Inpatient Pain Medicine

[fozzy40]

Hello! I was just wondering what type of consults do inpatient pain docs typically have. In addition, can anyone recommend any sources that describe the role of the PM&R doc in the cancer patient? Thank you.

---

Members don't see this ad.

 

[Ligament]

Usually its for the chronic pain or cancer pain patient. Acute pain can usually be handled by the Anesthesiology department.

EX: Woman with uncrontrolled pancreatic CA pain. On Duragesic 300mcg/hr q48hrs, Dilaudid PCA 1mg Q8min, etc etc. Pain in abd and back not controlled. We get consulted. Do a neurolytic Celiac Plexus Block in OR. Pain significantly improved and patient d/c'd. Pt. follows up in the clinic for eventual intrathecal opioid pump placement. Now comfortable.

EX: Man with prostate mets to spine. Prognosis 2 months. Dilaudid PCA not helping. We take him down to put in a tunnelled epidural catheter running Dilaudid and Marcaine, tip of catheter near site of most pain. Marcaine really helps his pain and he's happy.

EX: 100 patients with lumbar post lami syndrome on their 20th admission for intractable leg pain. Nobody has ever tried adjuvants on them or PT, or pain psych, or anything except Lortab. Hit them with 150mg Q12 Lyrica and ELavil and they feel better to go home. They don't get d/c'd with Lyrica or Elavil and they get readmitted 1 month later for their 6th Laminectomy revision. Pain gets worse post op, they get sent to the pain clinic NOW for "pain management." We get a positive urine drug screen for cocaine and pot and the patient gets discharged on their first visit. Calls later wanting to complain to the "guy in charge." "My cousin put cocaine on my wheaties as a joke, thats howcome I got coke on my urine test" Me: Ok, but that fentanyl lab that we sent out on your first visit just came back (we have to send out fentanyl screens) and your urine contained no fentanyl. Thats funny considering you are supposedly taking Duragesic evey couple days. Patient: click (hangs up).

EX: 29yo W with spine mets. Wants to get married in 3 weeks and walk down the aisle. Currently cant walk due to pain. Slap in a tunnelled epidural catheter with marcaine and Dilaudid, she feels a lot better, walks down the aisle and gets married. Dies a week later. RIP.

EX: woman with ischemic leg pain, s/p multiple revascularization surgeries. We see in in pain clinic, do a SCS trial, she gets 80% pain relief, all is well.

 

[fozzy40]

Thanks Ligament! Seems pretty interesting. I'll have to try and get some exposure at some point during my intern year.

 

[Mister Mxyzptlk]

Thanks Ligament! Seems pretty interesting.

"Interesting" in the sense that having root canal is interesting. Most of my inpatient consults fall into the category of "Why didn't they send this to me as an outpatient 3 months ago before it got out of control?"

Then there are the consults for chronic festering conditions that are incidental to the reason for admission, like chronic daily headaches in a postpartum patient.

Pain management doesn't move very fast. A lot of what we get consulted for cannot be addressed in the time frame of a hospital admission. I usually advise the patient to get out of the hospital ASAP before someone kills them with a medication error. You can lay around in bed taking pain medicine at home for a lot less money, the food is better, and quite often the sex is better. Then we can work on the problem as an outpatient.

 

[fozzy40]

"Interesting" in the sense that having root canal is interesting. Most of my inpatient consults fall into the category of "Why didn't they send this to me as an outpatient 3 months ago before it got out of control?"

Then there are the consults for chronic festering conditions that are incidental to the reason for admission, like chronic daily headaches in a postpartum patient.

Pain management doesn't move very fast. A lot of what we get consulted for cannot be addressed in the time frame of a hospital admission. I usually advise the patient to get out of the hospital ASAP before someone kills them with a medication error. You can lay around in bed taking pain medicine at home for a lot less money, the food is better, and quite often the sex is better. Then we can work on the problem as an outpatient.

So what do you like about inpatient pain medicine? What is your typical day like?

 

[anesthesiology]

Ligament
thats very interesting and nicely explained. I am starting my fellowship coming July. I think I will have lots of fun and a lot of learning also.

 

[ampaphb]

and quite often the sex is better.

quite often? I want to be a patient in YOUR facility, Gorback!

 

[Mister Mxyzptlk]

So what do you like about inpatient pain medicine? What is your typical day like?

I don't like anything about inpatient pain medicine. As I said, the majority are requests for care that exceeds the scope of a hospital stay or that doesn't require a hospital stay, and that should have been addressed before the crisis stage. It's also a PITA to have to run back and forth to see a single patient. And if you need to do a procedure on an inpatient you'll often end up doing it after office hours, tacked onto the end of the elective schedule.

There is no such thing as a typical day. My work week is "irregularly irregular", and the schedule is a hypothesis that usually gets refuted by 8 a.m.

 

[cdw]

"Interesting" in the sense that having root canal is interesting. Most of my inpatient consults fall into the category of "Why didn't they send this to me as an outpatient 3 months ago before it got out of control?"

My typical inpatient consult is SOME ONE ELSE'S pain management patient who needs babysitting through their spinal fusion post op pain because the royal anesthesia pain service only does "acute" pain, not those nasty chronic patients with acute problems. They're regular pain physician "doesn't do" hospital work.

 

[Mister Mxyzptlk]

You are not obligated to accept every consult that gets called in. You can be "unavailable for consults at this time" or "not accepting new inpatient consults at this time".

Or you can just flat out do what I do and say it's not your job to mitigate the deficiencies of the anesthesia department and/or the patient's regular pain doctor. By the time they finish looking up "mitigate", you've already hung up the phone.

 

[Mister Mxyzptlk]

quite often? I want to be a patient in YOUR facility, Gorback!

That can be arranged. Just present your insurance card at the front desk at the Texas Orchiectomy Hospital and we'll take of the rest.