Background: Despite medical advancements for organic and structural diseases, effectively managing acute and chronic functional pain syndromes remains a daunting challenge for hospitalists. Standard inpatient treatments frequently fail to adequately control symptoms, often compelling hospitalists to shift from diagnostics to the contentious task of tapering opioids in patients with legitimate pain. This pivot can lead [...]

Background: Despite medical advancements for organic and structural diseases, effectively managing acute and chronic functional pain syndromes remains a daunting challenge for hospitalists. Standard inpatient treatments frequently fail to adequately control symptoms, often compelling hospitalists to shift from diagnostics to the contentious task of tapering opioids in patients with legitimate pain. This pivot can lead [...]

Case Presentation: An 89-year-old man with coronary artery disease, hypertension, and osteoarthritis presented with acute-onset severe posterior neck pain, with no viral prodrome. The patient reported experiencing generalized weakness and associated headache, but denied any fevers, chills, cough, myalgia, joint pain, ulcers or rashes. Additionally, he did not report any photophobia, phonophobia, changes in vision, [...]

Case Presentation: A 23-year-old man with cystic fibrosis presented to the Emergency Department with a two-day history of gradual, persistent, right sided abdominal pain associated with dark, tarry stools. He was afebrile with unremarkable vital signs. Exam was notable for generalized abdominal tenderness most noticeable in the right lower quadrant and a normal rectal exam. [...]

Case Presentation: A 12-year-old Caucasian male with no significant medical history presented with a 6-day history of bilateral leg pain following a soccer game. As an avid soccer player, he had experienced similar episodes over the past three years, managed previously as “growing pains” with NSAIDs and acetaminophen. However, this presentation raised concern for an [...]

Background: Epipericardial fat necrosis (EFN) presents as acute chest pain with the potential to mimic life-threatening conditions. It is unclear whether this is truly a rare condition, or simply underdiagnosed by low threshold of suspicion. The literature suggests an estimated prevalence of 2% of EFN as the cause of chest pain in all patients presenting [...]

Background: Project Caring for Patients with Opioid Misuse through Evidence-Based Treatment (COMET) launched in 2019 to provide patients with opioid use disorders (OUD) individualized and evidence-based care at Duke University Hospital (DUH). Patients with OUD have higher rates of self-directed discharge (SDD) which is associated with higher healthcare utilization costs, hospital readmissions, and adverse health [...]

Background: Coronary Computed Tomography Angiography (CCTA) is a common anatomic modality for detection of cardiac ischemia in the setting of chest pain hospitalizations. However, invasive coronary angiography (ICA) is the gold standard for diagnosing ischemic coronary artery disease. Research showed that CCTA has a high sensitivity but lacks the specificity and accuracy component of Fractional [...]

Case Presentation: A 55-year-old male with history of bilateral degenerative hip joint disease presented for worsening serosanguinous drainage from his wounds one week after bilateral hip replacement. He further developed diaphoresis and chills and received cephalexin at an outside hospital from where he was later discharged. He did not have improvement from antibiotics and his [...]

Case Presentation: A 29-year-old African American male with chronic intermittent low back pain of several weeks presented with sudden-onset severe low back pain and inability to bear weight or ambulate. Prior to his hospitalization, he had a few urgent care visits, where he was diagnosed with back pain of muscular origin and was discharged home [...]