Narcotics should not be prescribed for migraine headaches, annual electrocardiograms are a no-no for low-risk patients, and cough and cold medications should never be given to children younger than 4, doctors announced Thursday.

Physicians from 17 leading specialty organizations produced lists with 90 tests, treatments and procedures that patients really don't need.

"We're hoping that on the physician side this will produce better care, and on the patient side, we hope they understand that more is not always better," said Dr. Daniel Wolfson, executive vice president of the American Board of Internal Medicine Foundation, co-sponsor of a campaign to limit unnecessary medical care.

This is the second consecutive year a list has been issued.

Each of the specialty organizations listed five unnecessary procedures or tests. The American Academy of Family Physicians, however, provided 10, cautioning foremost against MRIs for lower back pain within the first six weeks of onset. Lower back pain is one of the most common reasons patients nationwide seek medical care.

The American Academy of Neurology warned against prescribing narcotic medications to treat migraines.

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Dr. Brian Durkin, director of the Center for Pain Management at Stony Brook University Hospital, said narcotics are among the least effective drugs for migraines.

"Opioid medications can make the headache worse. When you take a narcotic, you increase the fluid volume in your brain and the brain itself is in an enclosed capsule," Durkin said of the skull.

"These medications work well for fractures, but they don't work well at all for nerve pain," he said, referring to migraines.

"It is a different kind of pain and is best treated with a neuropathic medication."

Some doctors, Durkin said, recommend the drug gabapentin -- a neuropathic medication -- to prevent migraines. Neuropathic drugs act on pain that emanates in the central nervous system.

Many of the medical organizations cited the overuse of antibiotics. The American Academy of Ophthalmology, for instance, warned against prescribing them for pink eye.

Dr. Jodi Luchs, an assistant clinical professor of ophthalmology at Hofstra University School of Medicine, said he's pleased the academy made the recommendation public.

"Up to 90 percent of infectious pink eye is viral, not bacterial," said Luchs, who is also director of clinical research at South Shore Eye Care in Wantagh. Antibiotics, he said, are designed to treat bacteria and have no impact on viruses.

Doctors questioned some recommendations, such as the American Academy of Pediatrics saying not to use CT scans for minor childhood head injuries. "That's a double-edged sword," said Dr. Elizabeth Trinidad of Neurological Surgery P.C., with offices in Nassau and Suffolk.

"It used to be a big controversy whether we do a CT scan or observe them overnight. But because of the current medical-legal environment, we now do both."

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Trinidad said it would be devastating to miss a serious head injury because a child was not screened for a fracture and/or internal bleeding. "One has to be thoughtful and use judgment," she said. "And unfortunately, with the attempts to make medicine something that is protocoled and practiced by guideline, it is often difficult to fit medical judgment into the equation."



Doctors call these unnecessary too


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Cough and cold medicines should not be prescribed or recommended for respiratory illnesses in children younger than 4.

Do not treat sinusitis with antibiotics.

Don't perform routine annual Pap tests in women 30-65 years of age.

Do not schedule non-medically indicated labor or Caesarean deliveries before 39 weeks of pregnancy.

Don't perform population-based screening for vitamin D deficiency.