In the Future:

Back pain, arthritis, neuropathy, metabolic, and cardiovascular pain are predicted through nanotech biosensors and AI digital twin models that simulate stress on the body decades in advance.

Prevention is AI-personalized. Systems prescribe precise exercise, posture correction, stress control, and nutrigenomic diets to minimize inflammation, reduce sodium and processed food, and counteract obesity—one of the strongest amplifiers of hypertension, diabetes, and spinal degeneration.

Therapies are continuously optimized. AI pharmacology engines monitor every molecule, preventing drug conflicts while dynamically adjusting doses for maximum benefit and minimal harm.

The outcome is proactive care. Pain and disease once considered inevitable are intercepted early, turning chronic suffering into largely preventable conditions.

DX --> CONSERVATIVE CARE --> INTEVENTIONAL --> MEDICAL --> SURGICAL TX

Videos on Dx = xray MRI CT Nerve Studies / EMG

Future of Dx | Tx | Dx codes Injection codes

Step 1 – Conversational AI Intake → SOAP Note Draft

AI captures the encounter in dialogue (patient + provider).
AI structures input into SOAP format:
- S (Subjective): “Patient reports constant low back pain radiating into left leg, worsened with sitting, improved slightly with rest. Pain 7/10.”
- O (Objective): “Normal gait, positive straight leg raise left at 45°. MRI shows L4–L5 disc protrusion contacting L5 nerve root.”
- A (Assessment): “Left L5 radiculopathy secondary to disc herniation. No red flags.”
- P (Plan): “Proceed with lumbar epidural steroid injection under fluoroscopic guidance.”

Step 2 – Conversational AI Verification & Clinical Decision Support

AI suggests guideline checks (e.g., conservative care attempted).
Flags contraindications (e.g., anticoagulant use).
Recommends confirming allergies, steroid selection, and dosage.
Provider confirms and finalizes plan inside EMR.

Step 3 – Automatic Coding Suggestions

ICD-10 Codes:
- M54.16 – Radiculopathy, lumbar region (sciatica).
- M51.26 – Other intervertebral disc displacement, lumbar region (if documented).
CPT Codes:
- 62323 – Injection(s), of diagnostic or therapeutic substance(s), including anesthetic, antispasmodic, opioid, steroid, or other solution, not including neurolytic substances, with or without contrast, lumbar or sacral, under imaging guidance.

Step 4 – Documentation to Billing Integration

AI auto-populates note, ICD-10, and CPT into EMR.
Generates procedure note template:
- “Under sterile technique, a 20-gauge Tuohy needle was advanced into the L4–L5 epidural space using fluoroscopic guidance. Contrast confirmed spread. A mixture of 2 mL preservative-free saline and 80 mg Depo-Medrol was injected without complication.”
Billing and compliance team receive finalized coded note.

For Education:

This image AI Generated to help you learn how to make AI more accurate

Lumbar MRI - Normal Bladder | Herniated Discs

Top 30 Pain Conditions with MRI Findings

Top 30 Pain Conditions with MRI

1. Low Back Pain (~70–80% lifetime prevalence)

MRI: Often normal; may show age-related disc bulging, mild facet arthropathy.

2. Headache Disorders

Tension-type (~42% adults), Migraine (~12%).
MRI: Typically normal; may show nonspecific white matter hyperintensities in migraine.

3. Neck Pain (~50% lifetime prevalence)

MRI: Often normal; may reveal degenerative disc disease, uncovertebral/facet changes.

4. Osteoarthritis (knee/hip/spine) (~10–18% adults >60 yrs)

MRI: Joint space narrowing, cartilage loss, subchondral sclerosis/cysts, osteophytes.

5. Degenerative Disc Disease (>40% of adults >40 yrs)

MRI: Disc desiccation (loss of T2 signal), height loss, Modic changes.

6. Fibromyalgia (~2–4% population, women > men)

MRI: Normal. Structural imaging does not detect the condition.

7. Myofascial Pain Syndrome (~30–85% of pain clinic patients)

MRI: Usually normal; occasionally subtle muscle edema on STIR.

8. Radiculopathy (~83/100,000 annually; lumbar > cervical)

MRI: Disc protrusion/extrusion, foraminal stenosis compressing nerve root, possible nerve root edema.

9. Facet Joint Arthropathy (~40% of chronic low back pain cases)

MRI: Facet joint hypertrophy, subchondral sclerosis, joint effusion, cysts.

