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The International Association for the Study of Pain and the World Health Organization have added a new diagnosis, chronic primary pain, and a new pain mechanism, nociplastic pain, to physicians' vocabularies. This new concept explains many pain presentations that have lacked a method of classification. The implications of this new concept regarding treatment options and for determining maximum medical improvement and permanent impairment are evolving. Incorporating the chronic primary pain diagnosis and the nociplastic pain mechanism into practice will require planning and action by physicians. In this article, the history of these terms and their applicability for the AMA Guides to the Evaluation of Permanent Impairment and related publications will be discussed.

The sixth edition (2023) of the AMA Guides® to the Evaluation of Permanent Impairment (AMA Guides) adopted the terminology and conceptual framework of disablement as put forward by the International Classification of Functioning, Disability, and Health. The sixth edition focuses on diagnosis-based impairments (6th ed, 2). In the AMA Guides, Sixth Edition (2008), Chapter 13, The Central and Peripheral Nervous System, had significant rating-process discrepancies with other chapters. This article identifies the discrepancies and explains the revisions made to Chapter 13 and its new title of “The Nervous System,” so that it is congruent with other chapters in the AMA Guides.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019 [COVID-19]) infections began in late 2019/early 2020 and quickly achieved pandemic proportions. Of significance is that, while most individuals recover, some do not. Those who have persistent symptoms are diagnosed with long COVID, or post-COVID syndrome. Individuals with long COVID develop symptoms related to multiple organ systems. One of the more frequent systems affected is the pulmonary system. Individuals develop shortness of breath and/or fatigue. These are sometimes unrelated to any abnormalities on physiological or radiographic testing. More frequently, however, there are abnormalities found radiographically (especially on computed tomography) and on physiological testing (generally, abnormalities in the diffusion capacity for carbon monoxide or in a 6-minute walk test with the oxygen saturation being measured during the test). This article reviews many published articles and is organized by the duration of signs, symptoms, and/or testing abnormalities after the initial diagnosis of COVID-19. The date of maximum medical improvement is suggested to be 12 months, although currently this cannot be definitively supported. More time will need to pass so that appropriate data can be collected.

The Centers for Disease Control has defined long COVID—or post–COVID-19 conditions—as a clinical syndrome reflecting a wide range of new, persistent, or recurring health problems experienced by individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019 [COVID-19]). What is known is that symptoms in these individuals diminish with time. It is unclear how long it takes to achieve maximum medical improvement. This article addresses the cardiac manifestations (including the pulmonary vascular and peripheral vascular manifestations) of long COVID. Emphasis is placed on recent articles (published in the last year) and issues relating to impairment evaluations.

There is an association between obesity and restriction on pulmonary function testing when relying on the forced vital capacity (FVC) as the defining parameter for restriction. Body mass index (BMI) may not be the best measure of obesity, but it is the most commonly used. Multiple examples of regression formulae have been developed to explain the relationship between obesity and restriction, but these may be too complicated for general use. This article reviews the medical literature concerning this association.

Independent medical examinations (IMEs) are elective evaluations of clinical conditions and differ from a clinical consultation in several important ways. They are conducted in many medicolegal contexts and are performed by a regulated health professional who is not the treating health care provider. An IME seeks objective information about the examinee's diagnoses, functional abilities and impairments, and other features relevant to addressing medicolegal-related cases by relying on multiple data sources. Best practice guidelines have been established for the completion of physical IMEs. However, similar mental and behavioral disorder (M&BD) standards are less common, and M&BD IMEs often do not follow a consistent process. This article offers guidance on applying and adapting existing standards to M&BD IMEs. We outlined the appropriate use of psychiatric nomenclature and how to apply recent changes to Chapter 14 of the AMA Guides to the Evaluation of Permanent Impairment. The article further offers a mechanism for introducing greater objectivity into an otherwise subjective process by employing relevant psychological validity testing and conducting a coherence analysis in formulating an opinion. In summary, we provide a synopsis of current best practices and offer the examiner a method for aligning M&BD IMEs with equally high standards of excellence.

In assessing spinal impairment, it is imperative to distinguish between limb pain or numbness that might be radicular, but with no objective verification, from symptoms that represent, in fact, true radiculopathy, ie, pain, numbness, or weakness that was related to objective radiculopathy. In the sixth edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), this distinction determines what row in the spine tables is used to rate impairment. Failure to discern between nonverifiable radicular complaints and true radiculopathy is a source of frequent errors in spinal impairment rating. True radiculopathy is pain, numbness, and/or weakness from nerve root damage, most commonly from a disc herniation. This article will review how the AMA Guides has dealt with the concept of radiculopathy through the years.

This Medical News feature discusses the prospect of the first birth control pill available without a prescription in the US.

