Darryl E. Barnes

Obesity and general pain in patients utilizing family medicine: should pain standards call for referral of obese patients to weight management programs?

Background Accredited medical care organizations are expected to assess pain levels in their patients. Appropriate responses to high pain levels have not been specified. Design This study was a retrospective analysis of information abstracted from medical records of 673 adult patients utilizing family medicine. Pain was measured using a scale ranging from 0 to 10. Scores of 7 and above were judged to represent high levels of pain. Multiple logistic regression was used to test the relationship between body mass index (BMI) and general pain, after adjustment for co-morbidity, physical limitations, and demographic characteristics. Results Multiple logistic regression analysis revealed that, in comparison with patients with normal body mass, patients with BMI greater than 35 had higher odds of experiencing pain scored 7 or over after adjusting for physical limitations, co-morbidity, age, and gender (adjusted odds ratio [AOR] = 1.89, P = .03). Odds ratios also were significant for subjects with any (vs none) physical limitations (AOR = 1.91, P = .01) and for men relative to women (AOR = 0.65, P = .04). co-morbidity, common diagnoses, and moderate BMI scores were not independently related to high pain levels. Conclusions In our sample of patients utilizing family medicine, BMI greater than 35 is a risk factor for elevated pain scores. This relationship appears to be independent of orthopedic consequences of obesity. Referral to weight management programs might be useful as a quality indicator for obese adults reporting high levels of general pain.

Sonographic Visualization of Thenar Motor Branch of the Median Nerve: A Cadaveric Validation Study

The thenar motor branch (TMB) of the median nerve may be affected in carpal tunnel syndrome and can be injured during carpal tunnel surgery. Although ultrasound has been used to identify small nerves throughout the body, the sonographic evaluation of the TMB has not been investigated formally.

General Pain and Frequency of Medical Visits in Family Medicine: A Retrospective Analysis of Medical Records

BackgroundPain assessment and control have received increasing attention as a quality issue in medicine. However, pain has rarely been addressed as a cost-containment issue.MethodsWe performed a single-center retrospective analysis of information abstracted from the medical records of 1445 adult patients who were treated in family medicine clinics and referred to specialists in Rochester, Minnesota, USA. Patients were categorized into frequent utilizers of physician visits and others, with those having more than eight medical visits in the previous 6 months being classified as frequent users. General pain was self-assessed using a 10-point scale. Multiple logistic regression analysis was used to test the relationship between pain and the frequency of visits, after adjustment for co-morbidities, body mass index (BMI), and demographic characteristics.ResultsFindings revealed that patients with pain scores ≥7 had higher odds of being frequent visitors after adjusting for co-morbidity, BMI, age, marital status, and gender (adjusted odds ratio [AOR] = 1.60; 95% CI 1.12, 2.28; p < 0.01). AORs for being a frequent user were significantly greater for patients with ‘moderate’ Charlson co-morbidity scores (AOR = 2.83; 95% CI 2.03, 3.95; p < 0.01) than for those with no co-morbid diseases. They were also lower for men than for women (AOR = 0.71; 95% CI 0.54, 0.94; p = 0.02), but higher for unmarried persons than for married persons (AOR = 1.72; 95% CI 1.28, 2.32; p < 0.01).ConclusionsSevere pain is associated with being a more frequent user of medical services.

Poster 186 Sonographic Visualization of the Thenar Motor Branch of the Median Nerve: A Cadaveric Validation Study.

Case/Program Description: Thirty-one-year-old woman with chronic right lateral elbow pain for three years was referred to our hospital for surgical treatment after previous standard conservative managements and extracorporeal shock-wave therapy (ESWT) had failed. Tenderness was prominent over the right lateral epicondyle and the pain was aggravated by resisted wrist extension. Laboratory findings were normal. Plain x-ray and T2-weighted fat-suppressed magnetic resonance imaging (MRI) showed the curvilinear calcification around lateral epicondyle of elbow. Numeric rating scale (NRS) was 7 and Roles-Maudsley score (RMS) “poor” grade. The patient received USguided barbotage and additional 3 sessions of ESWT (0.15 mJ/mm, 600 shocks, weekly). Setting: Tertiary care hospital. Results: After US-guided barbotage combined ESWT, pain and tenderness started to dramatically decrease. Two months after, additional three sessions of ESWT were given to reduce residual pain (NRS 3). At 8 months and 12 months follow-up, pain scores were NRS 1 and NRS 0, and RMSs were good and excellent, respectively. Calcific deposits nearly disappeared on X-ray at 8 months follow-up. Discussion: This is the first reported case, to our knowledge, of chronic intractable calcific tendinitis of the common extensor tendon which was successfully treated with US-guided barbotage combined with ESWT. Conclusions: US-guided barbotage combined with ESWT may be a good non-surgical therapeutic option for managements of chronic intractable calcific tendinitis of the common extensor tendon. Level of Evidence: Level V

Physical limitations and perceived quality of care among family medicine patients

Objective: To assess how physical limitations relate to patient satisfaction with the quality of medical care among family medicine patients, after adjustment for self-rated overall health and other patient characteristics. Design: A telephone survey of family medicine patients, linked with information extracted from medical records. Setting: A large family medicine department in Rochester, Minnesota. Subjects: Patient ratings of quality were linked to medical records for 674 adult patients. Results: Adjusting for self-rated overall health status and other confounders using multiple logistic regression analysis revealed that having physical limitations was inversely and independently related to excellent perceived quality (adjusted odds ratio = 0.56, P= 0.035). Conclusions: In our sample of family medicine patients, people with physical limitations experience a disparity in perceived quality of care.

Limited stair-climbing ability and weight control in family medicine patients.

Objective: To assess the association between self-assessed stair-climbing limitation and weight control among family medicine patients, after adjustment for age, gender, marital status, body mass index (BMI), and co-morbidity. Methods: This study was a retrospective analysis of a cohort of 840 adult family medicine patient records drawn from a large family medicine department in Rochester, Minnesota. Weight control was measured as no change or decline in BMI over approximately 1 year. Results: Adjusting for co-morbidity and other confounders using multiple logistic regression analysis revealed that limited stair-climbing ability was unrelated to weight control over approximately 1 year. Instead, patients with BMI ≥ 30 were more likely to control their weight (p<0.01), and age exhibited a non-linear relationship with weight control. The odds of weight control were lower for patients between the ages of 36 and 45 years than for those aged 18—35 years (p<0.01). Conclusions: In our sample of family medicine patients, self-assessed stair-climbing limitations did not preclude weight control. Weight gain prevention programmes might be targeted at patients who are entering middle age.