NANS Meet Up: January 18-21, 2024
2024 NANS Annual Meeting
Attend the premier meeting in neuromodulation, the 2024 NANS Annual Meeting, January 18-21, 2024 in Las Vegas.
www.neuromodulation.org
It's time to sharpen your pointy shoes and be prepared to be wowed. With more waveforms than a Casino buffet and battery lives that would make Elon Musk blush, this is the legit OG, SCS premier event and gathering of pain, neurosurgery, and spine royalty. Meet the new line-up of KOLs who will be available for pictures and schmoozing. Engage in stimulating, authentic, and thought-provoking di...
Source: Student Doctor Network - December 24, 2023 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums
How to not burn out
New attending, PP productivity gig
Two owners are great but one is old school and “limits” OME in the clinic to 90, one is younger and I think just happy to live life and go with the flow.
I’m fed patients from them and most end up wanting to stay with me because I touch and examine them rather than just a 2 minute refill visit. I set a monthly goal for myself to wean patients as possible to try and get my panel under 60 OME but I’ve been asking myself where the endpoint is and honestly I...
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Source: Student Doctor Network - December 24, 2023 Category: Universities & Medical Training Authors: PMROralBoards Tags: Pain Medicine Source Type: forums
Holiday drama
Patient with a disease state that warrants opioids under guidelines. Got to 120 MME and PCP asked my department to help out. We have a policy of helping PCP with unstable dose patients before handing patients back.
We transitioned them to a long acting agent and with PRNs. They originally didn’t like the plan, but then went through routine refills without any concerns.
They then called frantically requesting early refill before the holidays. When asked about overuse, they first said the...
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Source: Student Doctor Network - December 23, 2023 Category: Universities & Medical Training Authors: Czech777 Tags: Pain Medicine Source Type: forums
Anesthesia residents that are planning on doing/did a pain fellowship, what made you want to?
M2 here just considering going into anesthesia and potentially pain, and was wondering what made you want to go into pain since I know the day to day is quite different from general anesthesia. Also, did you always plan on going into pain and you just had to get through anesthesia residency? Or was it something you realized after starting residency. If you always knew you wanted to do pain, was there a reason you went the anesthesia instead of PM&R or other route?
Thanks so much for your...
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Source: Student Doctor Network - December 23, 2023 Category: Universities & Medical Training Authors: Spongeman7 Tags: Pain Medicine Source Type: forums
C2 nerve root block lateral
Only Serena few in training but I never seen it done this way always thought it's better to do posterior due to the vessel anatomy. Does anyone do this? (Source: Student Doctor Network)
Source: Student Doctor Network - December 22, 2023 Category: Universities & Medical Training Authors: interjectionreflection Tags: Pain Medicine Source Type: forums
What is a SNRB vs TFESI??
The IPSIS-recommended changes have clarified previously confusing reporting requirements that failed to differentiate between Selective Nerve Root Blocks (SNRBs) and Transforaminal Epidural Steroid Injections (TFESIs). For the MACs listed below, procedural reports should now incorporate baseline pain scores alongside the percentage of pain relief achieved immediately after the injection for SNRBs only. This requirement aims to enhance the accuracy and completeness of reporting...
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Source: Student Doctor Network - December 21, 2023 Category: Universities & Medical Training Authors: painfree23 Tags: Pain Medicine Source Type: forums
Genetic test for OUD
FDA Approves First Test to Help Identify Risk of Developing OUD (Source: Student Doctor Network)
Source: Student Doctor Network - December 20, 2023 Category: Universities & Medical Training Authors: nvrsumr Tags: Pain Medicine Source Type: forums
New fluoro table
We are buying a new fluoro table.
If you have a newer model please tell me what you have and why you like it (or don't like about it) (Source: Student Doctor Network)
Source: Student Doctor Network - December 19, 2023 Category: Universities & Medical Training Authors: specepic Tags: Pain Medicine Source Type: forums
Dealing with insurance dictating procedures..
