Post RFA Neuritis
Long time SDN lurker and I appreciate the wisdom of the docs in this forum. I've been out of fellowship about 1 year. Just wanted to get everyones thoughts on Post RFA neuritis (have had a few over the past year). Prescribed some neuropathic agens such as gabapentin vs lyrica vs duloxetine with modest benefit. Haven't found a whole lot of literature on any treatment algorithm. Have spoken to a few attendings about this in the past other options po steroid dose pack, vs doing mbbs at...
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Source: Student Doctor Network - December 6, 2023 Category: Universities & Medical Training Authors: schmee90 Tags: Pain Medicine Source Type: forums
chest pain
A patient for the group... 44yo F with a couple year history of right> left anterior chest pains along the lateral sternal border. She is allergic to NSAIDs. She wound up undergoing a breast reduction surgery to see if that would help. It did not. I performed some costochondral/sternocostal injections with steroid that were really quite helpful for a month or so. But then pains returned. Topicals and various oral medications (duloxetine, pregabalin, etc) have been tried in the past...
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Source: Student Doctor Network - May 4, 2023 Category: Universities & Medical Training Authors: Pain_doc Tags: Pain Medicine Source Type: forums
Algorithm for GAD
Wondering of some of the more experienced practitioners here can comment on their general GAD algorithm, or how they conceptualize GAD.
I've essentially boiled it down to a 3 level system as such:
First line, therapy and medicine (SRI - escitalopram or sertraline)
Second line, reiterate they should try therapy. Medication wise class switch to SNRI (duloxetine preferred)
Third line, reiterate that at this point medications are less established to work, and therapy is the most likely option...
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Source: Student Doctor Network - December 13, 2022 Category: Universities & Medical Training Authors: mistafab Tags: Psychiatry Source Type: forums
Medication monitoring
We have been having some discussions about what type of labs are needed and how often for medications. I am curious what if any labs do you do and how often for certain medications. Obviously if the patient has underlying medical issues this will change.
Amitriptyline: We do not check anything
Duloxetine/Venlafaxine: Do not check anything
Gabapentin/Lyrica: Right now we are being asked to check yearly kidney function, I don't really see the need to do this unless underlying kidney issues...
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Source: Student Doctor Network - June 20, 2022 Category: Universities & Medical Training Authors: kstarm Tags: Pain Medicine Source Type: forums
Has the "no opioid" thing gone too far or is it reasonable?
In my personal style of practice so far, I've found myself to be extremely reluctant to prescribe opioids in the outpatient setting. In the hospital, sure, if it's needed. But in the clinic? It seems like my mindset has been molded from day 1 to almost never prescribe them.
But then there are chronic pain patients who have objective imaging findings that correlate with their pain. They're on every lyrica, nsaid/tylenol, duloxetine and whatever cocktail you can think of and have done PT...
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Source: Student Doctor Network - April 3, 2022 Category: Universities & Medical Training Authors: MedicineZ0Z Tags: Family Medicine Source Type: forums
Duloxetine Useless of OA-related Pain
Muddled Picture for Antidepressant as Osteoarthritis Pain Reliever
Trial in primary care setting fails to confirm benefit seen in specialty clinics
www.medpagetoday.com (Source: Student Doctor Network)
Source: Student Doctor Network - February 6, 2022 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums
when all the usual treatment options have failed
Curious to know what you tell your patients when all the usual treatment options have failed? Especially the outside of the box, alternative options, perhaps not necessarily with strong evidence support?
By usual treatments, I am thinking:
1) Non-opioid meds: Tylenol, NSAIDs, muscle relaxers, anti-depressants (e.g. duloxetine), anti-neuropathic meds (e.g. gabapentin)
2) Tramadol
3) PT, exercise
4) chiropractic
5) acupuncture
6) injections, RFA
7) surgery
And then maybe take it one step...
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Source: Student Doctor Network - August 2, 2021 Category: Universities & Medical Training Authors: ctts Tags: Pain Medicine Source Type: forums
Chronic testicular pain
Pudendal, Genitofemoral, ilioinguinal, all failed. Lyrica, Cymbalta, Narcs, Gabapentin, tramadol, anti depressant all fail. MRI of spine is perfect. Someone tried TFESI without success. Ideas? Would SCS help? Will insurance cover? Thanks (Source: Student Doctor Network)
Source: Student Doctor Network - November 22, 2020 Category: Universities & Medical Training Authors: gator2886 Tags: Pain Medicine Source Type: forums
Patient can't stop moving while under GA! SSRI implicated?
