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The inherited pain patient is really one of our greatest challenges in medicine because even if their pattern of pharmacotherapy is irrational, the vast majority only got there with the help of a physician, and I think we owe a special duty of care to patients who have iatrogenetically come to harm...
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Inherited patients usually come in with certain pharmacotherapy and you have to decide after your history and physical whether that pharmacotherapy is irrational or rational. Is it pharmacotherapy that you feel comfortable prescribing and continuing without change? Is it pharmacotherapy that you’re...
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There are three pathophysiological aspects to consider with mild traumatic brain injury. The first that occurs is marked accumulation of glutamate, which essentially destroys cells. It burns cells out. It kills cells. But it’s just part of a major metabolic cascade that is unhelpful to the patient...
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There are number of problems for patients who suffer from chronic pain, and one of them is frustration with the treatment outcome. We in healthcare want to be the heroes, we want to be the fireman who’s going to rush in, break down the door with the axe and pull people to safety, and I think that...
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We know more now about the risk factors and patients who may be good candidates for naloxone. These would include patients on higher doses of opioids, patients with complicated comorbidities like renal or hepatic disease, sleep apnea, and most obviously, those with active substance abuse, or a...
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One of the things that can be difficult with respect to people who have acute pain is not thinking about the possible situation one, or three months out. Every so often patients deviate from the norm, which would be the healing and resolution of that acute pain. And it’s very easy, with an acute...
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Primary care practitioners need to be aware of some changes relating to the use of opioids to treat pain. State-licensing board guidelines are changing. There’s some new and good legislation regarding the use of naloxone kits to help people who might be at risk for opioid overdose or even...
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Ultrasound was started by Karl Dussik in the 1930s and’40s and he was trying to diagnose intracranial tumors. Things have progressed extensively over the last several decades and so ultrasound is now being used to help locate peripheral nerves and to help coordinate injections and to even show some...
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Chronic pain affects all segments of the population, but of course older adults are more likely to be impacted, particularly by joint pain and other forms of musculoskeletal pain. In some studies, up to 50% of the older population reports clinically significant pain. Those numbers go even higher in...
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Patient screening and risk management in opioid therapy is really quite a challenge and requires significant knowledge of the medications particularly with high-dose opioids. First of all, you have to make a decision of whether or not, as the dose escalates, the patient should even be on opioids...