question...
Greetings.
What do you say to your patients, who arent really looking for opioids, but have side effects to gabapentin, lyrica, nortyptiline and cymbalta...
They do say that ibuprofen works, etc...
lets take chronic lumbar radicular pain not responsive to ESIs in a 64 year old patient as an example. lets say that the patient does not want surgery or SCS trial or "anything invasive" - which I personally understand also. a lot of my elderly patients are reluctant to this, and also do not...
question... (Source: Student Doctor Network)
Source: Student Doctor Network - April 21, 2017 Category: Universities & Medical Training Authors: neutro Source Type: forums
Why do you have to do 3 years of IM before you can even subspecialize?
I get that internal medicine is the basis of all medicine subspecialities but shouldn't doing just 1 year of internship be enough before you subspecialize? If anesthesiology and radiology can do it, why can't we? And for the most part as an internist you're pretty much consulting other services anyway when someone shows up with something interesting (or even routine like CHF) and you're left managing the boring stuff like pain meds, social work, disposition and meds for their chronic...
Why do you have to do 3 years of IM before you can even subspecialize? (Source: Student Doctor Network)
Source: Student Doctor Network - February 26, 2017 Category: Universities & Medical Training Authors: Lord_Vader Source Type: forums
ultrasound in chronic pain
If starting a new practice , typical private practice set up (would count towards my overhead) would you recommend renting an old ultrasound machine for a few abdominal pain (ilioinguinal) blocks, stellates, occipital rds, etc procedures? Hate to lose those patients to another provider who would do those just bc I don't have ultrasound (Source: Student Doctor Network)
Source: Student Doctor Network - February 17, 2017 Category: Universities & Medical Training Authors: painfree23 Source Type: forums
Question from a PCP
I'm curious as to how many fellowship trained Pain Medicine physicians actually prescribe medications, or if what we are seeing in my area is the norm? Basically, referral to a "Pain Management" physician is futile, as unless the patient is wanting a procedure, they are refused any treatment, or denied. We have a significant population on higher doses of chronic narcs that many of us (PCP's) simply are not comfortable managing. These are almost always "inherited" patients....meaning, the...
Question from a PCP (Source: Student Doctor Network)
Source: Student Doctor Network - February 16, 2017 Category: Universities & Medical Training Authors: MJB Source Type: forums
Stereotactic radiation lung mass without biopsy
I am a pain management physician who is active on another forum. While I know that SDN Is not a place for medical advice I hope you will answer a question in general terms. 91 year old former smoker with multiple medical problems including COPD on chronic oxygen therapy and low dose steroids. However she is cognitively 100% intact. Incidentally found on chest CT is left upper lobe mass approx 3 cm in size. Not present on CT one year prior. In younger healthier patient she would be candidate...
Stereotactic radiation lung mass without biopsy (Source: Student Doctor Network)
Source: Student Doctor Network - February 13, 2017 Category: Universities & Medical Training Authors: NJPAIN Source Type: forums
Sean Mackey on Pain Medicine's Civil War
https://www.statnews.com/2017/01/17/chronic-pain-management-opioids/
“There’s almost a McCarthyism on this, that’s silencing so many people who are simply scared,” said Dr. Sean Mackey, who oversees Stanford University’s pain management program.
“The thing is, we all want black and white. We don’t do well with nuance. And this is an incredibly nuanced issue.” (Source: Student Doctor Network)
Source: Student Doctor Network - January 20, 2017 Category: Universities & Medical Training Authors: drusso Source Type: forums
Inherited opioid pts
Hello everyone
I was hoping for some advice from people that have been in a similar situation. I practice at a relatively underserved area with very few pain doctors. Recently a neighboring pain doctor retired and there is pressure from my institution to absorb his patients. He didn't run a pill mill or anything but he does have about 100 patients on chronic opioids, none exceeding 120 morphine equivalents.
My question is, what is the general philosophy concerning inherited patients. For...
Inherited opioid pts (Source: Student Doctor Network)
Source: Student Doctor Network - January 13, 2017 Category: Universities & Medical Training Authors: heathermed Source Type: forums
Currently in fellowship and hating it.....thoughts?
Hello all. It is not my intention to insult anyone here. I came to my pain management fellowship through anesthesia. It is not what I expected (or hoped, I guess). While I enjoy the procedures, especially SCS, there is so much of this fellowship I really don't like, including the tedious monotony of clinic (I hate doing H&P after H&P) and the chronic pain patients and their defeatist attitudes just bum me out.
I know some of the things I don't like about fellowship go away or get better...