62 y/o F, on Cymbalta x 25 years and amlodipine x 5 years for htn. Nervous Nelly in OR. Knee scope, surgeon likes GA.
Easy everything. At 1.0 MAC Sevo for start of operation. Pt moves. I do the usual (prop bolus, increase sevo), surgeon
tries again, again patient moving like crazy. Again, I deepen-pt still moving! Fed up with looking like a spam sandwich,
I give 30 mg rocuronium, after which she finally stops moving. What gives? Only thing I could think of was the Cymbalta-I
vaguely...
Patient can't stop moving while under GA! SSRI implicated? (Source: Student Doctor Network)
Source: Student Doctor Network - October 4, 2020 Category: Universities & Medical Training Authors: soorg Tags: Anesthesiology Source Type: forums
What do you guys prefer for neuropathic pharm treatment?
I'm a Psych resident, hoping to go into pain.
Anyways, our program, if we have a patient with depression and neuropathic pain, we seem to always jump straight for Cymbalta.
Was interested what the literature/your anecdotal data suggests for neuropathic pain? Effexor? Elavil? Neurontin?
Is Cymbalta the best? (Source: Student Doctor Network)
Source: Student Doctor Network - August 21, 2020 Category: Universities & Medical Training Authors: Blitz2006 Tags: Pain Medicine Source Type: forums
Safe to prescribe SNRI + Wellbutrin?
I Know officially Wellbutrin is NDRI.
So I'm concerned about the norepinephrine levels, and using wellbutrin as an adjunct to Cymbalta or Effexor for depression.
Should I avoid, or am I overthinking/wrong on this?
Thanks (Source: Student Doctor Network)
Source: Student Doctor Network - January 17, 2020 Category: Universities & Medical Training Authors: Blitz2006 Tags: Psychiatry Source Type: forums
Cervical radiculopathy
I have a young male patient with bothersome right hand paresthesias consistent with radiculopathy, tried gabapentin but had some sexual dysfunction so will not try anything else with that potential side effect (TCA, Cymbalta). NSAID not helpful, doesn't want anything "stronger" than that. Tried a bunch of muscle relaxants per PCP without help. CESi somewhat helpful. PT no help, chiro no help...any reccs on something else to help without affecting his libido? (Source: Student Doctor Network)
Source: Student Doctor Network - November 13, 2019 Category: Universities & Medical Training Authors: Bsb2015 Tags: Pain Medicine Source Type: forums
med management follow up
If you provide opioid med management, how often are you having patients follow up? How do you handle refills (call-in, multiple scripts given at visit)? If you are providing non-opioid management (gaba, duloxetine, etc), how often for follow up?
Thank you (Source: Student Doctor Network)
Source: Student Doctor Network - August 8, 2019 Category: Universities & Medical Training Authors: peytonm Tags: Pain Medicine Source Type: forums
Burning Feet
I wanted to pick the collective mind of IPM on SDN.
I have an 85 year old female. Chief complaint burning pain of bilateral feet (specifically the soles). Pain is worse at night.
Worked up relatively well by her PCP, podiatrist, and two neurologists.
Has had adverse effects with gabapentin, Lyrica, and duloxetine.
BMP, CBC, B12, folate, TSH, A1C, all unremarkable.
EMG of upper and lower extremities shows sensory neuropathy and what is most likely mild carpal tunnel of the wrist...
Burning Feet (Source: Student Doctor Network)
Source: Student Doctor Network - July 29, 2019 Category: Universities & Medical Training Authors: Biohazard685 Tags: Pain Medicine Source Type: forums
Chronic pain
90 year old patient with chronic low back (prior lami/fusion) and continued knee pain after TKA. I’m the 3rd PM doc she’s seen. She failed to follow up with the other PM bc she says nothing was helping. per chart review she’s been tried on multiple meds(meds all with side effects or no relief: gaba, Lyrica, cymbalta, savella, Tylenol #3, Vicodin, oxycodone) I’m hesitant to try TCA at her age and she has afibb. I tried her on Butrans but didn’t help. Compound cream slightly helpful. Starting...
Chronic pain (Source: Student Doctor Network)
Source: Student Doctor Network - April 28, 2019 Category: Universities & Medical Training Authors: Bsb2015 Tags: Pain Medicine Source Type: forums
