In episode 479, Mike and James update the latest information around cannabinoids for chronic pain. Unfortunately, there is not a lot of new information but we talk about what there is and then try and put all the evidence into context and then how to think about the information we have.

Show notes

1) Allan GM, Finley CR, Ton J, Perry D, Ramji J, Crawford K, et al. Systematic review of systematic reviews for medical cannabinoids: Pain, nausea and vomiting, spasticity, and harms.

Can Fam Physician. 2018;64(2):e78-e94.

2) Mücke M, Phillips T, Radbruch L, Petzke F, Häuser W. Cannabis-based medicines for chronic neuropathic pain in adults.

Cochrane Database Syst Rev. 2018 Mar 7;3(3):CD012182.

3) Wong SSC, Chan WS, Cheung CW.  Analgesic Effects of Cannabinoids for Chronic Non-cancer Pain: a Systematic Review and Meta-Analysis with Meta-Regression.

J Neuroimmune Pharmacol. 2020 Dec;15(4):801-829

4) Johal H, Devji T, Chang Y, Simone J, Vannabouathong C, Bhandari M.  Cannabinoids in Chronic Non-Cancer Pain: A Systematic Review and Meta-Analysis.

Clin Med Insights Arthritis Musculoskelet Disord. 2020 Feb 19;13:1179544120906461.

5) Fitzcharles MA, Baerwald C, Ablin J, Häuser W. Efficacy, tolerability and safety of cannabinoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome, back pain, osteoarthritis, rheumatoid arthritis): a systematic review of randomized controlled trials.

Schmerz. 2016;30(1):47–61.

In episode 478, James and Mike invite Jen Potter to the podcast yet again to talk about whether or not NSAIDs are effective for reducing menstrual bleeding. While the quality of the evidence is not great, there does appear to be some evidence that NSAIDs have an effect over placebo.

Show notes

Tools for Practice

How to Slow the Flow: NSAIDs for Heavy Menstrual Bleeding

In episode 477, James and Mike invite Jen Potter to the podcast for the first time to talk about the important topic of what to do around vaccine hesitancy. We find out the evidence suggests discussion should focus on the disease-prevention benefits for the individual rather than talking about misinformation around the harm or the benefits to society.

Show notes

Tools for Practice

Vaccine hesitancy in the office: What can I do?

In episode 476, James and Mike talk about a few new systematic reviews from the Cochrane library that look at 4 different common antibiotic questions in primary care – antibiotics for secondary prevention of cardiovascular disease, molar tooth extraction, Strep throat, and COPD exacerbation prevention. The PREMIUIM answers are no, yes, yes and yes – but you need to know the details, so have a listen.

Show notes

COCHRANE REVIEWS

Antibiotics for secondary prevention of coronary heart disease

Antibiotics to prevent complications following tooth extractions

Different antibiotic treatments for group A streptococcal pharyngitis

Prophylactic antibiotics for adults with chronic obstructive pulmonary disease: a network meta‐analysis

In episode 475, Mike and James invite Tina to talk about treatments for restless legs syndrome. in particular pramipexole. We find that pramipexole improves symptoms in ~20% of people over and above placebo and that low doses are just as good as higher doses. Who knew? In addition, you need to know that over a long period of time (> 1 year) that pramipexole can worsen restless syndrome so reassessment on a regular basis is key.

Show notes

1) Tools for Practice

A good sleep would be dop(aminergic) doc! Pramipexole in restless legs syndrome

2) CFPCLearn – Interactive e-learning. Reporting Simplified anytime, anywhere

In episode 474, Mike and James discuss the evidence around intermittent iron dosing for people with anemia. We find that once daily dosing of iron yields similar or slightly better hemoglobin versus twice weekly or alternate day over ~3 months but low dose is still the place to start. We also discuss the amount of iron in supplements and in food and try to put all that into context.

Show notes

1) Tools for Practice

Iron dosing frequency: Is less more or just less?

2) CFPCLearn – Interactive e-learning. Reporting Simplified anytime, anywhere

In episode 473, Mike and James invite Samantha Moe yet again to talk about a recent Tools for Practice that looked at treatments for osteoporosis. Sam helps us put all the evidence into perspective for bisphosphonates and denosumab when it comes to fractures. We discuss the numbers and help explain why secondary prevention in osteoporosis is not really secondary prevention.

Show notes

Tools for Practice

Osteoporosis treatment for post-menopausal women

In episode 472, Mike and James invite Samantha Moe in to talk about a recent Tools for Practice that looks at the evidence for glucosamine and chondroitin in osteoarthritis. Sam does a great job of showing why you have to look at publicly funded trials and responder analyses to really get the whole picture of the evidence around these products.

Show notes

1) Tools for practice

Glucosamine & Chondroitin: Natural remedies for osteoarthritis? 

2) PEER simplified decision aid: osteoarthritis treatment options in primary care

3) Pain calculator

In episode 471, Mike and James get back to being PREMIUM and discuss 2 studies that should impact what you do today in your practice. Is Vitamin C needed when you take iron? What does the evidence really show about the SGLT-2 and the GLP-1s for diabetes and is one better than the other?

Show notes

1) The Efficacy and Safety of Vitamin C for Iron Supplementation in Adult Patients With Iron Deficiency Anemia

JAMA Network Open. 2020;3(11):e2023644. doi:10.1001/jamanetworkopen.2020.23644

2) Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials 

BMJ 2021;372:m4573 http://dx.doi.org/10.1136/bmj.m4573

In episode 470, Mike and James finish their discussion about misinterpretation and misdirection in medicine by looking at some of the evidence about how we incorporate new information and whether or not we change our minds. We also talk about competence versus experience vs knowledge.