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
Multimodal anesthesia
Have you all been using multimodal anesthesia? If so, what? My current choices are listed below.
In pre-op holding:
Acetaminophen 975 mg PO
Celebrex 400 mg PO
Gabapentin 600 mg PO
At the start of anesthesia:
50 mg/kg MgSO4 IV
On certain cases I will add 10 mg dexamethasone to the bupivacaine for the local.
Patients complained about nausea when I've used OxyContin pre-op so I stopped.
I think what's made the most noticeable drop in post-op pain...
Multimodal anesthesia (Source: Student Doctor Network)
Source: Student Doctor Network - December 15, 2017 Category: Universities & Medical Training Authors: NatCh Source Type: forums
Re: Misuse of gabapentin and pregabalin may be underestimated
(Source: BMJ Comments)
Source: BMJ Comments - November 23, 2017 Category: General Medicine Source Type: forums
Enhanced recovery pathways
Since the OBGYN forum is dead, right i would post this here.
Just started out in practice. The place I'm at doesn't have a formal enhanced recovery order set so i carried one over from fellowship.
My current regimen :
Pre op
600mg gabapentin
1000mg po tylenol
400mg celebrex (i think this is not recommended for bowel cases but am unsure)
Intra op
Placed an On Q pain pump with ropivicaine, 0.2% at 6ml/hr
Post op
1000mg tylenol q6h scheduled
Toradol iv or ibuprofen po depending on...
Enhanced recovery pathways (Source: Student Doctor Network)
Source: Student Doctor Network - November 21, 2017 Category: Universities & Medical Training Authors: anonperson Source Type: forums
Preop opioid sparing meds
Do other people use preopedative meds significantly and feel it offers much? We routinely use Tylenol preop, plus or minus some Lyrica or gabapentin, I can’t say anecdotely I think it offers much though. Thoughts? (Source: Student Doctor Network)
Source: Student Doctor Network - November 9, 2017 Category: Universities & Medical Training Authors: dipriMAN Source Type: forums
Straight to Surgery?
67 yo guy
Totally normal, reasonable, very high functioning professional.
Has been having left arm radicular pain for several months. Noticing some weakness in the last month or two. Hard to carry books, drooped a few things etc. On exam some subtle weakness of grip strength/hand on that side, but still like 4.5/5.
MRI below. I measured the AP canal diameter at that tightest level at around 9mm.
Has not done cervical traction/gabapentin or CESI.
Surgeon has him on for mid Decemeber...
Straight to Surgery? (Source: Student Doctor Network)
Source: Student Doctor Network - November 3, 2017 Category: Universities & Medical Training Authors: Timeoutofmind Source Type: forums
Increased Prescribing of Gabapentin Is Cause for Concern
(Source: BMJ Comments)
Source: BMJ Comments - October 24, 2017 Category: General Medicine 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
Misuse of gabapentin and pregabalin is potentially being underestimated
(Source: BMJ Comments)
Source: BMJ Comments - October 19, 2017 Category: General Medicine Source Type: forums
Re: Is gabapentin effective for women with unexplained chronic pelvic pain?
(Source: BMJ Comments)
Source: BMJ Comments - October 13, 2017 Category: General Medicine Source Type: forums
Re: UK government to reclassify pregabalin and gabapentin after rise in deaths
(Source: BMJ Comments)
Source: BMJ Comments - October 3, 2017 Category: General Medicine Source Type: forums
NEJM: Increased RX of Gabapentin/Pregabalin Cause for Concern?
"Third, evidence suggests that some patients misuse, abuse, or divert gabapentin and pregabalin.5Some users describe euphoric effects, and patients can experience withdrawal when high doses are stopped abruptly. The likelihood of gabapentinoid abuse is reportedly heightened among current or past users of opioids and benzodiazepines. Whether misuse and abuse of gabapentinoids will become an important public...
NEJM: Increased RX of Gabapentin/Pregabalin Cause for Concern? (Source: Student Doctor Network)
Source: Student Doctor Network - August 3, 2017 Category: Universities & Medical Training Authors: drusso Source Type: forums
Gabapentin Abuse?
New on the streets: Drug for nerve pain boosts high for opioid abusers
"Linda Holley, a clinical supervisor at an Athens outpatient program run by the Health Recovery Services, said she suspects at least half of her clients on Suboxone treatment abuse gabapentin. But the center can’t afford to regularly test every participant." (Source: Student Doctor Network)
Source: Student Doctor Network - July 19, 2017 Category: Universities & Medical Training Authors: drusso Source Type: forums
Anti-epileptics instead of benzodiazepines for outpatient etoh wd?
PGY3 here. Recently got a handout from my addiction/substance use rotation. There's actually several regimens it lists here as appropriate for outpatient etoh wd. It states benzos are 1st line, but if there are concerns for CNS depression due to concurrent opioid use, it also has regimens that use exclusively tegretol, depakote, or gabapentin.
Has anyone used those anti epileptics in lieu of benzos for outpatient mild-moderate etoh wd? And what has your experience been like?
Thanks! (Source: Student Doctor Network)
Source: Student Doctor Network - July 16, 2017 Category: Universities & Medical Training Authors: lyla 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
