CRPS preventative anesthesia plan
I'm PMR/Pain. I have a long standing patient who I've been treating for chronic right SIJ dysfunction and mild left knee OA. Patient is a early 50s RN and previously underwent steroid injections to left knee and right SIJ without issues, but demonstrated moderate but noticeable hyperalgesia when I gave her a left ankle injection last year after she tore her lateral ankle ligaments and failed PT/orthotics.
She needs a brostrum and calcaneal osteomy for left ankle instability/hindfoot varus...
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Source: Student Doctor Network - March 15, 2023 Category: Universities & Medical Training Authors: bedrock Tags: Anesthesiology Source Type: forums
Cochrane review concludes SCS is ineffective for chronic low back pain
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD014789.pub2/full
“Authors' conclusions
Data in this review do not support the use of SCS to manage low back pain outside a clinical trial. Current evidence suggests SCS probably does not have sustained clinical benefits that would outweigh the costs and risks of this surgical intervention.” (Source: Student Doctor Network)
Source: Student Doctor Network - March 9, 2023 Category: Universities & Medical Training Authors: Agast Tags: Pain Medicine Source Type: forums
Re: Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials
(Source: BMJ Comments)
Source: BMJ Comments - March 7, 2023 Category: General Medicine Source Type: forums
just another kypho question
T12 compression fracture work related injury
initial compression 1 year ago, presented to me 3 months ago with worsening pain.
T12 compression worsening (acute on chronic). radiologist initially called chronic compression but i thought i saw edema on STIR (right side pic). spoke to another radiologist who agrees with subacute edema.
to kypho or not is the question. pain still 8/10. anterior portion almost vertebra plana, and protruding back with mild-mod...
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Source: Student Doctor Network - February 18, 2023 Category: Universities & Medical Training Authors: TIVAndy Tags: Pain Medicine Source Type: forums
Buprenorphine for Chronic Pain, Not Full Agonist Opioids, New VA Guidance Says
Unintended consequences of the recommendation need to be evaluated, experts maintain
www.medpagetoday.com
Could radically change day to day practice if they pilot this in the VA then move to the public (Source: Student Doctor Network)
Source: Student Doctor Network - February 16, 2023 Category: Universities & Medical Training Authors: TheLoneWolf Tags: Pain Medicine Source Type: forums
Extrapedicular Vertebral Augmentation
First time I have reason to do a true extrapedicular kypho. 60 y/o M on chronic glucocorticoids presents with severe low back pain. Edema noted at L3 and L4, patient with prior instrumented fusion at L4-5.
Screws are fairly superior at L4, so I was planning on using Beall's extrapedicular inferior end plate access, aka low and outside (3rd picture).
Since I hadn't augmented a fused level before, Stryker connected me to one of their KOLs. He was...
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Source: Student Doctor Network - February 10, 2023 Category: Universities & Medical Training Authors: manowar rules Tags: Pain Medicine Source Type: forums
Re: Rethinking use of medicines for chronic pain; involving people with chronic pain and those that recovered
(Source: BMJ Comments)
Source: BMJ Comments - February 10, 2023 Category: General Medicine Source Type: forums
Sedation protocols for RFA/rhizotomy
In med school/residency, 5-10 years ago we did these with a wiff of versed and copious local in the office.
New pain guys want essentially a motionless field, GA without an airway/ deep heavy propofol sedation in the OR.
Sometimes they are just too fat or sick and there is no way to make this happen.
Couple weeks back had a BMI 50 anxious chronic pain patient for bilateral c3-5 RFA. Usually I’d just tell pain guy I’m going to give a wiff of versed and deal with it. they expect more...
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Source: Student Doctor Network - January 17, 2023 Category: Universities & Medical Training Authors: DocMcCoy Tags: Anesthesiology Source Type: forums
NYT Op_Ed on Chronic Pain & Suicide
Opinion | ‘Entire Body Is Shaking’: Why Americans With Chronic Pain Are Dying
American medicine and law enforcement continue to fight the last opioid war.
www.nytimes.com
"It is not the fault of people who suffer pain that America has an addiction problem. Denying them access to needed medication helps no one." (Source: Student Doctor Network)
Source: Student Doctor Network - January 3, 2023 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums
The Successful Pain Medicine Fellowship Applicant
Hello!
