{"title":"Long-Term Pain Therapy With Opioids.","authors":"Lynn R Webster","doi":"10.1001/jama.2025.21043","DOIUrl":"10.1001/jama.2025.21043","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"372"},"PeriodicalIF":55.0,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John K Lin, Pengxiang Li, Xiudong Lei, Sunita M Desai, Jalpa A Doshi
{"title":"Specialty Oral Anticancer Prescription Fill Rates After Medicare Part D Cost-Sharing Changes in 2024.","authors":"John K Lin, Pengxiang Li, Xiudong Lei, Sunita M Desai, Jalpa A Doshi","doi":"10.1001/jama.2025.22134","DOIUrl":"10.1001/jama.2025.22134","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"366-367"},"PeriodicalIF":55.0,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12750331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Hsu, David Lawrence, Peter Capone-Newton, Lillian Gelberg
{"title":"Reframing Opioid Overdose as an Ambulatory Care-Sensitive Condition.","authors":"Michael Hsu, David Lawrence, Peter Capone-Newton, Lillian Gelberg","doi":"10.1001/jama.2025.23741","DOIUrl":"10.1001/jama.2025.23741","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"303-304"},"PeriodicalIF":55.0,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ethics and Social Medicine Education Under Political Pressure: Teaching Through Uncertainty.","authors":"Elizabeth Sonntag, James Levenson","doi":"10.1001/jama.2025.23747","DOIUrl":"10.1001/jama.2025.23747","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"305-306"},"PeriodicalIF":55.0,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Importance: </strong>Restless legs syndrome (RLS) is a sleep-related movement disorder that affects approximately 3% of US adults to a clinically significant extent and can cause substantial sleep disturbance.</p><p><strong>Observations: </strong>Restless legs syndrome is characterized by an overwhelming urge to move the limbs, typically the legs, often accompanied by unpleasant limb sensations (eg, achiness, tingling). Symptoms, provoked by immobility, are relieved while moving and are typically present or most severe in the evening or at night. Restless legs syndrome symptoms may lead to difficulty falling asleep, staying asleep, or returning to sleep. According to population-based studies, approximately 8% of US adults experience RLS symptoms of any frequency annually and 3% experience moderately or severely distressing symptoms at least twice weekly. Patients with RLS have impaired quality of life and elevated rates of cardiovascular disease (29.6% with coronary artery disease, stroke, or heart failure), depression (30.4%), and suicidal ideation or self-harm (0.35 cases/1000 person-years). Restless legs syndrome is common among patients with multiple sclerosis (27.5%), end-stage kidney disease (24%), and iron deficiency anemia (23.9%); during pregnancy and especially in the third trimester (22%); with peripheral neuropathy (eg, diabetic, idiopathic; 21.5%); and with Parkinson disease (20%). Other risk factors include family history of RLS, northern European descent, female sex (2:1 vs male sex), and older age (RLS prevalence of 10% in adults ≥65 years). Restless legs syndrome is diagnosed based on clinical history; polysomnography is not recommended for diagnosis. Iron supplementation with ferrous sulfate (325-650 mg daily or every other day) or intravenous iron (1000 mg) should be initiated for serum ferritin level less than or equal to 100 ng/mL or transferrin saturation less than 20%. If possible, medications associated with RLS, including serotonergic antidepressants, dopamine antagonists, and centrally acting H1 antihistamines (eg, diphenhydramine), should be discontinued. Gabapentinoids (eg, gabapentin, gabapentin enacarbil, pregabalin) are first-line pharmacologic therapy. In randomized clinical trials, approximately 70% of patients treated with gabapentinoids had much or very much improved RLS symptoms vs approximately 40% with placebo (P < .001). Dopamine agonists (eg, ropinirole, pramipexole, rotigotine) are no longer recommended as first-line medications due to the risk of augmentation, an iatrogenic worsening of RLS symptoms, which has an annual incidence of 7% to 10% with these medications. Patients who do not improve with first-line treatment or have augmented RLS often benefit from low-dose opioids (eg, methadone 5-10 mg daily).</p><p><strong>Conclusions and relevance: </strong>Restless legs syndrome affects approximately 3% of adults and can have negative effects on sleep and quality of life. Initial management incl
重要性：不宁腿综合征（RLS）是一种与睡眠相关的运动障碍，临床上约有3%的美国成年人受到影响，并可导致严重的睡眠障碍。观察：不宁腿综合征的特点是强烈地想要移动四肢，尤其是腿部，经常伴有肢体不愉快的感觉（如疼痛、刺痛）。由不动引起的症状在移动时缓解，通常在晚上或夜间出现或最严重。不宁腿综合征的症状可能导致难以入睡、保持睡眠或恢复睡眠。根据基于人群的研究，大约8%的美国成年人每年都会出现任何频率的RLS症状，3%的人每周至少两次出现中度或严重的痛苦症状。RLS患者的生活质量受损，心血管疾病（29.6%伴有冠状动脉疾病、中风或心力衰竭）、抑郁（30.4%）、自杀意念或自残（0.35例/1000人年）发生率升高。不宁腿综合征常见于多发性硬化症（27.5%）、终末期肾病（24%）和缺铁性贫血（23.9%）患者；在怀孕期间，特别是在妊娠晚期（22%）；周围神经病变（如糖尿病，特发性；21.5%）；帕金森病（20%）。其他危险因素包括RLS家族史、北欧血统、女性（2:1 vs .男性）和年龄较大（65岁以上成年人中RLS患病率为10%）。不宁腿综合征是根据临床病史诊断的；多导睡眠图不推荐用于诊断。当血清铁蛋白水平低于或等于100 ng/mL或转铁蛋白饱和度低于20%时，应开始补充硫酸亚铁（325-650 mg /天或每隔一天一次）或静脉注射铁（1000 mg）。如有可能，应停用与RLS相关的药物，包括血清素能抗抑郁药、多巴胺拮抗剂和中枢作用H1抗组胺药（如苯海拉明）。加巴喷丁类药物（如加巴喷丁、加巴喷丁那沙比尔、普瑞巴林）是一线药物治疗。在随机临床试验中，大约70%的加巴喷丁类药物治疗的患者的RLS症状得到了很大或非常大的改善，而安慰剂治疗的患者约为40% (P结论和相关性：不宁腿综合征影响约3%的成年人，并对睡眠和生活质量产生负面影响。最初的治疗包括停止加重药物，以及对铁指数低正常的患者补充铁。如果需要药物治疗，加巴喷丁类药物是一线治疗。