10. Cervical/Lumbar Disc Herniation (~1–3% annually symptomatic)

MRI: Focal disc protrusion/extrusion, annular tear, nerve root displacement.

11. Sacroiliac Joint Dysfunction (~15–30% of chronic low back pain)

MRI: SI joint sclerosis, joint space narrowing, edema in inflammatory type.

12. Spinal Stenosis (lumbar) (~9% adults >60 yrs)

MRI: Narrow canal, thickened ligamentum flavum, facet hypertrophy, reduced CSF space.

13. Spondylosis (Spinal Osteoarthritis) (>60% adults >50 yrs)

MRI: Osteophytes, disc height loss, facet changes, canal or foraminal narrowing.

14. Spondylolisthesis (~5–7% adults; higher in women)

MRI: Anterior translation of vertebral body, facet degeneration, pars defect if isthmic.

15. Rheumatoid Arthritis (~0.5–1% population)

MRI: Synovial pannus enhancement, joint erosions, cervical instability, odontoid erosion.

16. Chronic Pelvic Pain (non-endometriosis) (~15% women worldwide)

MRI: Often normal; sometimes pelvic floor muscle asymmetry or incidental endometriosis.

17. Endometriosis (pelvic pain) (~10% reproductive-age women)

MRI: Endometriomas (T1 hyperintense, T2 shading), adhesions, thickened uterosacral ligaments.

18. Diabetic Peripheral Neuropathy (~25–50% of long-standing diabetics)

MRI: Typically normal spine; MR neurography may show peripheral nerve T2 hyperintensity.

19. Post-Surgical/Failed Back Surgery Syndrome (~10–40% after spine surgery)

MRI: Scar tissue (enhances with gadolinium), recurrent disc (non-enhancing), post-laminectomy changes.

20. Chronic Postsurgical Pain (non-spine) (~10–50% depending on procedure)

MRI: Usually normal unless structural complication (neuroma, fibrosis).

21. Whiplash-Associated Disorders (~300/100,000 annually)

MRI: Often normal; occasionally soft tissue/ligament edema.

22. Osteoporosis (vertebral compression fractures) (~16% women, 5% men lifetime)

MRI: Vertebral height loss, marrow edema (acute fracture), chronic wedge deformity.

23. Vertebral Compression Fractures (symptomatic) (~750,000 annually US)

MRI: Acute fractures show STIR hyperintensity; chronic appear with cortical collapse.

24. Neuropathic Pain (general) (~7–10% population)

MRI: Usually normal unless secondary cause (disc, tumor, MS plaques).

25. Postherpetic Neuralgia (~10–20% of zoster cases)

MRI: Normal spine; trigeminal or DRG may show signal change in severe cases.

26. Complex Regional Pain Syndrome (CRPS) (~26/100,000 annually)

MRI: Often normal; may show patchy bone marrow edema or soft tissue changes.

27. Spinal Tumors/Metastases (~70% of cancer patients develop spine mets)

MRI: Focal marrow-replacing lesions (T1 dark, T2 bright), cord compression possible.

28. Cancer-Related Pain (general) (~30–50% of all patients; 70–90% advanced)

MRI: Depends on location (mets, fractures, nerve compression).

29. Infectious Spondylodiscitis (~4–24/100,000 annually)

MRI: Disc T2 hyperintensity, endplate irregularity, paraspinal/epidural enhancement.

30. Ankylosing Spondylitis (~0.1–0.5% population)

MRI: SI joint erosions, bone marrow edema (STIR), syndesmophytes, bamboo spine in advanced cases.

✅ Key Pattern

Most common pain: low back, headache, neck, OA, disc degeneration.
MRI normal: fibromyalgia, myofascial pain, many headache disorders, CRPS, neuropathic pain without structural cause.
MRI abnormal: disc disease, stenosis, fracture, infection, tumor, arthritis.

