, Musculoskeletal Disorders, Manual Therapy, pharmacological interventions

Key and Current Issues in the Management of Insomnia

Teaser: 

Louis T. van Zyl, MD, M.Med.,1 Colin Shapiro, B.Sc. (Hon.), MB, BCh, PhD,2 Dora Zalai, MD, PhD,3

1Professor of Psychiatry (Emeritus), Queen's University, Canada. 2Professor of Psychiatry and Ophthalmology (Emeritus) University of Toronto, Canada Director of the Youthdale Child & Adolescent Sleep Clinic and International Sleep Clinic Parry Sound Toronto, Canada. 3Clinical Psychologist, Sleep on the Bay, Toronto, Canada.

CLINICAL TOOLS

Abstract: There is increasing appreciation of the relevance of sleep to general well-being, especially for those with medical—including psychiatric—illnesses. This growing recognition of the relevance of sleep is reflected in the DSM-V guidelines. We endeavor to present a nuanced understanding and usage of sedative hypnotic medications in the management of insomnia. New medications that reduce wakefulness is also mapped out in this overview. In addition, we briefly discuss the intervention of cognitive behavior therapy for insomnia (CBT-I) as the mainstay of treatment for chronic insomnia.
Key Words: sleep disorders, insomnia, management, treatment.
Insomnia is a sleep disorder in its own right. It is no longer regarded as just a symptom. It calls for specific, targeted insomnia treatment, especially in situations where insomnia is comorbid with medical conditions.
Cognitive behavioural therapy for insomnia (CBT-I) produces moderate to large effects on insomnia measures when insomnia is comorbid with chronic medical conditions. It is the mainstay of treatment in most cases of chronic insomnia.
The use of hypnotics should be planned strategically. In general, short term hypnotic use should be the objective, but for many patients long term use may be necessary and appropriate.
The initial dose of sedative-hypnotics should be determined on an individual basis and titrated in accordance with the patients' needs. While too high dose is not desirable, too low a dose would result in under-treatment and is counter-productive.
Insomnia may become a chronic disorder and as such may necessitate long-term management. Prescribe carefully-chosen hypnotics for the requisite period and re-evaluate patients in follow up. Consider CBI-I as a treatment option, independently or in conjunction with pharmacotherapy.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Mental Health, sleep disorders, insomnia, management, treatment
Disclaimer: 
Disclaimer at the end of each page

Diabetes Complications: Erectile Dysfunction

Teaser: 

Dean Elterman, MD, MSc, FRCSC,

Associate Professor, Division of Urology, University Health Network, University of Toronto, Toronto, ON.

CLINICAL TOOLS

A clear relationship, with shared risk factors, exists between diabetes, ED and CVD.
Use of ED as a harbinger of CVD is most predictive in younger men (ED may precede CVD by 2-5 yrs, 3 avg).
The identification of ED may allow for risk reduction and preventative measures in large numbers of men.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Diabetes-Endocrine Disorders, diabetes, diabetic management, treatment, erectile dysfunction
Disclaimer: 
Disclaimer at the end of each page

Diabetes Complications: Diabetic Nephropathy

Teaser: 

Louis-Philippe Girard, MD, MBT, FRCSC,

Clinical Nephrologist, Associate Professor, University of Calgary, Calgary, AB.

CLINICAL TOOLS

The hallmark of Diabetic Nephropathy is albuminuria. Albuminuria is a marker of poor renal and CV prognosis and should be identified in all patients where CKD is suspected.
Organ protection should be a priority in patients with DN. Very solid evidence exists for the SGTL2i class as it pertains to renal protection. Patients with DN are at very high risk of CV disease and its complications. There are robust data demonstrating CV protection when SGLT2i and GLP-1RAs are used in patients with DKD.
A1C control remains a critical component of preventing the progression of DN and can now be achieved in a safe manner with newer agents that do not cause hypoglycemia.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Diabetes-Endocrine Disorders, diabetes, diabetic management, treatment, nephropathy
Disclaimer: 
Disclaimer at the end of each page

Diabetes Complications: Diabetic Neuropathy

Teaser: 