Hey everyone, I can’t be the only one dealing with facet treatment denials when the patients notes some leg pain. I literally had a denial where the patient had severe facet OA, mild foraminal stenosis and more back pain than leg pain with pos. Facet loading etc. The denial said “your imaging shows other causes” so now we have someone probably with no training in pain and probably not even a doctor dealing out denials based on imaging reports. This seems to be more and more common. Any...
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Source: Student Doctor Network - December 19, 2023 Category: Universities & Medical Training Authors: Laryngospasm Tags: Pain Medicine Source Type: forums
Clinical Acumen
What things after training really helped you develop your clinical acumen? Were there any good books that helped you make better diagnoses based off of patient history (eg exacerbating/mitigating factors)? Any epiphanies you had during your first few years out after training? How long did it take you to really get comfortable/confident in what you were doing? (Source: Student Doctor Network)
Source: Student Doctor Network - December 17, 2023 Category: Universities & Medical Training Authors: po_boy Tags: Pain Medicine Source Type: forums
Treating back pain in the ER
Hey all,
ER doc starting a pain fellowship next year. Wondering if you have any tips/tricks or nuances I could start implementing in the ER, particularly with respect to low-risk back pain (strain, sciatica). Actually didn't see much in residency (since 10 hour waits were typical) but see a bunch now in the community. Assuming no red flag symptoms, the typical approach amongst my colleagues is NSAIDs, Lidoderm +/- Robaxin/Flexeril/Valium (rarely). X-ray if patient insists (recognizing...
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Source: Student Doctor Network - December 16, 2023 Category: Universities & Medical Training Authors: TrailRun Tags: Pain Medicine Source Type: forums
Matthew Perry Ketamine overdose
According to the toxicologist, he had “general anesthetic” levels of ketamine in his blood and that trace amounts were found in his stomach, however his last infusion was 1.5 weeks prior. So did he overdose on oral ketamine??? Also therapeutic levels of buprenorphine found.
Curious to hear your thoughts. I personally view oral ketamine and buprenorphine a rather benign combination as far as accidental overdose risk goes. So tragic. (Source: Student Doctor Network)
Source: Student Doctor Network - December 16, 2023 Category: Universities & Medical Training Authors: PainBrain78 Tags: Pain Medicine Source Type: forums
Experience with Durolane?
Have the option of either using Synvisc One or Durolane. I don't have any personal experience with Durolane although a brief lit search shows that it may be slightly superior to Synvisc. Curious what folks have noted in the real world. (Source: Student Doctor Network)
Source: Student Doctor Network - December 11, 2023 Category: Universities & Medical Training Authors: oneforfighting Tags: Pain Medicine Source Type: forums
AI for clinical notes
Anyone using AI to generate clinical notes? My understanding is it listens to your visit and transcribes it. I have heard good things about GetFreed. Our hospital is trialing DAX copilot.
With my templates I copy and paste relevant info from my old notes and takes me about 3 min typing for follow-up and 5 mins for new. At least that's a guess, I think I'll time myself to see. Usually I do about half the documentation while patient is in the room and finish as they are checking oit6. Not...
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Source: Student Doctor Network - December 11, 2023 Category: Universities & Medical Training Authors: ragnathor Tags: Pain Medicine Source Type: forums
Midlevel education
I have had a few new mid-levels join recently with no previous pain medicine experience. Any recommendations for guides or resources for them to get their bearings? Alternatively I thought about creating my own handbook explaining my preferences for certain procedures, medication preferences and other pearls of wisdom, but I feel this will take a long time to create. Has anyone done something like that before or have any advice? We are a high volume clinic and they shadow me for a few weeks...
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Source: Student Doctor Network - December 11, 2023 Category: Universities & Medical Training Authors: PainBrain78 Tags: Pain Medicine Source Type: forums
