Geographic Variation of Chronic Opioid Use in Fibromyalgia

Geographic Variation in Use of Vestibular Testing among Medicare Beneficiaries.

Objective There is a lack of consensus regarding the indications for vestibular testing in the evaluation of dizziness and balance disorders. Geographic variation in health services utilization is associated with lack of consensus. To understand the variation in current practice, we investigated the patterns of use of vestibular testing and diagnosis codes for dizziness and balance disorders am...

Geographic variation in the appropriate use of cesarean delivery.

There is enormous geographic variation in the use of cesarean delivery: For births over 2,500 grams, adjusted cesarean rates vary fourfold between low- and high-use areas. Even for births under 2,500 grams, high-use counties have rates that are double those of low-use ones. Higher cesarean rates are only partially explained by patient characteristics but are greatly influenced by nonmedical fac...

Cerebrospinal fluid levels of opioid peptides in fibromyalgia and chronic low back pain

BACKGROUND The mechanism(s) of nociceptive dysfunction and potential roles of opioid neurotransmitters are unresolved in the chronic pain syndromes of fibromyalgia and chronic low back pain. METHODS History and physical examinations, tender point examinations, and questionnaires were used to identify 14 fibromyalgia, 10 chronic low back pain and 6 normal control subjects. Lumbar punctures wer...

Rational Use of Opioid Analgesics in Chronic Musculoskeletal Pain

Throughout history, various forms of morphine have been the most effective medications in relieving pain. Opioid analgesics—the natural, semisynthetic, and synthetic derivatives of morphine—are used routinely in the management of acute musculoskeletal pain. However, myths and misunderstandings about these drugs often prevent primary care physicians from prescribing them for chronic pain, such a...

Principles of opioid use in chronic noncancer pain.