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
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
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
Preop meds for pain control
Can some of you anesthesiologists please remind me what preop meds are now used for reducing postop pain?
In my day I seem to remember lyrica, clonidine, and/or celebrex being meds that would be taken PO several hours before surgery and that made post op pain more tolerable
Please elighten me on what pre op PO meds are used for this (at least at academic centers) (Source: Student Doctor Network)
Source: Student Doctor Network - March 2, 2023 Category: Universities & Medical Training Authors: bedrock Tags: Pain Medicine 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
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
Controlled Rxs- fill or refuse?
Hey everyone,
When do you feel it's appropriate for a patient to be on high doses of Norco, oxycodone, lyrica, modafinil and xanax? Considering it's not a cancer patient and the doctor has been disciplined in the past by the medical board for over-prescribing. Would you keep filling these prescriptions? Or how would you go about refusing to fill them? What would you say to that regular customer and doctor? Do you often see people being on 2 short acting opioids?
I'd appreciate your input...
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Source: Student Doctor Network - April 16, 2022 Category: Universities & Medical Training Authors: mimi06bg Tags: Pharmacy 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
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
UDS for lyrica/pregabalin
Being told that I need to UDS for patients that I am only prescribing lyrica/pregabalin to. I don't feel comfortable with it and not sure I see the value. Anyone typically UDS for these patients? (Source: Student Doctor Network)
Source: Student Doctor Network - September 3, 2020 Category: Universities & Medical Training Authors: Dansk703 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
Post-COVID Painful Polyneuropathy
I think that I made my first diagnosis in clinic today on a woman diagnosed with COVID-19 in early March. PCR(+) and Ab(+) Moderate illness: Hospitalized 3 days and on supplemental O2 but no ventilator.
Developed sub-acute painful burning feet end of April. EMG shows mild sensorimotor peripheral polyneuropathy. No help from gabapentin, TCA's. Pregabalin caused edema. Tramadol causes twitching. Trialed low dose naltrexone and topicals. Trialed neutraceuticals and alpha-2-lipoic acid...
Post-COVID Painful Polyneuropathy (Source: Student Doctor Network)
Source: Student Doctor Network - June 25, 2020 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums
