Caring for patients with chronic pain: pearls and pitfalls.

Chronic, nonmalignant pain is a substantial public health problem in the United States. Research over the past 2 decades has defined chronic pain by using a "biopsychosocial model" that considers a patient's biology and psychological makeup in the context of his or her social and cultural milieu. Whereas this model addresses the pathology of chronic pain, it also places many demands on the physician, who is expected to assess and manage chronic pain safely and successfully. There is a growing body of evidence suggesting that opioids can be effective in the management of chronic pain, but there has also been a rise in opioid-related overdoses and deaths. Clinicians should be aware of assessment tools that may be used to evaluate the risk of opioid abuse. A basic understanding of chronic pain pathophysiology and a uniform approach to patient care can satisfy the needs of both patients and physicians.

Severe vitamin D deficiency in Arab-American women living in Dearborn, Michigan.

OBJECTIVE: To determine the prevalence and degree of 25-hydroxyvitamin D deficiency in a group of Arab-American women in the largest, most-concentrated Arab-American settlement in the United States and to search for correlations with dress, diet, and use of vitamin D-fortified foods and vitamin supplements. METHODS: In this cross-sectional study, Arab-American women, 18 years and older, who attended an ethnic market on April 7 or 14, 2007, were recruited. Participants were interviewed by bilingual English- and Arabic-speaking investigators using a semi-structured interview to assess dress; demographic variables; medical history; medication use; clinical symptoms associated with vitamin D deficiency (eg, joint or bone pain, muscle weakness); and dietary intake of vitamin D from fortified orange juice, milk, and vitamin supplementation. Blood samples were drawn to measure concentrations of serum calcium, creatinine, phosphorus, alkaline phosphatase, parathyroid hormone, and 25-hydroxyvitamin D. Participants were initially divided into 2 groups based on whether the woman was veiled and further subdivided into 3 groups on the basis of vitamin D intake from supplemented food sources (milk or vitamin D-fortified orange juice) and vitamin pills: unveiled, veiled and taking supplements, and veiled and taking no supplements. RESULTS: Eighty-seven women participated. Serum 25-hydroxyvitamin D levels were uniformly low, with the highest levels in the unveiled group (median [interquartile range]) (8.5 ng/mL [5.75-13.5 ng/mL]) followed by the veiled, supplemented group (7 ng/mL [4-11.5 ng/mL]) and the veiled, unsupplemented group (4 ng/mL [2-6.8 ng/mL]). 25-Hydroxyvitamin D levels were lower in women with less experience in the United States and in those with less education. Vitamin D-fortified orange juice consumption had a greater positive predictive effect on serum 25-hydroxyvitamin D levels than either milk or vitamin pills and may possibly serve as a surrogate marker for vitamin D awareness. CONCLUSIONS: Vitamin D deficiency, as assessed by 25-hydroxyvitamin D concentrations, is endemic in a sample of Arab-American women living in Dearborn, Michigan. These findings potentially identify an important health problem in the largest, most-concentrated Arab-American population in the United States.