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With acetaminophen, the most important thing to think about is liver toxicity, and remembering to take age into account when you’re thinking about the maximum dosing. And it’s important to be sure that patients are aware that there are a lot of agents out there that have acetaminophen as an...
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A number of factors have coalesced to make pain and hormones a topical issue in pain management. One is that there are enough scientific studies to show us that pain itself has a dramatic effort on the hormone system. It will deplete hormones, for example. We also have learned that you can’t get...
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Pretty much any relationship between pain and depression that you can imagine has data behind it. There is evidence that they both interact. There’s evidence that pain impedes treatment of depression. There’s evidence that depression impedes treatment of pain. They are distinct but related problems...
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Ketamine has been in clinical use for over 30 years. It has an excellent safety profile and profound analgesia. In the operating room, we really like it for specific populations. It’s related to the drug PCP and it does have some psychomimetic effects which is actually one of the reasons it’s not...
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Pharmacogenetic testing is a new idea and a new science that has been attached to chronic pain prescribing, but it’s important to note that it may not be appropriate for every patient in your practice. As a prescriber, you have to be the one to make that differentiation.
Examples of patients you...
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Why would envy have anything related to someone in physical pain? At first blush you might say it wouldn’t, in part because we typically assume that if someone is in physical pain, especially, our automatic reaction should be empathy. That is a natural response. But there are going to be cases that...
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I am very fortunate and honored to represent the American Society of Interventional Pain Physicians who have led the way in teaching and implementation of interventional pain medicine. IPM techniques are effectively applied to spinal pain, the most prevalent pain we have. They are also effective for...
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I think the important thing with methadone is safety first. Even though I’m a big methadone fan, I don’t think everyone is an ideal candidate for methadone therapy. I think we have to have a patient who’s very reliable, who will follow the plan of care, who will follow the directions, someone who...
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Aura is basically secondary to what has been termed the cortical spreading depression, and what that means is that you have oligemia. You have blood flow decrease starting at the back in the brain and it moves forward. With this cortical spreading depression, the oligemia--the decreased blood flow-...
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In my clinical experience, the most commonly seen foot condition--and also a reason for referral to see a specialist--is plantar fasciitis. Other conditions that the primary care clinician will see include trauma, ankle sprains, and fractures. Less commonly seen conditions of the foot and ankle...