Currently in fellowship and hating it.....thoughts? (Source: Student Doctor Network)
Source: Student Doctor Network - January 2, 2017 Category: Universities & Medical Training Authors: stormtrooper123 Source Type: forums
Do NSAIDS cause chronic pain?
An unhealed injury becomes a chronic injury which sometimes leads to chronic pain. NSAIDS alter the inflammatory healing cascade and may delay healing. So, is using NSAIDS for an acute injury increasing risk of developing chronic pain?
I've asked orthopedic surgeons about NSAID use after surgery of various types and some say avoid NSAIDS after any type of bone, tendon or ligament surgery and some say use it prn. No consensus.
Any studies with a definitive answer? (Source: Student Doctor Network)
Source: Student Doctor Network - December 29, 2016 Category: Universities & Medical Training Authors: SpineBound Source Type: forums
suprascapular nerve block and radiofrequency ablation
Has anyone have any experience performing suprascapular nerve blocks and, if the blocks were successful, radiofrequency ablations of the suprascapular nerve for treatment of chronic shoulder pain? If so, what are the landmarks and techniques you use to perform both the block and the radiofrequency ablation of the suprascapular nerve? As the suprascapular nerve contains both sensory and motor fibers, I am also curious to know why radiofrequency ablation of the suprascapular nerve does not...
suprascapular nerve block and radiofrequency ablation (Source: Student Doctor Network)
Source: Student Doctor Network - December 27, 2016 Category: Universities & Medical Training Authors: promethius Source Type: forums
A sedentary PA specialty??
Hi there,
I'm 23 and I've wanted to work in a clinical care setting for many years.
I currently work in a pathology lab.
I was pre-med in college and shadowed some surgeons and family-docs, however I think the PA route is better for me.
Unfortunately I spend my day mostly on my feet doing lab stuff, but I don't think I can do this much longer due to previously fractured vertebrae and pelvis. I have a lot of chronic pain.
I like pathology since if you are reading slides it does NOT...
A sedentary PA specialty?? (Source: Student Doctor Network)
Source: Student Doctor Network - December 26, 2016 Category: Universities & Medical Training Authors: ElJamo17 Source Type: forums
Chronic Pain Case
I don't know how this will go over here but here goes.
My group was consulted to assist with pain control on an inpt with new onset rectal cancer undergoing radiation and chemo after having a diverting colostomy. He is otherwise healthy but has some psych issues which have not been fully determined. Middle aged, 5'10" 180lbs. No home meds. No allergies on admission. Fentanyl was added as an allergy after admission because of hallucinations. Pain meds tried are fentanyl patch,...
Chronic Pain Case (Source: Student Doctor Network)
Source: Student Doctor Network - November 24, 2016 Category: Universities & Medical Training Authors: Noyac Source Type: forums
Cervical facet issues post MVA but nothing on MRI
Question:
I have a patient who had no pre-existing chronic pain. Was rear ended. Has had pretty debilitating neck pain for several months now, seems to be getting worse. Has failed all the conservative stuff.
On history and exam, has all the signs of being facetogenic... not even really any myofascial tenderness to speak off, nothing radicular, and worse with neck ROM.
He did have a cervical flex ex that was normal, and no comments about his facets. Also his MRI does not show...
Cervical facet issues post MVA but nothing on MRI (Source: Student Doctor Network)
Source: Student Doctor Network - November 16, 2016 Category: Universities & Medical Training Authors: Timeoutofmind Source Type: forums
pain control admissions
When do pts get admitted for pain control? Specifically, backpain, but any pain in general.
I had a pt with low back pain after camping on an airmattress and lifting her 35 pound little kid. she is set up for "an injection" for her chronic back pain in 2 days but came to the ER so she could be admitted for her pain and get some rest (she has 3 kids she tells me) and get the shot sooner. Completely normal neuro exam. In fact, I met her while she was walking back from the bathroom. She...
pain control admissions (Source: Student Doctor Network)
Source: Student Doctor Network - November 9, 2016 Category: Universities & Medical Training Authors: RevEM Source Type: forums
Hi, I'm a Chiropractor :)
It's clear to me after reading so many of the posts in this forum of Pain Medicine that most MD'S still think DC'S are quacks or have had poor experiences with them. I'm sorry on the behalf of my community. Not all of us wave a magic wand over patients who are lying on our table, then demand they stop taking their lisinopril. I'll start by saying I see many of your chronic pain patients. Also, that I didn't study from the Harry Potter series before any of my exams or the national boards....
Hi, I'm a Chiropractor (Source: Student Doctor Network)
Source: Student Doctor Network - November 4, 2016 Category: Universities & Medical Training Authors: DC-holla Source Type: forums
