"Lawsuit: CVS Pharmacy refused to fill Riverview woman ’s opioid prescription"
Lawsuit: CVS Pharmacy refused to fill Riverview woman’s opioid prescription A Riverview woman is leading the charge against what she calls discrimination of people with chronic pain. She recently filed a class action lawsuit against the biggest pharmacy chain in America; C… www.wfla.com (Source: Student Doctor Network)
Source: Student Doctor Network - August 14, 2020 Category: Universities & Medical Training Authors: WVUPharm2007 Tags: Pharmacy Source Type: forums

cancer pain only practice
Do you guys think there is enough volume to support an outpatient interventional cancer pain & cancer rehab practice? I will be starting my PM&R residency training at one of the top programs in the country after this academic year (am an prelim medicine intern right now). And I ultimately want to help cancer survivors. I think with the continuing improvements with cancer treatments (most recently with immunotherapy), cancer will be/is a chronic disease with debilitating side effects that... cancer pain only practice (Source: Student Doctor Network)
Source: Student Doctor Network - August 4, 2020 Category: Universities & Medical Training Authors: Slowpoke Tags: Pain Medicine Source Type: forums

Belbuca
I’ve been seeing a lot of patient on Belbuca for chronic pain. 1. do you guys think belbuca is more efficacious or lower risk than just using conventional opioids for chronic pain. 2. I’ve seen some people prescribing big doses of Belbuca, and concurrently prescribing immediate release oral opioids for breakthrough pain. Am I right in thinking these IR opioids aren’t really doing anything? (Source: Student Doctor Network)
Source: Student Doctor Network - July 31, 2020 Category: Universities & Medical Training Authors: dipriMAN Tags: Pain Medicine Source Type: forums

case - options for pain control
40 yo F morbid obesity (BMI 50 w/ OSA requiring CPAP) presents for bariatric surgery - laparoscopic. H/o Chiari malformation, h/o hydrocephalus w/ ventricular-thoracic shunt and lumbar-peritoneal-shunt s/p multiple revisions for failure and optic nerve fenestration for blindness, chronic neck/headaches on Norco 10-325, gabapentin 300 once daily, flexeril, fibromyalgia. Thoughts on pre-intra-post operative pain control options? Neuraxial? Multimodal? How would you manage her preop opioid use? (Source: Student Doctor Network)
Source: Student Doctor Network - July 29, 2020 Category: Universities & Medical Training Authors: mtu620 Tags: Anesthesiology Source Type: forums

Chronic pain: how to bill for a placebo?
(Source: BMJ Comments)
Source: BMJ Comments - July 28, 2020 Category: General Medicine Source Type: forums

Sign NANS Petition to Fix CDC Guidelines to Include IPM
Petition Call to Action – CDC Opioid Guidelines www.ipetitions.com "As part of the process of creating the next edition of the guidelines, we urge the CDC to recommend that patients with chronic pain lasting for more than 3 months, be referred to a pain management specialist, who can assist in determining the precise cause of the pain and thereby best help guide treatment through a multimodal platform that may include nonopioid medications, minimally... Sign NANS Petition to Fix CDC Guidelines to Include IPM (Source: Student Doctor Network)
Source: Student Doctor Network - June 8, 2020 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums

Electronic prescribing of controlled substances: building a momentum for chronic pain patients
(Source: BMJ Comments)
Source: BMJ Comments - April 2, 2020 Category: General Medicine Source Type: forums

HEART score in chronic chest pain
I'm sure we all have them. The high HEART score patient with chronic chest pain who comes back every 2-3 days. I'm curious how you handle them as I got into a fight with one of my PAs who was angry I wouldn't admit the HEART score 5 chronic chest painer with 3 admissions already this month. I usually document "Patient has chronic chest pain, and this is unchanged from baseline. Workup shows no evidence of acute ischemia". Some of my colleagues admit these every single time and don't... HEART score in chronic chest pain (Source: Student Doctor Network)
Source: Student Doctor Network - March 29, 2020 Category: Universities & Medical Training Authors: GeneralVeers Tags: Emergency Medicine Source Type: forums