Osteoporosis Risk Factors

🦴 Osteoporosis Risk Factors

🔄 Modifiable (can be improved or managed)

Dietary intake → calcium, vitamin D, protein, magnesium, vitamin K, etc.
BMI/weight → low BMI (<20) = ↑ risk; maintain healthy 20–25
Physical activity → weight-bearing & resistance training ↑ BMD
Smoking → accelerates bone loss
Alcohol → heavy intake impairs bone remodeling
Medications → long-term glucocorticoids, PPIs, aromatase inhibitors
Falls risk → vision, balance, home hazards, sarcopenia, etc.
Chronic diseases → diabetes, thyroid disorders, malabsorption, hypogonadism

🔒 Non-modifiable (cannot be changed)

Age → risk ↑ with aging (esp. >50 in women, >65 in men)
Sex → women at higher risk (post-menopause, lower baseline bone mass)
Genetics/family history → parental hip fracture strongly predictive
Ethnicity → Caucasian and Asian populations generally higher risk
Body frame size → small, thin frames = less bone reserve
Past fractures → strongest predictor of future fractures

✅ Takeaway:

You can’t change age, sex, genetics, or body frame.
You can change nutrition, BMI, exercise, smoking/alcohol, and fall prevention strategies — these make up the core of prevention and management.

🩺 Patient Instructions ON BENDING LIFTING

English

Use a lumbar brace during work that involves bending or lifting.
Avoid heavy lifting when possible; ask for help with loads over 20–25 lbs.
Bend at the knees, not the waist; keep the back straight when lifting.
Take frequent breaks to stretch your back and legs.
Apply ice or heat as needed for pain relief.
Continue any prescribed exercises or physical therapy.
Report worsening pain, numbness, or weakness to your doctor immediately.

Español

Use un cinturón lumbar durante el trabajo que implique agacharse o levantar objetos.
Evite levantar objetos pesados cuando sea posible; pida ayuda con cargas de más de 9–11 kg.
Doble las rodillas, no la cintura; mantenga la espalda recta al levantar.
Tome descansos frecuentes para estirar la espalda y las piernas.
Aplique hielo o calor según sea necesario para aliviar el dolor.
Continúe con los ejercicios o la fisioterapia indicada.
Informe de inmediato a su médico si el dolor empeora, o si siente adormecimiento o debilidad.

Liver Failure & Pain Management

Here are four solid, clinically relevant studies tying ascites in cirrhosis to pain/symptom burden and showing symptom (incl. pain/discomfort) relief with effective drainage:

Liver Transplantation (Wong et al., 2020) — “Improvement in Quality of Life and Decrease in Large-Volume Paracentesis After Alfapump Implantation”
Results: In 30 cirrhotic patients with recurrent ascites, alfapump markedly reduced paracentesis needs and significantly improved QoL (Ascites Questionnaire + CLDQ), which include abdominal discomfort/pain domains.
URL: https://journals.lww.com/lt/fulltext/2020/05000/improvement_in_quality_of_life_and_decrease_in.9.aspx Lippincott Journals+1
United European Gastroenterology Journal (Mazumder et al., 2024) — “The physiological determinants of symptom burden in cirrhosis with ascites”
Results: Symptom burden (including abdominal discomfort/pain) correlates with ascites pressure/volume; paracentesis is commonly used to relieve discomfort.
URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC11578835/ PMC
Alimentary Pharmacology & Therapeutics (Macken et al., 2020) — “Randomised clinical trial: palliative long-term abdominal drains vs large-volume paracentesis in refractory ascites due to cirrhosis (REDUCe)”
Results: Feasibility RCT showed high symptom burden measured by IPOS and EQ-5D (includes pain/discomfort), with LTADs reducing hospital time and costs; qualitative data reported improved symptom control.
URL: https://www.bsms.ac.uk/_pdf/ctu/reduce-results-paper.pdf Brighton and Sussex Medical School
Hepatology (Campbell et al., 2005) — “Quality of Life in Refractory Ascites: Transjugular Intrahepatic Portosystemic Shunt (TIPS)”
Results: In refractory ascites, TIPS improved health-related QoL scores, including bodily pain domains, supporting that effective ascites control eases pain/discomfort.
URL: https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.20840

Liver Failure & Pain Medication +

⚠️ Note: This is educational only — dosing in liver failure is highly individualized and should be verified against the latest hepatology/pain guidelines.

1. Acetaminophen (Non-Opioid Analgesic)

Acetaminophen (Tylenol) → Max 2 g/day (avoid chronic high-dose; safe in low dose with monitoring).

2. NSAIDs (Avoid in Cirrhosis/Ascites/Varices)

(generally contraindicated due to GI bleed, renal injury, and sodium retention risk)

Ibuprofen → Avoid in decompensated liver disease.
Naproxen → Avoid.
Diclofenac → Avoid.
Ketorolac → Avoid.

