Diabetic Peripheral Neuropathy – Rueppel

Acute reversible neuropathy - associated with hyperglycemia and rapid correction of hyperglycemia.  Ex: DKA.  Improvement is ~50% chance, and can take up to a year to resolve. Pathophysiology:  involves deposition of sorbitol?   Chronic persistent neuropathy: Systemic polyneuropathy:  classic stocking-glove neuropathy; reduced or lost sensation on monofilament testing; burning or tingling. Autonomic neuropathy:  smooth muscle;… Continue reading Diabetic Peripheral Neuropathy – Rueppel

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Differentiating Conversion vs Factitious vs Malingering Disorders – Hughes

Difficulty is that these cannot be differentiated by self-report only; the clinician HAS to investigate other sources of information. CONVERSION Symptoms or deficits affecting voluntary motor or sensory functioning Actually very rare Commonly recurs (25% in the first year) Risk factors:  maladaptive personality traits (borderline, histrionic traits), history of childhood abuse/neglect, stressful life events may… Continue reading Differentiating Conversion vs Factitious vs Malingering Disorders – Hughes

Chronic Low Back Pain: What does and does not work (according to current evidence)

DOES WORK: Keeping moving Physical therapy or manipulation therapies Acupuncture, tai chi (clinician should emphasize possible benefits - likely enhances the placebo effect!) NSAIDs - lowest effective dose for shortest period - 1st line pharmacotherapy Can try APAP in those with NSAID contraindications, but unlikely to help Duloxetine (other SNRIs may work, but evidence lacking)… Continue reading Chronic Low Back Pain: What does and does not work (according to current evidence)

Total Knee Arthroplasty Superior to Non-Surgical Treatment for Pain from Knee Osteoarthritis

n = 100, Danish study; mod-to-sev knee OA eligible for unilateral TKA Randomized to TKA followed by 12 wks non-surg tx vs non-surg tx alone (exercise, education, weight loss advice, insoles, APAP/NSAIDs). Intent-to-treat analysis TKA pts had greater improvement in pain, function and QOL, but also more adverse events (3 had DVT) and need for… Continue reading Total Knee Arthroplasty Superior to Non-Surgical Treatment for Pain from Knee Osteoarthritis