{"title":"Restless Legs Syndrome: A Review.","authors":"John W Winkelman, Benjamin Wipper","doi":"10.1001/jama.2025.23247","DOIUrl":"https://doi.org/10.1001/jama.2025.23247","url":null,"abstract":"<p><strong>Importance: </strong>Restless legs syndrome (RLS) is a sleep-related movement disorder that affects approximately 3% of US adults to a clinically significant extent and can cause substantial sleep disturbance.</p><p><strong>Observations: </strong>Restless legs syndrome is characterized by an overwhelming urge to move the limbs, typically the legs, often accompanied by unpleasant limb sensations (eg, achiness, tingling). Symptoms, provoked by immobility, are relieved while moving and are typically present or most severe in the evening or at night. Restless legs syndrome symptoms may lead to difficulty falling asleep, staying asleep, or returning to sleep. According to population-based studies, approximately 8% of US adults experience RLS symptoms of any frequency annually and 3% experience moderately or severely distressing symptoms at least twice weekly. Patients with RLS have impaired quality of life and elevated rates of cardiovascular disease (29.6% with coronary artery disease, stroke, or heart failure), depression (30.4%), and suicidal ideation or self-harm (0.35 cases/1000 person-years). Restless legs syndrome is common among patients with multiple sclerosis (27.5%), end-stage kidney disease (24%), and iron deficiency anemia (23.9%); during pregnancy and especially in the third trimester (22%); with peripheral neuropathy (eg, diabetic, idiopathic; 21.5%); and with Parkinson disease (20%). Other risk factors include family history of RLS, northern European descent, female sex (2:1 vs male sex), and older age (RLS prevalence of 10% in adults ≥65 years). Restless legs syndrome is diagnosed based on clinical history; polysomnography is not recommended for diagnosis. Iron supplementation with ferrous sulfate (325-650 mg daily or every other day) or intravenous iron (1000 mg) should be initiated for serum ferritin level less than or equal to 100 ng/mL or transferrin saturation less than 20%. If possible, medications associated with RLS, including serotonergic antidepressants, dopamine antagonists, and centrally acting H1 antihistamines (eg, diphenhydramine), should be discontinued. Gabapentinoids (eg, gabapentin, gabapentin enacarbil, pregabalin) are first-line pharmacologic therapy. In randomized clinical trials, approximately 70% of patients treated with gabapentinoids had much or very much improved RLS symptoms vs approximately 40% with placebo (P < .001). Dopamine agonists (eg, ropinirole, pramipexole, rotigotine) are no longer recommended as first-line medications due to the risk of augmentation, an iatrogenic worsening of RLS symptoms, which has an annual incidence of 7% to 10% with these medications. Patients who do not improve with first-line treatment or have augmented RLS often benefit from low-dose opioids (eg, methadone 5-10 mg daily).</p><p><strong>Conclusions and relevance: </strong>Restless legs syndrome affects approximately 3% of adults and can have negative effects on sleep and quality of life. Initial management incl","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":""},"PeriodicalIF":55.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"What Is Restless Legs Syndrome?","authors":"Kristin Walter","doi":"10.1001/jama.2025.26155","DOIUrl":"https://doi.org/10.1001/jama.2025.26155","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":""},"PeriodicalIF":55.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Management of Opioid Use Disorder.","authors":"Sarah E Messmer, Molly M Perri, Andrew M Davis","doi":"10.1001/jama.2025.25464","DOIUrl":"https://doi.org/10.1001/jama.2025.25464","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":""},"PeriodicalIF":55.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Did You Eat?","authors":"Eric Nzirakaindi Ikoona","doi":"10.1001/jama.2025.22779","DOIUrl":"https://doi.org/10.1001/jama.2025.22779","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":""},"PeriodicalIF":55.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"World AIDS Day-At a Crossroads.","authors":"Anna K Person, Colleen F Kelley","doi":"10.1001/jama.2025.23506","DOIUrl":"10.1001/jama.2025.23506","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"209-210"},"PeriodicalIF":55.0,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Primary Biliary Cholangitis.","authors":"Michele M Tana, Gideon M Hirschfield","doi":"10.1001/jama.2025.20067","DOIUrl":"10.1001/jama.2025.20067","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"269-270"},"PeriodicalIF":55.0,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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