April 3, 2013

DynaMed EBM Journal Volume 8, Issue 14

DynaMed Weekly Updates

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Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: April 3, 2013

Expiration Date: April 3, 2014

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company


Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote EducationCompany and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: Enduring Material activity, DynaMed EBM Focus, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each EBM Focus is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.

Program ID: 1210393E


Last week 672 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 233 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article of significant interest was selected by the DynaMed Editorial Team.

OnabotulinumtoxinA Appears to Improve Pain and Sleep in Patients with Chronic Postherpetic Neuralgia
Reference: Clin J Pain 2013 Jan 30 early online, (level 2 [mid-level] evidence)

About 10% of patients develop severe chronic neuropathic pain following acute herpes zoster, with the frequency being higher in older patients. Postherpetic neuralgia can be difficult to manage. Various treatments that have been used include oral analgesics, tricyclic antidepressants, anticonvulsants, topical lidocaine and topical capsaicin. A recent small randomized trial evaluated the efficacy of onabotulinumtoxinA injections for pain relief in chronic postherpetic neuralgia.

Thirty adults with postherpetic neuralgia for at least 3 months (mean duration 104 days) were randomized to onabotulinumtoxinA (100 units in 4 mL normal saline) vs. placebo in a single treatment of 40 subcutaneous injections. The injections were made with 30-gauge needles in a chess board pattern over the affected areas designated by the patients (thoracic dermatomes in 25 patients, brachial plexus in 4 patient, and sciatic nerve in 1 patient). The minimal distance between injection sites was 1 cm. Pain was rated on 0-10 visual analog scale and sleep quality was rated on 0-15 scale by 5-item questionnaire (higher scores indicating worse outcomes).

At 4 weeks, pain reduction of at least 50% was reported in 87% with onabotulinumtoxinA compared to 0% with placebo (p < 0.001, NNT 2). The median time to 50% pain reduction was 7.4 days, and pain reduction was maintained for median 16 weeks. The mean sleep scores at 4 weeks were 4.1 with onabotulinumtoxinA vs. 8.5 with placebo (p < 0.001), and this difference was maintained at 16 weeks. No adverse events were reported.

For more information, see the Postherpetic neuralgia topic in DynaMed.

Earn CME Credit for reading this e-Newsletter.
For more information on this educational activity, see the CME sidebar.

DynaMed Events

American College of Physicians (ACP) Internal Medicine 2013, April 11- 13, 2013
Senior Deputy Editor Larissa Lucas, MD, FACP, and Deputy Editor Sheila Bond, MD, will be attending the American College of Physicians Internal Medicine 2013 conference, held at The Moscone Center in San Francisco, California. Representatives will be available at the DynaMed booth (1402) to discuss peer review, mobile access, and free trial information.

Visit the American College of Physicians website to learn more about the event and for registration information.

Massachusetts Academy of Family Physicians (MassAFP) 2013 Spring CME Refresher, April 12 – 13, 2013
Senior Deputy Editor Alan Ehrlich, MD, will be presenting at the Massachusetts Academy of Family Physicians 2013 Spring CME Refresher, held at the Four Points Sheraton in Leominster, Massachusetts. The title of the presentation is “Medical Marijuana” and will be presented at 10:30 AM on Friday April 12th.

Visit the Massachusetts Academy of Family Physicians website to learn more about the event and for registration information.

If you would like to meet with a DynaMed representative at any of our conferences, please contact us at DynaMedCommunity@ebscohost.com.

Call for Peer Reviews

We are currently seeking reviewers for:

Neurogenic bladder

Spinal muscular atrophy (SMA)