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 28, 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 16, 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 highly mar...
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 29, 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 demonstrating a s...
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
