PCP Notes
We get a lot of crappy notes from PCPs who have no idea what is going on and what should be done. And then we sometimes (rarely) get remarkable notes.
I appreciate the heck out of a doctor who takes the time to T up a patient like this for me. Kudos to Dr. B (in house referral).
Cervical spondylosis (M47.812)
Current Plans
Started traMADoL 50 mg tablet, 1 Tablet every day at bedtime, #30, 01/15/2024, Ref. x1.
Continued methocarbamoL 500 mg tablet, 1 Tablet at bedtime as needed, #30...
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Source: Student Doctor Network - January 25, 2024 Category: Universities & Medical Training Authors: lobelsteve Tags: Pain Medicine Source Type: forums
Why the hell does Medicare not cover bupe?
Got this lovely message today, in regards to an 86 year old woman, whose 2 tramadol per day are not helping anymore: Buprenorphine 5mcg/hr patch - Drug not on formulary - Plan does not cover the medication - We cannot do PA. She provided the preferred alternative: Morphine Sulfate ER tablets and Oxymorphone HCL ER tablets, and she submitted a test claim for both medications, stating that it was paid and that no PA was required.
In the midst of the "opioid epidemic" that everyone is...
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Source: Student Doctor Network - November 16, 2023 Category: Universities & Medical Training Authors: drrosenrosen Tags: Pain Medicine Source Type: forums
Tramadol
This report describes CDC’s updated clinical practice guideline for prescribing opioids for pain.
www.cdc.gov
So 2 tramadol a day is now a higher MME dose than oxycodone 5 BID? (Source: Student Doctor Network)
Source: Student Doctor Network - October 18, 2023 Category: Universities & Medical Training Authors: fathead88 Tags: Pain Medicine Source Type: forums
Dea training requirement
I can’t remember if I got this link from this forum, or from work.
Regardless - this free training from NEJM is easy to do and gives you the 10 required credits.
Pain Management and Opioids
But here is my actual point -
First, let me just say that I have mostly stopped giving long-term opioid therapy so really have little recent experience. When I do, I’ll give Nucynta, Butrans patch, or rarely, Tramadol.
The training above is question/answer format - and you get to see how many...
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Source: Student Doctor Network - July 15, 2023 Category: Universities & Medical Training Authors: epidural man Tags: Pain Medicine Source Type: forums
Med malpractice reviewer: fall after Ativan and Tramadol prescriptions
Fall After Ativan and Tramadol Prescriptions
Fascinating read (Source: Student Doctor Network)
Source: Student Doctor Network - April 15, 2022 Category: Universities & Medical Training Authors: Agast Tags: Pain Medicine Source Type: forums
Medical marijuana and OMS-3/4
Long time SDN user, but I created this throwaway account for anonymity. I was diagnosed with Hodgkins Lymphoma during OMS-1 in 2020. Took a leave of absence for treatment and praise God I’m in remission now. I still have residual pain (and all the oncologists and pain doctors have informed me this is extremely unusual with my diagnosis and chemo regimen). I take tramadol, medical marijuana and am about to start some kind of patch because with students returning to campus I know I will have...
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Source: Student Doctor Network - September 29, 2021 Category: Universities & Medical Training Authors: MaryJaneGanja Tags: Medical Students (DO) Source Type: forums
CVS refusing to fill opioid when patient is also on a benzo
Over the last 2-3 weeks, I have had CVS pharmacies in my area, Indiana, refusing to fill pain medications when a patient is on benzos.
The medications I prescribe 99% of the time is T#3, Tramadol, or belbuca/butrans. On occasion it is a 7-day norco rx. This is not just for new RX, but also for patients with pre-existing RX.
Pharmacist refuses to fill even if I call, so I stopped calling.
Now patients are calling my office to re-send RX elsewhere.
Anyone else dealing with this? What have...
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Source: Student Doctor Network - September 17, 2021 Category: Universities & Medical Training Authors: myrandom2003 Tags: Pain Medicine Source Type: forums
Tramadol
Saw this on another forum and am curious what other pain specialists think of this information. Anyone ever see seizures or serotonin syndrome in clinical practice from using Tramadol? I’ve never had any issues with prescribing it. (Source: Student Doctor Network)
Source: Student Doctor Network - August 4, 2021 Category: Universities & Medical Training Authors: DOctorJay 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
Question about max dosage variability per package insert
Hi everyone,
I know the max dose for tramadol is 400mg/day and the max dose for apap is 4g/day (rx). Why is it that for tramadol/apap which comes as 37.5mg/325mg, that the max is listed as 8 pills per day? That’s only 300 mg tramadol and 2600mg apap.
Unless that’s just initial use and it can go up to ~400mg with 10 pills=375mg/day of tramadol and 3250mg of apap. Sorry, never filled this before and just got curious while coming across the drug.
Similar story with hydrocodone/apap. Different...
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Source: Student Doctor Network - July 17, 2021 Category: Universities & Medical Training Authors: Curiousone1111 Tags: Pharmacy Source Type: forums
Buprenorphine
Starting practice in July and have been thinking about what I will do for controlled substances.
Thinking of doing primarily buprenorphine patch after non opioids, injections, topicals, etc. What do people go with as their first line weak opioid, my impression is most do tramadol, I personally have seen more success with bupi. Anyone here doing buprenorphine a lot? Any pros/cons for me to consider. (Source: Student Doctor Network)
Source: Student Doctor Network - May 29, 2021 Category: Universities & Medical Training Authors: dipriMAN 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
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
Tramadol and psychiatric meds
It seems that tramadol has MAJOR drug interactions with all psychiatric drugs , eg. Reducing seizure threshold (lithium) , increasing risk of serotonin syndomre (SSRIs) and CNS depression with atypical antipsychotics. How do you deal with this? Is advising the patient to discuss with PCP about switching to another pain medication a viable strategy? (Source: Student Doctor Network)
Source: Student Doctor Network - January 31, 2020 Category: Universities & Medical Training Authors: the5thelement Tags: Psychiatry Source Type: forums