Medical management of chronic low back pain with Modic 1 changes: treatment by antibiotics or advice on probiotics?
(Source: BMJ Comments)
Source: BMJ Comments - March 17, 2020 Category: General Medicine Source Type: forums

Suspending CDC Opioid Guidelines During COVID-19 Crisis?
Which parts of the 2016 CDC Guidelines are reasonable and necessary to suspend during a pandemic? Considering Whether to Use Opioids for Chronic Pain Management Recommendation 1. Prioritize nonpharmacologic and nonopioid pharmacologic pain management strategies, unless the expected benefits of opioids for both pain and function are anticipated to outweigh risks to the patient. Recommendation 2. Establish treatment goals with patients that include realistic pain and function... Suspending CDC Opioid Guidelines During COVID-19 Crisis? (Source: Student Doctor Network)
Source: Student Doctor Network - March 15, 2020 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums

Stocking up on supplies for COVID-19 pandemic
We've stocked up on anticipated medical supplies, mask-respirators, and even canned goods/bottle water/ready-to-eat meals anticipating supply chain disruption. Have also notified scheduled med refill patients about possible disruption in chronic opioid refill interval changes. (Source: Student Doctor Network)
Source: Student Doctor Network - March 7, 2020 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums

Actiq for chronic pain
So I inherited a patient on actiq and fentanyl patch for>6 years. She states its the only thing that works. I told her Actiq is usually only for cancer pain and she showed me the REMS registration that says it can be used for non cancer pain. I am still planning on telling her to find another provider because I don't feel comfortable having patients on that. Is that unreasonable of me? She has been taking the medication safely for many years but I simply do not feel comfortable with... Actiq for chronic pain (Source: Student Doctor Network)
Source: Student Doctor Network - February 27, 2020 Category: Universities & Medical Training Authors: Nonphysiologic Tags: Pain Medicine Source Type: forums

Re: Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial
(Source: BMJ Comments)
Source: BMJ Comments - February 20, 2020 Category: General Medicine Source Type: forums

Beth Darnall, PhD, Says De-Prescribing Can Be Risky...
Life after opioids: 'We have not served our patients well' More than 3 million Australians are living with chronic pain, and the medical system is struggling to help them as it turns away from its reliance on opioids www.theguardian.com “You may have a patient that has been on a stable dose of opioids for 10 years, and then you start de-prescribing. We are now exposing them to new risks for opioid overdose, for suicidality, for actual suicide, for withdrawal symptoms, for increased pain.” People living in chronic pain are a hi...
Source: Student Doctor Network - February 17, 2020 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums

Indication for Suprascapular Injection?
What type of chronic shoulder pain do you consider suprascap for? OA? Rotator Cuff? Post Op? (Source: Student Doctor Network)
Source: Student Doctor Network - January 30, 2020 Category: Universities & Medical Training Authors: Blitz2006 Tags: Pain Medicine Source Type: forums

Re: Chronic use of tramadol after acute pain episode: cohort study
(Source: BMJ Comments)
Source: BMJ Comments - January 4, 2020 Category: General Medicine Source Type: forums

Blood Patch?
Alright, I had an OB pt yesterday that a colleague put an epidural in. She has a long history of spinal issues (repaired tethered cord, repaired scoliosis fused from T4-L4). First attempt his epidural did nothing. Second attempt he thought was successful, but produced profound analgesia and was obviously intrathecal. This is a sound and experienced individual placing the epidural. Now she's got a horrible spinal HA. She's also a chronic pain nightmare. I can't reasonably say that doing a... Blood Patch? (Source: Student Doctor Network)
Source: Student Doctor Network - January 2, 2020 Category: Universities & Medical Training Authors: Pharmado Tags: Anesthesiology Source Type: forums

