More research needed on long-term opioids

This issue covers topics including opioid pain management, malnutrition, and ‘incidentalomas' during imaging.

Long-term use of opioids for noncancer pain continues to be a common problem in medicine, and definitive answers, unfortunately, continue to be scarce, as a National Institutes of Health-sponsored evidence review and position paper published in January in Annals of Internal Medicine found. The most important areas for further research, the Annals papers noted, are in determining which patients will benefit from long-term opioids and which will not, as well as what other pain management strategies can be useful. In the meantime, however, primary care physicians still need to address this issue in practice. Charlotte Huff talks to pain management experts about ways to quantify pain, reduce chances of long-term opioid use, and assess patients' risk for future addiction before medications are prescribed.

Malnutrition, both under- and overnutrition, is not something internists always specifically look for in their patients, in part because of time constraints and gaps in training, experts say. But it's an assessment that's important, since malnutrition can have a deleterious effect on all areas of a patient's overall health. Our story looks at how screening, evaluation, and counseling can be streamlined to fit easily into the clinical encounter and offers advice on determining which patients may be at highest risk for nutrition problems, as well as finding potential solutions.

With more sensitive imaging come more diagnoses, not all of them necessary or helpful. “Incidentalomas,” or imaging findings unrelated to the reason a test was ordered, can cause additional unneeded tests and treatments, not to mention increased patient anxiety. Our story looks at the frequency of incidentalomas, how they differ from overdiagnosis, and how to communicate treatment plans, or a “watch and wait” philosophy, to patients.

This month, ACP published the second edition of the “Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health.” Cultural shifts have occurred since the publication of the first edition in 2007, including legalization of same-sex marriage in many states. However, LGBT patients still face discrimination and have unique health care needs. Primary care physicians can do a lot to improve care by making their practices more inclusive and by building relationships characterized by trust. In a Q&A, authors of the Fenway Guide detail how physicians can create a welcoming environment, why training of all staff is important, and which health issues are most pressing for LGBT patients.

Finally, as always, our staff will be on site in Boston later this month for Internal Medicine Meeting 2015. From April 30 through May 2, check our blog and our Twitter feed, as well as our daily e-mail dispatches, to stay up to date. Let us know what you think of our coverage.


Jennifer Kearney-Strouse