This Medical News article discusses how the frequency and distribution of US power outages affects patients who use electronic medical equipment.

This Viewpoint discusses how sex and gender subpopulations may be differentially affected by tobacco products and suggests that the FDA formulate regulations in clinically meaningful ways.

This JAMA Insights in the Women’s Health series examines the management of asthma during pregnancy, including diagnosis, treatment, and the handling of exacerbations.

This Medical News feature discusses the increasingly common combination of xylazine, an animal tranquilizer, and illicit fentanyl.

This study used a population-based individual patient data set that included diagnoses of COVID-19 to determine whether there was a temporal association between COVID-19 and type 1 diabetes in children.

ImportanceDiscussions about goals of care are important for high-quality palliative care yet are often lacking for hospitalized older patients with serious illness.ObjectiveTo evaluate a communication-priming intervention to promote goals-of-care discussions between clinicians and hospitalized older patients with serious illness.Design, Setting, and ParticipantsA pragmatic, randomized clinical trial of a clinician-facing communication-priming intervention vs usual care was conducted at 3 US hospitals within 1 health care system, including a university, county, and community hospital. Eligible hospitalized patients were aged 55 years or older with any of the chronic illnesses used by the Dartmouth Atlas project to study end-of-life care or were aged 80 years or older. Patients with documented goals-of-care discussions or a palliative care consultation between hospital admission and eligibility screening were excluded. Randomization occurred between April 2020 and March 2021 and was stratified by study site and history of dementia.InterventionPhysicians and advance practice clinicians who were treating the patients randomized to the intervention received a 1-page, patient-specific intervention (Jumpstart Guide) to prompt and guide goals-of-care discussions.Main Outcomes and MeasuresThe primary outcome was the proportion of patients with electronic health record–documented goals-of-care discussions within 30 days. There was also an evaluation of whether the effect of the intervention varied by age, sex, history of dementia, minoritized race or ethnicity, or study site.ResultsOf 3918 patients screened, 2512 were enrolled (mean age, 71.7 [SD, 10.8] years and 42% were women) and randomized (1255 to the intervention group and 1257 to the usual care group). The patients were American Indian or Alaska Native (1.8%), Asian (12%), Black (13%), Hispanic (6%), Native Hawaiian or Pacific Islander (0.5%), non-Hispanic (93%), and White (70%). The proportion of patients with electronic health record–documented goals-of-care discussions within 30 days was 34.5% (433 of 1255 patients) in the intervention group vs 30.4% (382 of 1257 patients) in the usual care group (hospital- and dementia-adjusted difference, 4.1% [95% CI, 0.4% to 7.8%]). The analyses of the treatment effect modifiers suggested that the intervention had a larger effect size among patients with minoritized race or ethnicity. Among 803 patients with minoritized race or ethnicity, the hospital- and dementia-adjusted proportion with goals-of-care discussions was 10.2% (95% CI, 4.0% to 16.5%) higher in the intervention group than in the usual care group. Among 1641 non-Hispanic White patients, the adjusted proportion with goals-of-care discussions was 1.6% (95% CI, −3.0% to 6.2%) higher in the intervention group than in the usual care group. There was no evidence of differential treatment effects of the intervention on the primary outcome by age, sex, history of dementia, or study site.Conclusions and RelevanceAmong hospitalized older adults with serious illness, a pragmatic clinician-facing communication-priming intervention significantly improved documentation of goals-of-care discussions in the electronic health record, with a greater effect size in racially or ethnically minoritized patients.Trial RegistrationClinicalTrials.gov Identifier: NCT04281784

This Viewpoint discusses the long-term medical, emotional, and financial implications of using amnioinfusion to treat anhydramnios; outlines the ongoing Renal Anhydramnios Fetal Therapy (RAFT) trial, which aims to document outcomes and survival in infants after amnioinfusion; and suggests that amnioinfusions be withheld in early anhydramnios, pending the findings of the RAFT trial.

This Viewpoint discusses the legal risks physicians and health care facilities may incur by miscoding a surgical or chemical abortion as a miscarriage to conceal an abortion procedure.

This article summarizes the recent update of guidelines on health care for transgender and gender diverse people, including primary care, gender-affirming care, mental health care, and education of the clinical workforce.

This Viewpoint explains the “legal limbo” physicians may find themselves in, straddling state laws banning gender-affirming care and federal nondiscrimination law, both of which remain unclear due to ongoing legal challenges in the courts.

This Viewpoint from the CDC discusses the prevalence of dengue infection in US territories and opportunities to combat it, such as vaccines and novel vector control methods.

This Medical News story discusses a new study in JAMA Neurology that links exposure to contaminated drinking water at Marine Corps Base Camp Lejeune to an increased risk of Parkinson disease.