Who manages fibromyalgia?
I'm sorry if this has been discussed elsewhere, but in y'alls practice setting, who manages fibromyalgia? I'm starting to get more and more of these patients with diffuse muscle and joint pain, especially now that I just started seeing medicaid, yay. Typically I will refer to PT and a pain psych consult for cbt (which >50% never go to, and I'm in a small city with no good psych so refer outside), maybe start gabapentin/lyrica/cymbalta.
There is no rheum in my town. I'll order the basic...
Who manages fibromyalgia? (Source: Student Doctor Network)
Source: Student Doctor Network - December 18, 2017 Category: Universities & Medical Training Authors: manowar rules Source Type: forums
Postherpetic neuralgia
I’ve had many patients in the past that are difficult to treat (read refractory).
I have an 85yo patient with PHN following T12 and L1 dermatomes on the right.
-tried: opiates in the past; does not want narcs, didn’t tolerate TCAs
-currently on: Gabapentin (dose limited by renal insufficiency), on Cymbalta 60mg daily and Lidoderm.
I did a T12-L1 interlam a few weeks ago. First time his pain has been below an 8 in the last 3 years since onset. Only lasted 3 days (80mg Depo and 3ml...
Postherpetic neuralgia (Source: Student Doctor Network)
Source: Student Doctor Network - October 22, 2017 Category: Universities & Medical Training Authors: newbie04 Source Type: forums
Antidepressant for parkinsons patient?
So I got a patient who has had long standing depression. She has been on 60 mg of Cymbalta and was weaning down to 40 because it stopped working. She wants med management and therapy, I like therapy and will be seeing her every other week for therapy- she can only come every other week for therapy due to transportation issues. The first step was easy, titrate down to 20 mg of Cymbalta. NO antidepressant works with her parkinsons meds because they are all a risk for serotonin syndrome....
Antidepressant for parkinsons patient? (Source: Student Doctor Network)
Source: Student Doctor Network - September 30, 2017 Category: Universities & Medical Training Authors: futuredo32 Source Type: forums
Duplicate Therapy- SSRI+SSRI/SSRI+SNRI
How often do you encounter this combination working in retail and how do you resolve it? I have seen numerous patients that have prescriptions for escitalopram 10 mg + escitalopram 20 mg from the same prescriber, in addition to something like venlafaxine/duloxetine or fluoxetine and/or amitriptyline from another.
To make it worse, most of these all are usually a (re)fill 05 and only have DUR comments that only contain 'dose ok' or 'patient on both' without providing any more information. (Source: Student Doctor Network)
Source: Student Doctor Network - September 19, 2017 Category: Universities & Medical Training Authors: josh6718 Source Type: forums
SSRI/SNRI Cross-Taper, increased risk for serotonin syndrome?
Just wondering, because I came across some discussions on patients that were on Cymbalta/Effexor, and due to no efficacy, was decided to be switched to a SSRI. Also pain docs who want to switch a patient off SNRI...
But as we know, at higher doses of Effexor (>100 mg), less serotonin reuptake, and more on the Norepi reuptake.
So if you do a cross-taper, e.g, tapering at 225 mg Effexor, starting 20 mg Prozac, is there a heightened risk of serotonin syndrome? Should you first taper off the...
SSRI/SNRI Cross-Taper, increased risk for serotonin syndrome? (Source: Student Doctor Network)
Source: Student Doctor Network - August 26, 2017 Category: Universities & Medical Training Authors: Blitz2006 Source Type: forums
How do YOU dose Cymbalta?
So I know officially Cymbalta goes up to 120 mg/day, but I've been told that there is no clinical benefit/efficacy after crossing 60 mg. Is this true? I can't find paper that gives evidence for this.
Do you usually dose the 60 mg, 30 mg q12h or 60 mg q24h? I have a lot of patients that have neuropathic pain as well, and our hospital seems to like to jump straight to cymbalta....but pain docs usually also stop at 60 mg for neuropathy...
Do you think cymbalta is good, or better off using...
How do YOU dose Cymbalta? (Source: Student Doctor Network)
Source: Student Doctor Network - July 23, 2017 Category: Universities & Medical Training Authors: Blitz2006 Source Type: forums
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
Pain after laminotomy lead
Morbidly obese 59 yo patient s/p lumbar 4-5 and L5-S1 discectomy followed by two failed PLIF. Never fused. Was off of opioids prior to SCS trial. Had successful trial and was implanted with thoracic paddle lead by experienced neurosurgeon. Complaining of burning sensation and intermittent intense spasm in area of implant (paddle) since surgery. Surgeon prescribes hydromorphone and valium. Unsuccessfully trys: Neurontin, pregabalin, duloxetine, Lidoderm and compounded cream. Then, off...
Pain after laminotomy lead (Source: Student Doctor Network)
Source: Student Doctor Network - April 20, 2016 Category: Universities & Medical Training Authors: NJPAIN Source Type: forums