3. Weak Opioids

Tramadol → 25–50 mg PO q8–12h (reduce dose/interval; risk of encephalopathy).
Codeine → Avoid (variable metabolism, risk of accumulation).

4. Strong Opioids

(Use with caution; start low, go slow, prefer short-acting forms)

Morphine → 2.5 mg PO/SC q4–6h (avoid if severe encephalopathy/renal issues).
Hydromorphone → 0.5–1 mg PO/SC q4–6h (preferred over morphine; less active metabolites).
Fentanyl (short-acting, IV/transdermal) → No active metabolites; safe option but start very low.
Oxycodone → 2.5 mg PO q6h (reduce dose; impaired clearance in cirrhosis).
Methadone → Specialist use only; prolonged half-life, requires careful titration.

5. Adjuvant Analgesics – Neuropathic Pain

Gabapentin → 100 mg PO qHS (increase slowly; renally cleared, safe in liver).
Pregabalin → 25–50 mg PO qHS (renal dosing; safe in liver).
Duloxetine (SNRI) → Avoid in severe hepatic impairment.
Amitriptyline (TCA) → 5–10 mg PO qHS (use caution; risk of sedation and encephalopathy).

6. Topical Agents

Lidocaine 5% patch/gel → Apply up to 12h/day; minimal systemic absorption.
Capsaicin cream/patch → Apply locally; safe, no hepatic metabolism concerns.

✅ Summary Principles in Liver Failure:

Prefer acetaminophen (≤2 g/day) over NSAIDs.
Use short-acting opioids at low doses; avoid codeine and meperidine.
Favor adjuvants like gabapentin/pregabalin for neuropathic components.
Topicals are very safe and useful.

Coccyx Pain

🔹 OTC Topicals

1. Lidocaine 4% (cream/patch)

Dose: Apply cream up to 3–4×/day; patch ≤ 12 hrs/24 hrs.
Best for: Localized, sharp/stabbing coccyx pain.

2. Diclofenac 1% gel

Dose: 2–4 g up to 4×/day (upper vs lower body).
Best for: Inflammatory pain.

3. Capsaicin 0.025–0.1%

Dose: Thin layer 3–4×/day; takes 1–2 weeks for full benefit.
Best for: Chronic, neuropathic pain.

4. Menthol/methyl salicylate rubs

Dose: Apply 3–4×/day.
Best for: Quick cooling/warming distraction.

5. Camphor 4–11%

Dose: Rub in 3–4×/day.
Best for: Mild aches, soothing effect.

🔹 Physical Treatments

1. Cushions (donut or wedge pillow)

Relieves direct coccyx pressure when sitting.

2. Heat or Ice Therapy

Ice: 15–20 min, 3–4×/day in first 48 hrs for acute flare.
Heat: After 48 hrs, apply warm compress or heating pad 20 min, 3×/day for muscle relaxation.

3. Posture Modification

Sit leaning slightly forward, weight on thighs instead of coccyx.
Avoid hard chairs.

4. Gentle Stretching

Pelvic tilts, child’s pose, and piriformis stretches 1–2×/day can ease tension.

5. Core/Glute Strengthening

Exercises like bridges, bird-dogs, planks help stabilize pelvis and reduce coccyx strain.

6. Manual Therapy (if persistent)

Physical therapy, massage, or pelvic floor therapy may address muscle imbalance.

Herbals/Natural Remedies for Pain and Anxiety

1. Natural Remedies for Pain

Ginger (Zingiber officinale)
Systematic review of 8 RCTs (n ≈ 400+)
Dose: 500–2,000 mg/day powdered or capsule form; some trials used divided doses 2–3x/day
Duration: 3–12 weeks (OA and dysmenorrhea), acute doses post-exercise
Result: Reduced menstrual pain by ~25–30% vs placebo; improved OA pain scores
Ref: https://academic.oup.com/painmedicine/article/12/12/1808/1846834

Topical herbal agents (essential oils, ointments)
Multiple herbs (menthol, arnica, camphor, capsaicin) studied
Dose: Applied to affected area 1–3x daily
Duration: Ranged from days (acute pain) to 6–8 weeks (chronic OA pain)
Result: Consistent localized pain relief; fewer systemic effects than oral meds
Ref: https://pmc.ncbi.nlm.nih.gov/articles/PMC9785912