Check out our blog for those applying to pain fellowships this cycle!
Pain Medicine Fellowship: Factors for a Successful Applicant
Chronic pain medicine fellowships have been increasingly popular in recent times. In the 2022 appointment year match, 84.5% of applicants secured an ACGME-accredited Pain Medicine fellowship through the NRMP (362 of 428)...
medicaladvisingcenter.com (Source: Student Doctor Network)
Source: Student Doctor Network - December 9, 2022 Category: Universities & Medical Training Authors: MedicalAdvisingCenter Tags: Pain Medicine Source Type: forums
I told OpenAI to Prescribe treatment for chronic back pain in the style of Eminem
Fun link from r/medicine
ChatGPT
A conversational AI system that listens, learns, and challenges
chat.openai.com
“Prescribe treatment for chronic back pain in the style of Eminem”
First, I gotta give a shout out to my homie with chronic back pain
You need some relief, bro, you can't be living in constant strain
So here's the prescription, my man, listen up
No more popping pills, no more trying to tough it out
First, gotta stretch it out, get that spine aligned Yoga, Pilat...
Source: Student Doctor Network - December 4, 2022 Category: Universities & Medical Training Authors: Agast Tags: Pain Medicine Source Type: forums
Clinic visit prior to Kypho?
Patient with h/o of compression fxs comes in to clinic with acute on chronic back pain. Following day MRI shows acute thoracic compression fracture.
Question: Do I need to bring the patient back into clinic to review the MRI and order Kyphoplasty or can I just schedule and do an addendum to my most recent clinic note?
This patient has Medicare which does not require prior auth.
She has had prior Kypho with me this year and already indicated that she would want repeat procedure if new...
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Source: Student Doctor Network - November 23, 2022 Category: Universities & Medical Training Authors: oneforfighting Tags: Pain Medicine Source Type: forums
Deciding between two jobs
I've been going back and forth between these two jobs. So thought I'd post this here and maybe get some insight.
Job 1 (current job):
-Private group practice
-$420k salary (note: I'm in a no income tax state) - no bonuses of any kind, just flat salary.
-7 hour work days
-See ~25 patients on clinic days, probably do ~40 fluoro procedures a week in office. Very efficient workflow.
-Moderate amount of chronic opioid prescribing, but all pretty low doses (<60 MME). Really dislike this aspect...
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Source: Student Doctor Network - November 16, 2022 Category: Universities & Medical Training Authors: Forwho Tags: Pain Medicine Source Type: forums
JAMA's Fake Science/Hit Piece on SCS for Chronic Radic after Spine Surgery
If I were an SCS KOL, I'd be pissed...
Effect of Spinal Cord Burst Stimulation vs Placebo Stimulation on Disability in Patients After Lumbar Spine Surgery
This placebo-controlled, crossover randomized clinical trial compares the effects of spinal cord burst stimulation vs placebo stimulation in patients with chronic radiculopathy after surgery for degenerative lumbar spine disorders.
jamanetwork.com (Source: Student Doctor Network)
Source: Student Doctor Network - October 19, 2022 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums
SCS & PNS LCD Proposal by CMS - all neurostimulator practitioners should be acting on this now
Hey everyone,
The time has finally come for the CMS to screw with SCS and PNS LCD
PNS Is being affected, and also the proposal limits SCS/PNS to just ONE TIME per lifetime of the patient.
(1) patient with CRPS of the legs, gets SCS for that, and later it spreads the arms, they are screwed.
(2) Patient with SCS for lumbar postlaminectomy who later gets cervical ACDF but has chronic radic pain in the arm is also SOL.
(3) same goes for shoulder replacement and knee replacement patient with...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - September 22, 2022 Category: Universities & Medical Training Authors: -Sojourner- Tags: Pain Medicine Source Type: forums