Re: Chronic use of tramadol after acute pain episode: cohort study
(Source: BMJ Comments)
Source: BMJ Comments - December 30, 2019 Category: General Medicine Source Type: forums

Game-changer: New Guidelines for Interosseous Ablation of Basivertebral Nerve
ISASS Guideline – Intraosseous Ablation of the Basivertebral Nerve for the Relief of Chronic Low Back Pain – ISASS – The International Society for the Advancement of Spine Surgery ISASS - The International Society for the Advancement of Spine Surgery www.isass.org "Intraosseous ablation of the basivertebral nerve is a relatively new minimally invasive treatment for the relief of CLBP that is diagnosed using well-established clinical and MR imaging findings. The procedure is supported by Level I evidence including 2 RCTs demon...
Source: Student Doctor Network - December 24, 2019 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums

Chronic Pain – Where to start?
Hi guys! Im starting a fellowship in Interventional Chronic Pain in Canada next July. I have some free time before and want to prepare myself as much as possible cause in my residency Chronic Pain exposure was 0, so im pretty at a lost with everything. I just finished a regional fellowship so US and blocks related stuff is pretty solid. TL;DR = Looking for recommendation on good textbook/sources to start getting acquainted with this field. As always, thanks in advance. (Source: Student Doctor Network)
Source: Student Doctor Network - December 13, 2019 Category: Universities & Medical Training Authors: JWebar Tags: Anesthesiology Source Type: forums

How do you deal with those pain sesking patients?
I have this 20 year old male on dialysis secondary to uncontrolled diabetes who came in with intractable abdominal pain nausea and vomiting.Dont get me wrong hes not on any chronic opiod regimen so dont want to jump to conclusions but his pain is 20/10 getting fentanyl 25 q3 hrs. Ct abdomen completely normal. Egd normal. BP normal, Labs nml Tried reglan for concern for gastroparesis yet nothing. Tried to wean this guy off fentanyl and his mom throws a tantrum that he is in so much pain. No... How do you deal with those pain sesking patients? (Source: Student Doctor Network)
Source: Student Doctor Network - December 7, 2019 Category: Universities & Medical Training Authors: Cadet133 Tags: Internal Medicine and IM Subspecialties Source Type: forums

Physician gets fined for tapering off?
Portsmouth doctor reprimanded for treatment of chronic pain patient CONCORD — A Portsmouth doctor has been reprimanded and fined by the New Hampshire Board of Medicine after he cut back a chronic pain patient’s prescription opioid painkillers — and www.unionleader.com Pretty f-ed up scenario. I thought boards are there to protect us healthcare professionals. So does this mean everything is state dependent and they can screw you over for whatever reason? (Source: Student Doctor Network)
Source: Student Doctor Network - December 4, 2019 Category: Universities & Medical Training Authors: Chrish Tags: Pharmacy Source Type: forums

Can some one tell me how this case makes sense?
Portsmouth doctor reprimanded for treatment of chronic pain patient CONCORD — A Portsmouth doctor has been reprimanded and fined by the New Hampshire Board of Medicine after he cut back a chronic pain patient’s prescription opioid painkillers — and www.unionleader.com I don’t understand this. Maybe the taper was too quick but I felt like he took appropriate measures even warning local authorities and primary care provider. I really don’t know what he was supposed to do? What am I missing? I actually have one patient ...
Source: Student Doctor Network - November 27, 2019 Category: Universities & Medical Training Authors: Nonphysiologic Tags: Pain Medicine Source Type: forums

Re: Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial
(Source: BMJ Comments)
Source: BMJ Comments - November 27, 2019 Category: General Medicine Source Type: forums