Aaron Izenberg, MD, FRCSC,

Neurologist, Sunnybrook Health Sciences Centre, Assistant Professor, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Neuropathy is a very common complication of diabetes with sensorimotor neuropathy being the most common subtype of diabetic neuropathy
Other types of diabetic neuropathies include autonomic, treatment-induced, diabetic lumbosacral radiculoplexus, and mononeuropathies
Diagnostic testing for sensorimotor neuropathy includes bedside testing (e.g., Monofilament) and electrodiagnostic methods
Treatment of sensorimotor diabetic neuropathy includes achieving good glycemic control and appropriate use of pain medications
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Diabetes-Endocrine Disorders, diabetes, neuropathy, diabetic management, treatment
Sign inBuy ArticleSubscribe
Disclaimer: 
Disclaimer at the end of each page

Diabetes Complications: Diabetic Retinopathy

Teaser: 

Carol Schwartz, MD, FRCSC, DABO,

Assistant Professor, University of Toronto, Ophthalmologist, Sunnybrook Health Sciences Centre, Toronto, ON.

CLINICAL TOOLS

Appropriate screening
Good systemic control of blood sugar, hypertension, dyslipidemia and renal function
Timely treatment involving intra-vitreal anti-VEGF injections, laser photocoagulation when appropriate and surgical intervention when necessary
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Diabetes-Endocrine Disorders, diabetes, diabetic retinopathy, diabetic management, treatment
Sign inBuy ArticleSubscribe
Disclaimer: 
Disclaimer at the end of each page

A Practical Guide to Managing Low Back Pain in the Primary Care Setting: Imaging, Diagnostic Interventions and Treatment—Part 2

Teaser: 

Conner Joseph Clay1, José M. Orenday-Barraza, MD2, María José Cavagnaro MD2, Leah Hillier MD CCFP (SEM)3, Leeann Qubain1, Eric John Crawford MD MSc(c) FRCSC4, Brandon Hirsch MD5, Ali A. Baaj MD2, Robert A. Ravinsky MDCM MPH FRCSC5

1 University of Arizona College of Medicine – Phoenix, Phoenix, AZ.
2Department of Neurosurgery, University of Arizona College of Medicine – Phoenix, Phoenix, AZ.
3Department of Family Medicine & Community Medicine, Banner University Medical Center Phoenix, University of Arizona College of Medicine – Phoenix, Phoenix, AZ.
4Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
5Department of Orthopaedic Surgery, University of Arizona College of Medicine – Phoenix, Phoenix, AZ.

CLINICAL TOOLS

Abstract: Low back pain (LBP) is one of the most common presenting complaints in the primary care setting with significant economic implications and impairment of quality of life. Effective treatment of LBP can frequently be delivered in the primary care setting. Knowledge of common pain generators and recognition of pain patterns based on the history and physical exam helps guide the treatment of LBP without the need for excessive resource utilization. The majority of patients presenting with LBP can be confidently managed with targeted conservative management; when this fails further investigation may be warranted. Part 2 of this review focuses on imaging and diagnosis of LBP, as well as a detailed review of treatment modalities.
Key Words: low back pain, imaging, diagnostic interventions, treatment.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
Patients presenting with lumbar-related complaints, in the absence of red flags or neurological deficits, can safely undergo a course of conservative treatment prior to ordering imaging studies.
Nonsurgical treatment modalities that can be attempted in patients with LBP include oral medications, topical medications, passive modalities, active physical therapy and cognitive interventions.
Diagnostic interventions such as selective nerve root blocks, diagnostic facet joint injections, medial branch blocks and provocative discography can be useful in confirming that a particular anatomical structure is a clinically relevant pain generator.
Surgery, in the absence of red flags or neurological deficits, should only be considered after the patient fails a thorough course of conservative treatment.
Images of the spine are not necessary to initiate management of mechanical low back pain; they may even be counterproductive.
When required, initial radiological evaluation of the lumbar spine involves upright plain radiographs. Further investigation may include use of MRI or CT myelography.
Diagnostic interventions can aid in establishing the dominant pain-generating anatomical structure but are not required if the patient is improving as anticipated.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, low back pain, imaging, diagnostic, intervention, treatment
Sign inBuy ArticleSubscribe

An Evidence-Based Approach to the Neck Assessment

Teaser: 

Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH1 Pierre Côté, DC, PhD2 Dr. Hamilton Hall, MD, FRCSC3

1is a Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor. 2Professor and Canada Research Chair in Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT); Director, UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC). 3 is a Professor in the Department of Surgery at the University of Toronto. He is the Medical Director, CBI Health Group and Executive Director of the Canadian Spine Society in Toronto, Ontario.

