Leg cramps
Have a patient with moderate lumbosacral stenosis that I did bilateral S1 tfesi about 6 weeks ago with good relief of radic symptoms but consistent cramping throughout legs after the procedure. Encouraged hydration and after two weeks symptoms persisted. EMG was normal, started low dose neurontin without much benefit. Any thoughts on this? More time? Referral to neurology? (Source: Student Doctor Network)
Source: Student Doctor Network - March 20, 2024 Category: Universities & Medical Training Authors: Dr. Ice Tags: Pain Medicine Source Type: forums
Gabapentin and COPD exacerbation
Saw a few articles on this. I haven't really noticed any of my patients with COPD go into an exacerbation. Has anyone experienced this ?
https://www.jwatch.org/na57032/2024/01/25/gabapentin-and-pregabalin-are-associated-with-severe-copd (Source: Student Doctor Network)
Source: Student Doctor Network - February 4, 2024 Category: Universities & Medical Training Authors: soxman Tags: Pain Medicine Source Type: forums
TFESI for huge disc extrusions vs surg ref
Greetings all,
I had an experience last week with a surgical referral I placed and would love any input in the group. Long story short young healthy guy with a huge disc exrtrusion l4-5 with severe stenosis NF narrowing severe pain X6 months with all the classic radic symptoms and severe pain. Failed PT, NSAIDS, gabapentin. Neuro exam in tact other then some reduced sensation to LT but no weakness and sym reflexes... just severe pain. Talked to patient about options for tx including...
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Source: Student Doctor Network - December 29, 2023 Category: Universities & Medical Training Authors: schmee90 Tags: Pain Medicine Source Type: forums
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
Chemotherapy induced peripheral neuropathy
88yo with h/o chemotherapy induced neuropathy in BLE. Tried gabapentin, duloxtine, lyrica, topamax, ALA, topical lido/voltaren/menthol/capsaicin, TENS. Pt not interested in SCS, worried about sedation. Lives alone and also given age, I've tried to hold off on TCAs...but I may need to go that route as pain is worsening. What else can I offer? LESI?? (Source: Student Doctor Network)
Source: Student Doctor Network - August 22, 2023 Category: Universities & Medical Training Authors: oneforfighting Tags: Pain Medicine Source Type: forums
There are wins sometimes
December 2020: Patient presents for intake on following combination of medications (among others) from elderly out of state psychiatrist who is not good about responding to communication but patient kind of idolizes:
Diazepam 15 mg qAM, 10 mg qnoon, 10 mg q4PM, 15 mg qHS
Adderall IR 20 mg TID
temazepam 30 mg qHS
Ambien 15 mg qHS
gabapentin 600 mg qAM + 300 mg qHS
Patient had struggled to get off suboxone they were put on for chronic pain in the past but had been sober for a few years...
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Source: Student Doctor Network - May 26, 2023 Category: Universities & Medical Training Authors: clausewitz2 Tags: Psychiatry Source Type: forums
Gabapentin and Lyrica synergistic effects?
What are your opinions on using gabapentin AND pregabalin at the same time in select patients? Apparently there may be some synergistic effects? Just saw a patient from a different provider on the combo and they say they have been on them both for years...
Never heard of it in my training and I was kinda shocked to see it. (Source: Student Doctor Network)
Source: Student Doctor Network - July 31, 2022 Category: Universities & Medical Training Authors: GottaHaveIt Tags: Pain Medicine Source Type: forums
Is PM & R Boring?
I'm in the 1st week of my M4 PM&R rotation. I really wanted to like this rotation, and was strongly considering going into PM&R. But so far, it feels pretty boring. Mostly stroke patients. We manage bowel regimens, mostly for constipation. They have neuropathic pain - we start gabapentin. They have HTN - we add on another antihypertensive. The most exciting thing to happen so far was a patient getting an AKI 2/2 TMP-SMX renal toxicity. Overall it's felt like IM-light. The outpatient clinic...
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Source: Student Doctor Network - June 24, 2022 Category: Universities & Medical Training Authors: WashingtonR Tags: PM&R 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
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
Intrathecal Methylprednisolone for PHN
I have an 88yo patient with severe PHN. Has failed the usual suspects: Lyrica, TCA, gabapentin, capsaicin, opioids, Lidoderm. He is losing weight, has become inactive and is in severe pain. I've come across research about intrathecal Methylprednisolone injection and some studies look to be quite effective. Have any of you done this? I have never injected IT steroids and know about concerns with additives causing arachnoiditis, etc.
Can anyone comment on whether IT steroids should be...
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Source: Student Doctor Network - May 15, 2021 Category: Universities & Medical Training Authors: dhcofc Tags: Pain Medicine Source Type: forums
Help with tough case.
70 year old female with bad spondy. Predominant leg symptoms. Too osteopenic for TLF. Moderate dementia and depression.
Lyrica and Gabapentin worsen mental function to the point she can't use. SCS trial failed due to dementia limiting proper management of device. On SSRI for depression (sertraline.) I added tramadol with the hopes it would not worsen mental function and tapered off sertraline. Patient now having crying spells and worsening depression. It was thought if the pain improved...
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Source: Student Doctor Network - November 24, 2020 Category: Universities & Medical Training Authors: gator2886 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
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
Gabapentin and Lyrica
Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain:A Systematic Review and Meta-analysis | Anesthesiology | ASA Publications
In this new meta-analysis in this months’ Anesthesiology, the use of these drugs is very much called into question. Will this change your practice? (Source: Student Doctor Network)
Source: Student Doctor Network - August 4, 2020 Category: Universities & Medical Training Authors: kmurp Tags: Anesthesiology Source Type: forums