Can pain pumps reduce oral opioid consumptions?
Error - Cookies Turned Off "Our study showed 81.5% of patients with chronic noncancer pain reduced their average daily opioid dose immediately prior to or in the 395 days following implantation of an intrathecal drug‐delivery system. Overall, 43% of patients discontinued systemic opioids following implantation of an intrathecal drug‐delivery system, with discontinuation associated with significantly lower costs from a payer... Can pain pumps reduce oral opioid consumptions? (Source: Student Doctor Network)
Source: Student Doctor Network - November 20, 2019 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums

Re: Management of chronic pain using complementary and integrative medicine
(Source: BMJ Comments)
Source: BMJ Comments - November 7, 2019 Category: General Medicine Source Type: forums

Re: Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial
(Source: BMJ Comments)
Source: BMJ Comments - November 5, 2019 Category: General Medicine Source Type: forums

Chronic pain is rising in many countries
(Source: BMJ Comments)
Source: BMJ Comments - October 27, 2019 Category: General Medicine Source Type: forums

ESIs on possible surgical patients?
Just curious how those more experienced than me would handle this. Young person comes in subacute pain, imaging shows chronic pars defects with grade I listhesis and nasty looking HNPs at L4-5 and L5-1 Book the patient for an ESI, when they come back for the procedure a couple weeks later now they have mild dorsiflexion weakness that they didn't have before and severe pain. Because of this person's age and occupation, trying to treat somewhat aggressively and am reaching out to ortho... ESIs on possible surgical patients? (Source: Student Doctor Network)
Source: Student Doctor Network - October 26, 2019 Category: Universities & Medical Training Authors: Baron Samedi Tags: Pain Medicine Source Type: forums

Re: Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial
(Source: BMJ Comments)
Source: BMJ Comments - October 26, 2019 Category: General Medicine Source Type: forums

Pain Medicine is an Official Subspecialty of Emergency Medicine
Just a reminder. This fellowship exists for you. I just got a private message from another Emergency Physician who matched in Pain. EM people are getting in and have been for years now. If you like cool procedures, it might be worth looking into. If you want more control over your life, schedule and patient population, if constantly changing shifts gives you chronic circadian rhythm dysphoria that you don't think you can sustain until retirement, it might be worth looking into. The... Pain Medicine is an Official Subspecialty of Emergency Medicine (Source: Student Doctor Network)
Source: Student Doctor Network - October 17, 2019 Category: Universities & Medical Training Authors: Birdstrike Tags: Emergency Medicine Source Type: forums

Re: Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial
(Source: BMJ Comments)
Source: BMJ Comments - October 17, 2019 Category: General Medicine Source Type: forums

NPR: Low Dose Naltrexone Can Help Some with Chronic Pain
In Tiny Doses, An Addiction Medication Moonlights As A Treatment For Chronic Pain Naltrexone, commonly used for opioid and alcohol use disorders, may also help patients with chronic pain — when prescribed in microdoses. But few doctors or patients seem to know about it. www.npr.org "Those patients may report that this is indeed a game changer," Vrooman says. "It... NPR: Low Dose Naltrexone Can Help Some with Chronic Pain (Source: Student Doctor Network)
Source: Student Doctor Network - September 27, 2019 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums

WaPo: Opioid Crackdown Forces Chronic Pain Patients Off Meds
https://beta.washingtonpost.com/health/opioid-crackdown-forces-pain-patients-to-taper-off-drugs-they-say-they-need/2019/09/10/3920f220-c8da-11e9-a4f3-c081a126de70_story.html?fbclid=IwAR3JRUBkVb5Arcc0YomrjBrmVmJ_FwSr8-mlz1bE3vt02joHJBuN_PuAl3U "The United States is now in the midst of a “national experiment” as misguided as the one it conducted 20 years ago, when doctors put millions of patients on opioids with little understanding of the consequences, says... WaPo: Opioid Crackdown Forces Chronic Pain Patients Off Meds (Source: Student Doctor Network)
Source: Student Doctor Network - September 13, 2019 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums

Re: Gabapentinoids should not be used for chronic low back pain, meta-analysis concludes
(Source: BMJ Comments)
Source: BMJ Comments - September 3, 2019 Category: General Medicine Source Type: forums

