Vasovagal reactions are a benign but common outcome of interventional pain management procedures that can negatively impact patient care, including aborted procedures and fear of future procedures that would otherwise help the patient. Research has been done on the incidence, risk factors, and management of vasovagal reactions resulting from such procedures, but less is known about how to prevent these reactions from occurring. In this paper, we present a literature review of the pathophysiology, incidence, risk factors, prevention, and management of vasovagal reactions during interventional pain management procedures, with an emphasis on the relative lack of research and conflicting advice on preventive measures. We found that moderate sedation and anxiolytics have been used prophylactically to prevent vasovagal reactions, but their side-effect profiles prevent them from being used commonly. Less studied is the prophylactic administration of antimuscarinics and IV fluids, despite the potential benefit of these measures and relatively low side-effect profile. We explore these topics here and offer advice for future research to fill the gaps in our knowledge.

Background Selective androgen receptor modulators (SARMs) are becoming increasingly common amongst athletes and the general population, but their side effect profile in human subjects at recreational doses is understudied. Case presentation A 27-year-old asymptomatic male weightlifter presented for an annual physical exam and was coincidentally found to have an abnormal lipid panel, which the patient believed to be due to recreational SARMs (LGD-4033 and S-23) usage. Further work-up revealed elevated liver enzymes suggestive of hepatocellular injury and suppression of the pituitary–gonadal axis. Lipids, hepatic function, and hormones returned to baseline after cessation of SARMs. Conclusions This is the first case report on how SARMs may impact LDL, cause hepatocellular rather than cholestatic liver injury, and alter health markers despite complete lack of symptoms. It is also the first case report on the potential negative effects of the SARM S-23.