Acetaminophen poisoning has become the commonest cause of acute liver failure. Newly reported research now suggests that staggered acetaminophen overdose — that is, taking too much of the drug too frequently for pain relief — can be more life-threatening than a single, massive overdose.
Diagnosing excessive acetaminophen (APAP, or paracetamol) ingestion can be a clinical challenge, because patients may not report an overdose of the drug but they feel unwell. The situation may arise when persons with pain repeatedly take a little more APAP than they should, either individually or in combination products, and do so repeatedly over time — the damage builds up with this sort of “staggered overdose.” It is a clinical situation that needs to be recognized and treated rapidly because patients can be at even greater danger than persons taking a single, large overdose in attempted suicide.
An extensive review and analysis of research studies proposes that over-the-counter vitamin D3 is preferred rather than prescribed forms of vitamin D2. Although, an excellent paper offering guidelines for clinicians suggests that either D2 or D3 is acceptable, provided supplementation is sufficient to adequately raise deficient levels of the vitamin.
We have previously written in these UPDATES about naloxone for overdose rescue [eg, 
A new survey of cancer specialists, or oncologists, found that many have relatively little training and knowledge when it comes to assessing and managing their patients’ pain. A number of other barriers also prevent adequate pain care in patients with cancer, and only a minority of oncologists refer these patients to pain specialists.
Two recently reported studies explore the importance of adequate vitamin D for patients undergoing spine surgeries and in those with inflammatory spinal cord disease. Although further research is required to confirm the benefits, vitamin D supplementation in these patients could be an essential component of improved spine health and effective pain management.
Many readers have questioned the latest figure that 116 million American adults suffer from chronic pain, which represents more than a third of the total population. Yet, looking at the original source of this data, the evidence seems generally reliable and, furthermore, the U.S. is not unique in the world — chronic pain seems to be a truly huge problem of global proportions.
Research presented at the recent American College of Rheumatology Annual Scientific Meeting examined whether a shift from nonopioid analgesics toward the use of opioids to treat arthritis pain in senior citizens also incurred an increase in falls and fractures. While, overall, there was a marked increase in the percentage of elderly patients who suffered a fall or fracture, a cause-effect relationship solely implicating opioid analgesics should not be inferred from this sort of research.
Ginger — from the underground stem of the plant Zingiber officinale — has been widely used in traditional medicine for a variety of therapeutic purposes, one of which is relieving pain. Researchers in the UK conducted a systematic review to evaluate evidence from all clinical trials assessing the efficacy of ginger as a sole agent for the treatment of any pain condition. They conclude that, while some results seem promising, there is insufficient evidence to broadly recommend ginger for treating pain and inflammation.
In a newly reported study, using nonsteroidal anti-inflammatory drugs (NSAIDs) during pregnancy more than doubled the odds for a miscarriage. Risks were greatest with diclofenac, and aspirin was not examined; however, the results suggest that all NSAIDs should be used cautiously in women who are or who may become pregnant.
The U.S. Centers for Disease Control and Prevention (CDC) recently launched a new campaign to alert the public about deadly risks of opioid analgesics. While the government’s systematic collection and skillful presentation of data are impressive and overwhelming, this may be tilting away from a balanced perspective in order to incite fears of a so-called “epidemic” of opioid misuse, overdoses, and deaths.
Chronic, nonspecific lower back pain can be a difficult condition to treat and often cannot be managed with analgesics alone. Appropriate exercise has proven beneficial for many patients, and yoga — with an emphasis on both physical and mental aspects of pain relief — may be particularly appealing for some patients. In a recently reported clinical trial, patients with low back pain benefitted from moderately increased functionality as a result of yoga instruction; however, added pain relief was not achieved and there were numerous limitations that weakened this research.
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