Be my devils advocate, why shouldn't you do Neurology?
I am very interested in Neurology as a specialty choice. The nervous system, brain and all the amazing pathology. No other specialty made me want to come in on the weekend to see patients. It sounds like a great specialty choice, but as a student I only know so much about what happens in the real word. So be my devils advocate. Help me make an informed decision on a career. Is it the chronic pain patients? The relationships between other specialties? Is it the pressure put on administration... Be my devils advocate, why shouldn't you do Neurology? (Source: Student Doctor Network)
Source: Student Doctor Network - August 11, 2019 Category: Universities & Medical Training Authors: neuro4me Tags: Neurology Source Type: forums

Re: What does chronic pain look like?
(Source: BMJ Comments)
Source: BMJ Comments - August 7, 2019 Category: General Medicine Source Type: forums

Re: Chronic use of tramadol after acute pain episode: cohort study
(Source: BMJ Comments)
Source: BMJ Comments - July 19, 2019 Category: General Medicine Source Type: forums

Chronic pain after near fatal swatting.
Swatting a Fly Without Killing It May Cause It Pain for the Rest of Its Life, Study Finds — Gizmodo Barely missing a fatal slap at a bothersome fly might be a headache for both of you, according to new research from scientists at the University of Sydney. They say they’ve found evidence that insects are capable of feeling chronic pain after an injury, much like we do. What’s more, studying why... apple.news Treatment algorithms? CBT? (Source: Student Doctor Network)
Source: Student Doctor Network - July 16, 2019 Category: Universities & Medical Training Authors: lobelsteve Tags: Pain Medicine Source Type: forums

Kevin MD: Doctors being killed for not writing opioids...
Physicians are being murdered for not prescribing opioids I would argue that a large portion of what we are truly treating with chronic opioid therapy is psychological. www.kevinmd.com "Why is it that I as a double board certified pain physician have to consider whether or not I should have a firearm in my office to protect myself or my staff? Should I carry one at home in the event someone tries to find me or my children? It is easy to think, “Wow, this lady needs some Zoloft and a few... Kevin MD: Doctors being killed for not writing ...
Source: Student Doctor Network - July 16, 2019 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums

Psychiatric letter of medical necessity for a surgical procedure
I have an adolescent female patient who wants to get a breast reduction due to the effects her breast size have had on her, contributing to her depression and causing chronic pain. She has been wanting to have this procedure for more than a year but just recently brought it up to me. She has already met with a surgeon who recommended the procedure, and suggested she meet with me to talk about this. After discussing the impact this has had on her life, I agree that she would likely benefit... Psychiatric letter of medical necessity for a surgical procedure (Source: Student Doctor Network)
Source: Student Doctor Network - July 12, 2019 Category: Universities & Medical Training Authors: SpongeBob DoctorPants Tags: Psychiatry Source Type: forums

Suicidal pt due to chronic pain
Are there any good treatments for a lady on the inpatient unit that was admitted because of suicidal ideation due to chronic pain. She’s had many surgeries in the past and as a result has chronic pain all day only relieved by tons of opioids which were stopped by her pain medicine doc. She’s still on 7.5 mg Percocet 4x a day but that’s not enough she says. If her pain was manageable she would be able to move around the house and do stuff and be less depressed and suicidal but I can’t really... Suicidal pt due to chronic pain (Source: Student Doctor Network)
Source: Student Doctor Network - July 4, 2019 Category: Universities & Medical Training Authors: Merely Tags: Psychiatry Source Type: forums

For those of your prescribing opioids?
For those of your prescribing opioids, what percentage of your COT pts are on>90MME for chronic non cancer pain? (Source: Student Doctor Network)
Source: Student Doctor Network - June 25, 2019 Category: Universities & Medical Training Authors: thecentral09 Tags: Pain Medicine Source Type: forums