Volume 105, Issue 2

Ketorolac tromethamine injected intramuscularly (IM) has been shown to be an effective analgesic in treating patients with acute musculoskeletal pain in the emergency department (ED). The authors compare the efficacy of a single dose of IM ketorolac to osteopathic manipulative treatment (OMT) as delivered in the ED for the management of acute neck pain. A randomized clinical trial was conducted in three EDs. A convenience sample of 58 patients with acute neck pain of less than three weeks' duration were enrolled. Subjective measures of pain intensity on an 11-point numerical rating scale were gathered from patients immediately before treatment and one hour afterward. Subjects received either OMT or 30 mg, IM ketorolac. Subjects' perceived pain relief was also recorded at one hour after treatment on a subjective 5-point pain relief scale. Twenty-nine patients received IM ketorolac, and 29 patients received OMT. Although both groups showed a significant reduction in pain intensity, 1.7±1.6 ( P <.001 [95% CI, 1.1–2.3]) and 2.8±1.7 ( P <.001 [95% CI, 2.1–3.4]), respectively, patients receiving OMT reported a significantly greater decrease in pain intensity ( P =.02 [95% CI, 0.2–1.9]). When comparing pain relief at one hour posttreatment, there was no significant difference between the OMT and ketorolac study groups ( P =.10). The authors found that, at one hour posttreatment, OMT is as efficacious as IM ketorolac in providing pain relief and significantly better in reducing pain intensity. The authors conclude that OMT is a reasonable alternative to parenteral nonsteroidal anti-inflammatory medication for patients with acute neck pain in the ED setting.

Patients commonly seek care from their family physicians for symptoms that are suggestive of peripheral nervous system (PNS) dysfunction. At some point in active practice, virtually all family physicians will be required to conduct at least an initial evaluation of a patient with PNS. The authors outline and describe common themes found in the symptoms and diagnoses of PNS dysfunctions. These themes may be useful to physicians when performing initial evaluations of patients with PNS dysfunctions. The authors also discuss diagnostic methods and effective therapeutic interventions for this population.

Objective : The authors gathered survey data regarding the use of cellular telephones among families who reside in the New York metropolitan area and whose children receive medical care in a hospital-affiliated general pediatrics clinic. Methods : Two investigators distributed a 34-question, self-administered survey in pencil-and-paper format to pediatric patients and the adults who accompanied them in the waiting room of a hospital-affiliated, outpatient pediatric practice in Mineola, New York. Results : Completed surveys were obtained from 35 families. Twenty-eight (80%) of the 35 families completing surveys reported that at least one family member owned and used a cellular telephone. Of these 28 families, 9 (32%) reported that at least one household member aged to 18 years owned and used a cellular telephone. The mean age at which children obtained their first cellular telephone was 15.3 years. The primary reason these respondents cited for providing children with cellular telephones was safety (75%). Conclusion : The authors conclude that cellular telephone use is widespread among families in the New York metropolitan area. Although the primary reason families provide for obtaining cellular telephones is safety, convenience to household members and peer pressure also play roles.