Boswellia (Frankincense)
Clinical studies (n ≈ 545 across pooled trials)
Dose: 100–250 mg extract, 2–3x/day (standardized to 30–40% boswellic acids)
Duration: 4–12 weeks
Result: Improved joint pain and stiffness, better function vs placebo
Ref: https://www.healthline.com/health/pain-relief/surprising-natural-pain-killers

Curcumin / Turmeric
RCTs & meta-analyses (n > 700 total)
Dose: 1,000–1,500 mg/day curcuminoids; often with piperine for absorption; bioavailable forms effective at 500 mg BID
Duration: 4–8 weeks
Result: Pain & stiffness reductions comparable to ibuprofen or paracetamol
Ref: https://journals.lww.com/ebp/fulltext/2020/03000/does_curcumin_reduce_pain_in_patients_with_knee.14.aspx

Palmitoylethanolamide (PEA)
Meta-analysis of 10 studies (n = 786 treatment, 512 controls)
Dose: 300–1,200 mg/day orally; capsules often 300 mg taken 2–3x/day
Duration: 3–12 weeks
Result: Significant reductions in neuropathic and sciatic pain intensity
Ref: https://en.wikipedia.org/wiki/Palmitoylethanolamide

TENS (Transcutaneous Electrical Nerve Stimulation)
Meta-analyses and RCTs
Dose: Not a drug—device settings vary. Common protocol: 20–60 minutes/session, 1–2x daily
Duration: From days (post-op) to months (chronic pain trials)
Result: Reduced pain in knee OA, low back pain, neuropathy; benefits depend on intensity/frequency settings
Ref: https://en.wikipedia.org/wiki/Transcutaneous_electrical_nerve_stimulation

2. Natural Remedies for Anxiety / PTSD

Yoga for PTSD
Systematic review, 2024 (n ≈ 500 across included trials)
Dose: Classes 1–3x/week, ~60 minutes each
Duration: ≥8 weeks, some programs up to 12–16 weeks
Result: Reduced PTSD and depression scores; improved emotional regulation
Ref: https://www.sciencedirect.com/science/article/pii/S0165178124003834

Mind-body therapies (meditation, relaxation, mindfulness)
RCTs & reviews (n > 1,000 across pooled data)
Dose: Practices 20–45 minutes/session, often daily or several times per week
Duration: 6–12 weeks, sometimes longer
Result: Reduced PTSD severity, anxiety, improved sleep and affect regulation
Ref: https://pmc.ncbi.nlm.nih.gov/articles/PMC6508087

Herbal / dietary supplements (e.g. lavender, kava, passionflower)
Systematic review, 2022
Dose: Varies by herb (e.g. lavender 80–160 mg/day, kava 120–300 mg/day, passionflower ~260 mg extract daily)
Duration: 4–12 weeks
Result: Some herbs showed significant anxiolytic benefit vs placebo; mixed evidence for others
Ref: https://www.sciencedirect.com/science/article/abs/pii/S1043661822001499

Yoga + Complementary/Integrative health for PTSD
VA systematic review (7+ trials, n ≈ 400)
Dose: Yoga or integrative therapy 1–2x/week; 60–90 min sessions
Duration: 8–12 weeks
Result: Improved PTSD symptoms and quality of life vs usual care
Ref: https://www.ptsd.va.gov/professional/treat/txessentials/complementary_alternative_for_ptsd.asp

Real-time fMRI Neurofeedback (experimental)
Controlled trial, veterans with combat PTSD (n=31; 20 active, 11 control)
Dose: 3 sessions of neurofeedback training, ~30–45 min each
Duration: Short-term (weeks)
Result: Significant reduction in CAPS (PTSD) scores, esp. hyperarousal & avoidance symptoms
Ref: https://arxiv.org/abs/1801.09165

🌸 Menstrual Cramp Relief – Rx | Natural | Physical Meds | CBD/Terpenes

🌸 Menstrual Cramp Relief – Research-Backed Options

NSAIDs (ibuprofen, naproxen, mefenamic acid) = Start 12–24h before period; inhibit prostaglandins; most effective first-line.

Heat therapy = Heating pad/heat patch; pain relief comparable to NSAIDs in some studies.

Exercise = Regular activity (≥8 weeks); reduces severity and improves long-term outcomes.

TENS (transcutaneous electrical nerve stimulation) = Can reduce pain intensity; moderate evidence.

Hormonal birth control (OCPs, patch, ring, implant, injection) = Suppress ovulation + lower prostaglandins; continuous regimens more effective than cyclic; side effects may include irregular bleeding, nausea, headache.