CLINICAL TOOLS

Abstract:Neck pain is a common musculoskeletal condition that frequently resolves spontaneously or with conservative treatment and only occasionally requires surgical intervention. The purpose of the neck examination is to determine if the etiology is neurological or mechanical pain, which determines treatment planning, and then to rule out red flags. There is good evidence that on examination clinicians cannot reliably differentiate specific anatomical structures but they should still perform a focused clinical examination to locate typical pain on movement and establish the neurological status. Base treatment on exercise, activity management and pain control.
Key Words: neck, examination, treatment, differential diagnosis.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
If your patient is presenting with symptoms of systemic disease, deteriorating neurological status or focal severe pain, initiate further investigations and or referral.
Once red flags have been ruled out, neck pain will fall into two categories: neurological or mechanical pain.
Range of Motion testing should be done in 3 specific planes; flexion-extension, lateral flexion and rotation. Moving the neck in circles does not provide useful clinical information.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, neck, examination, treatment, differential diagnosis
Sign inBuy ArticleSubscribe
Disclaimer: 
Disclaimer at the end of each page

Goal-setting in the Office: Tips for Success

Teaser: 

Dr. Marina Abdel Malak

is a Family Medicine Resident at the University of Toronto. She graduated and completed her Bachelor of Science in Nursing and went on to study Medicine. She has a passion for medical education, patient empowerment, and increasing awareness about the relationship between mental, emotional, and physical health.

CLINICAL TOOLS

Abstract:Empowering patients to set health-directed goals can be a challenging process. The skilled clinician successfully supports patients in setting goals that are SMART (specific, measurable, achievable, realistic/relevant, and time-related). When goals are made in collaboration with patients, they are more likely to be long-lasting and impactful. This article will focus on how physicians can work with patients to identify, create, and work towards meaningful interventions that optimize health.
Key Words: motivation, behaviour changes, counselling, goals, treatment.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
Goal-setting should be a partnership between physicians and patients
Asking patients what THEY want—and can—change in their lives/health is the first step to eliciting what behaviours can be targeted
After goals are set, it is important for physicians to reassess patients' progress by asking them if goals were met, and why or why not. When success occurs, patients should be congratulated on their achievements. If the goals were not met, physicians should seek to understand why this occurred, and work with patients to create new goals that are more realistic or achievable
Physicians should motivate patients to set goals that are SMART (specific, measurable, achievable, realistic/relevant, and time-related)
Patients are more likely to adhere to behaviours, habits, or interventions if they feel understood, supported, and empowered
Supporting patients in achieving goals that optimize health can have significant impacts on patient wellness, self-esteem, functioning; and strengthens the physician-patient relationship
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Caregiving, motivation, behaviour change, counselling, treatment
Sign inBuy ArticleSubscribe
Disclaimer: 
Disclaimer at the end of each page

Unknown Origins of Syncope

Teaser: 

Dr. M.S. Alam, MD, MBBS, CCFP, FCFP

Clinical Lecturer, Cumming School of Medicine, Calgary, University of Calgary, Family Medicine Department, Calgary, AB.

CLINICAL TOOLS

Abstract: Syncope is generally categorized by such known causes as vasovagal syncope, situational syncope, postural syncope, neurologic syncope, postural-orthostatic tachycardia syndrome, and unknown causes. The unknown causes of syncope can be challenging to diagnose and treat since possible causes can range from benign to life-threatening. This article will focus on unknown cases with no evident cause.
Key Words: syncope, unknown causes, diagnosis, treatment.
Incidents of syncope with unknown origin can be challenging to diagnose and treat since possible causes can range from benign to life-threatening.
One of the challenges associated with diagnosing and treating syncope is the plethora of possible causes.
Concrete guidelines for syncope risk assessment would prove to be an invaluable tool in urgent and emergent care environments as well as in family medicine clinics. A standardized approach to syncope cases with unknown origin will improve patient care immeasurably.
No matter whether an incident involving syncope is benign or potentially high risk, any injury sustained should be addressed according to ATLS, ACLS, and PALS guidelines.
The ability to flag patients who are at high risk for morbidity and mortality, judicial use of diagnostic tools.
In 50 % of patients, the cause of a syncope incident will not be evident; a risk stratification (scoring) system ranging from low to intermediate to high would be beneficial.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Cardio-Cerebrovascular, syncope, diagnosis, treatment, unknown causes
Sign inBuy ArticleSubscribe
Disclaimer: 
Disclaimer at the end of each page