case - options for pain control
40 yo F morbid obesity (BMI 50 w/ OSA requiring CPAP) presents for bariatric surgery - laparoscopic. H/o Chiari malformation, h/o hydrocephalus w/ ventricular-thoracic shunt and lumbar-peritoneal-shunt s/p multiple revisions for failure and optic nerve fenestration for blindness, chronic neck/headaches on Norco 10-325, gabapentin 300 once daily, flexeril, fibromyalgia.
Thoughts on pre-intra-post operative pain control options? Neuraxial? Multimodal?
How would you manage her preop opioid use? (Source: Student Doctor Network)
Source: Student Doctor Network - July 28, 2020 Category: Universities & Medical Training Authors: mtu620 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
Re: Pregabalin and gabapentin for pain
(Source: BMJ Comments)
Source: BMJ Comments - May 29, 2020 Category: General Medicine Source Type: forums
Is gabapentin and/or lyrica safe in pregnancy and/or breastfeeding patients?
Reviewing the literature online, seems to be somewhat limited in recommendations:
Gabapentin and breastfeeding: a case report. - PubMed - NCBI
Adverse pregnancy outcomes in women exposed to gabapentin and pregabalin: data from a population-based study | Journal of Neurology, Neurosurgery & Psychiatry
Your thoughts SDN?
And if safe, up to normal max doses (3600 mg/300 mg)? (Source: Student Doctor Network)
Source: Student Doctor Network - May 5, 2020 Category: Universities & Medical Training Authors: Blitz2006 Tags: Pain Medicine Source Type: forums
Re: Pregabalin and gabapentin for pain
(Source: BMJ Comments)
Source: BMJ Comments - April 30, 2020 Category: General Medicine Source Type: forums
Gabapentin for anxiety, refused by pharmacist
I have a 17-year-old patient who was started on a low dose of gabapentin, 100-200 mg tid prn for anxiety, by her PCP a couple of years ago, and it has worked well. She doesn't really need it much, but needs a new prescription because her old one is expired. Surprisingly, it's not the insurance company preventing the prescription from being filled, but the pharmacist. I guess this pharmacist wants proof, in the form of scholarly research, showing that gabapentin is effective for treating...
Gabapentin for anxiety, refused by pharmacist (Source: Student Doctor Network)
Source: Student Doctor Network - January 16, 2020 Category: Universities & Medical Training Authors: SpongeBob DoctorPants Tags: Psychiatry Source Type: forums
FDA warning on Gabapentin.
in case you didn't see this last Thursday...
Gabapentin and Pregabalin: Drug Safety Communication - Due to Serious
FDA is warning that serious breathing difficulties may occur in patients using gabapentin or pregabalin who have respiratory risk factors.
www.fda.gov
Neurontin, Gralise, Horizant (gabapentin) and Lyrica, Lyrica CR (pregabalin): Drug Safety Communication - Serious Breathing Problems
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Source: Student Doctor Network - December 23, 2019 Category: Universities & Medical Training Authors: Ducttape Tags: Pain Medicine 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
Restoring misreported trials of gabapentin for neuropathic pain
(Source: BMJ Comments)
Source: BMJ Comments - August 31, 2019 Category: General 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
Need for International Classification of Gabapentin as Controlled Substance
(Source: BMJ Comments)
Source: BMJ Comments - November 6, 2018 Category: General Medicine Source Type: forums
Re: Pregabalin and gabapentin become controlled drugs to cut deaths from misuse
(Source: BMJ Comments)
Source: BMJ Comments - October 29, 2018 Category: General Medicine Source Type: forums
Pharmacist in need of advice
A patient comes in with prescriptions for hydromorphone, alprazolam, carisoprodol (I also saw gabapentin on her profile) all from the same prescriber from a reputable pain management clinic. I told her I would not fill her scripts until I talked to her doctor/physician's assistant, which isn't possible since I'm staffed overnight.
I normally refuse all holy trinity scripts, but this is the first time I've see that combo prescribed from that clinic (we fill a ton of their other scripts and...
Pharmacist in need of advice (Source: Student Doctor Network)
Source: Student Doctor Network - February 7, 2018 Category: Universities & Medical Training Authors: techniques Source Type: forums