Levonorgestrel IUD (Mirena, Liletta, Kyleena, etc.) = Strong evidence for reducing cramps and heavy bleeding; effective long-term option.

Magnesium = 300–500 mg/day; lowers cramp severity, also helps PMS mood/bloating.

Vitamin B1 (Thiamine) = 100 mg/day; RCT showed >80% pain relief after 3 months.

Ginger = 750–2000 mg/day (divided doses during first 3 days of menses); as effective as NSAIDs in some trials.

Vitamin E = 400 IU/day (start 2 days before period → day 3); reduces pain & bleeding.

Omega-3 fatty acids (EPA + DHA) = 1000–2000 mg/day; anti-inflammatory, reduces prostaglandin activity.

Zinc = 30–50 mg/day elemental; decreases severity/duration of cramps; may regulate cycles.

Cannabinoids (CBD, THC) & Menstrual Pain

1. CBD Isolate (Oral)

A small open-label, randomized trial (2024) asked participants to take CBD softgels (either 160 mg or 320 mg twice daily) for five days during periods across three months. Compared to baseline, participants reported reductions in menstrual-related symptoms (MRS), irritability, anxiety, stress, and overall severity.
Limitations: No placebo control. Further research needed. PubMed

2. High-CBD Vaginal Suppositories

A quasi-experimental study evaluated a 100 mg hemp-derived, broad-spectrum CBD suppository used PRN over two menstrual cycles. Those using CBD reported significant improvements in symptom frequency and severity, daily functioning, and reduced need for pain meds compared to controls—notably, the suppository seemed more effective for congestive (dull, achy) symptoms than spasmodic cramps. Nature

3. Survey and Observational Reports

Surveys and cohort studies highlight that many individuals with PMS, endometriosis, or dysmenorrhea report using cannabis for relief—citing improvements in pain, mood, sleep, and reduced use of conventional analgesics. Nature PMC
However, robust clinical trial data remains lacking. PMC ACOG

4. Clinical Guidelines

A 2024 ACOG guidance (American College of Obstetricians and Gynecologists) notes some improvement in dysmenorrhea and dyspareunia from cannabis-related products, but emphasizes the need for medical supervision due to limited evidence and concerns about potential side effects. ACOG

Terpenes (Cannabis-Derived Aromatic Compounds)

Preclinical and limited clinical evidence suggests terpenes—like myrcene, β-caryophyllene (BCP), linalool, and pinene—have analgesic, anti-inflammatory, and anxiolytic effects. However, direct trials for menstrual cramps are still absent. MDPI PMC ScienceDirect
Popular culture sources and cannabis-focused platforms note:
- Linalool, pinene, BCP, and myrcene are commonly cited as potentially helpful in menstrual relief. The Cannigma Leafwell cannabisaccessclinics.co.uk
- Some strains labeled as helpful include Type I (THC-dominant) or Type II (balanced THC:CBD), especially with terpene profiles rich in linalool, pinene, or BCP. The Cannigma Veriheal
- These anecdotal suggestions remain speculative and are not backed by rigorous clinical data. The Cannigma Veriheal

Other Endocannabinoid-Related Therapies

Palmitoylethanolamide (PEA), an endocannabinoid-like dietary supplement, combined with antioxidants like polydatin or alpha-lipoic acid, showed promising results:
- In an RCT involving young individuals (16–24 years old) with primary dysmenorrhea, PEA-polydatin (400 mg + 40 mg) taken daily for 10 days around menstruation led to significant pain reduction compared to placebo. ACOG
- Additional cohort studies in endometriosis or chronic pelvic pain found >70% of patients reported symptom improvement with PEA-based supplements, though most lacked control groups. ACOG

White Coat Syndrome ...

Evidence & Typical Range

Transient rise: Most studies show systolic blood pressure (SBP) increases by ~10–30 mmHg and diastolic blood pressure (DBP) by ~5–15 mmHg during acute anxiety, stress testing, or panic attacks.
White coat hypertension: Patients with clinical anxiety in medical settings often show SBP increases of 10–40 mmHg compared to home values.
Mechanism: Anxiety → ↑ sympathetic outflow → ↑ heart rate, cardiac output, and vasoconstriction → acute BP elevation.

Important Notes

These increases are temporary; anxiety does not cause sustained hypertension, but in people with existing hypertension, repeated spikes may worsen vascular risk.
Chronic anxiety can contribute indirectly to hypertension through poor sleep, alcohol, and reduced exercise.

PAIN DX

Board-Style Pain Diagnosis (Q + A same line)

Low back pain most commonly originates from which spinal structure? Intervertebral disc
Positive straight leg raise suggests what diagnosis? Lumbar radiculopathy (sciatica)
Most common level for lumbar disc herniation? L4–L5 or L5–S1
Facet joint pain often worsens with what motion? Extension
Radiculopathy from L5 nerve root causes weakness in what movement? Great toe dorsiflexion
Pain from sacroiliac joint often radiates to where? Buttock
Rheumatoid arthritis most commonly affects which cervical joint? Atlantoaxial (C1–C2)
Bamboo spine appearance is diagnostic for what? Ankylosing spondylitis
Complex Regional Pain Syndrome hallmark symptom? Disproportionate pain
Myofascial pain syndrome hallmark finding? Trigger points
Fibromyalgia diagnostic criterion involves how many tender points? 11 of 18
Most common cause of chronic low back pain in adults? Degenerative disc disease
Vertebral compression fractures are most often caused by what? Osteoporosis
Cancer pain most commonly due to what mechanism? Bone metastases
Postherpetic neuralgia follows infection by what virus? Varicella zoster
Pain improved with leaning forward suggests what spinal condition? Lumbar spinal stenosis
In Whiplash, which structure is commonly injured? Cervical soft tissues/ligaments
Pain out of proportion with allodynia suggests what? CRPS (Complex Regional Pain Syndrome)
Saddle anesthesia suggests what urgent diagnosis? Cauda equina syndrome
Knee osteoarthritis pain is worse with what activity? Weight bearing
Radiculopathy from S1 root affects what reflex? Ankle jerk reflex
Which cancer most often metastasizes to the spine? Breast
Burning foot pain in diabetes is due to what? Peripheral neuropathy
First-line imaging for suspected vertebral fracture? X-ray
Diffuse, widespread musculoskeletal pain lasting >3 months suggests what? Fibromyalgia
Psoriatic arthritis pain commonly involves what joints? Sacroiliac and peripheral joints
Gout most often begins in what joint? First metatarsophalangeal
Polymyalgia rheumatica presents with pain in what regions? Shoulders and hips
Shoulder pain worsened by overhead activity suggests what? Rotator cuff pathology
Median nerve compression at the wrist causes what syndrome? Carpal tunnel syndrome
Pain radiating down posterior leg to foot indicates which nerve root? S1
Night pain relieved by NSAIDs suggests what tumor? Osteoid osteoma
Chronic pelvic pain in women often due to what? Endometriosis
Temporal headache with jaw claudication suggests what? Giant cell arteritis
First-line treatment for fibromyalgia pain? Exercise and education
Which MRI sequence best detects vertebral metastases? T1-weighted
Vertebral hemangioma is usually what type of lesion? Benign
Pain relief when supine, worsened by standing = what? Spinal stenosis
Trigeminal neuralgia pain is classically described as what? Electric shock-like
Which vitamin deficiency may cause neuropathic pain? Vitamin B12
What systemic disease strongly predisposes to neuropathic pain? Diabetes mellitus
Phantom limb pain is what type of pain? Neuropathic
Which imaging is best for detecting disc herniation? MRI
Chronic widespread pain with fatigue and poor sleep? Fibromyalgia
Pain worse with sitting, better with standing suggests what? Discogenic pain
Pain radiating from SI joint down posterior thigh stops where? Above the knee
Chronic pancreatitis causes pain in what region? Epigastric with radiation to back
Which diagnosis involves both pain and abnormal sweating? CRPS
Vertebral compression fracture acute pain best seen on what MRI sequence? STIR
Which diagnosis often shows Modic endplate changes on MRI? Degenerative disc disease

Disclaimer: Information provided is for reference only and does not imply affiliation or endorsement with the mentioned individuals, companies, products, services, treatments, and websites. For informational purposes only - contact your medical provider for health and medical advice. Content accuracy, completeness, and timeliness are not guaranteed. Inclusion of information and websites does not constitute endorsement. Users should exercise caution when accessing external content. See your medical, legal, finance, tax, spiritual and other professionals for discussion, guidance, planning, recommendations and greater understanding of the risks, benefits, options and ability to apply any information to your situation.

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