Pain Management Guidelines/Algorithms

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Sparda29 said:
Does anyone know of anywhere I can find pain management guidelines or algorithms?

Thanks
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What sort of pain management are you talking about? They tend to be specific to the disease state and situation. Post-operative pain management after an appendectomy is going to be very different from post-operative management after a total knee replacement. Management of pain in an acute sickle cell crisis is going to be very different than management of pain due to bone metastases.

Look up guidelines on the disease state itself, and you'll tend to find pain management right in there.
 
Praziquantel86 said:
What sort of pain management are you talking about? They tend to be specific to the disease state and situation. Post-operative pain management after an appendectomy is going to be very different from post-operative management after a total knee replacement. Management of pain in an acute sickle cell crisis is going to be very different than management of pain due to bone metastases.

Look up guidelines on the disease state itself, and you'll tend to find pain management right in there.
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Arthritis/Inflammation of Meniscus and knee ligaments.
 
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Looks like the first line drugs are the NSAIDs. I'm trying to figure out what sort of plan my orthopedic physician is coming up with. Over the past 3 months I've been through a regimen of ibuprofen, nabumetone, meloxicam, naproxen, and diclofenac, with none of them providing adequate pain relief. Of course, the life style modification of losing weight is kinda hard to do when the pain is in your knees.

My uncle who is a general physician gave me tramadol 50 mg, and what do you know, it works beautifully. He just said the only issue with only taking tramadol is that it's not going to reduce the inflammation.
 
anybody have the chart comparing each pain drug?
 
Lol it's been three months with failure of 5+ NSAIDs? He must be deathly afraid of opioid receptors.

I wouldn't think tramadol would be that big of a deal, but I don't know about long term use.
 
meister said:
Lol it's been three months with failure of 5+ NSAIDs? He must be deathly afraid of opioid receptors.

I wouldn't think tramadol would be that big of a deal, but I don't know about long term use.
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I called the office today to ask if he could prescribe it for me. Last time the joints hurt this bad, I called him up on the weekend with an emergency line and he was really hesitant to even give me Tylenol #3, which didn't even help out.
 
Because if you try to take 20 Ultracets you could nuke your liver.


Just as APAP is added to hydrocodone or promethazine to codeine. It's crude addiction prevention and is really sad imho.
 
meister said:
Because if you try to take 20 Ultracets you could nuke your liver.


Just as APAP is added to hydrocodone or promethazine to codeine. It's crude addiction prevention and is really sad imho.
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Yeah, so he rather risk me nuking my liver. It has a relatively low risk of addiction too compared to the hydrocodones, oxycodones, morphines, etc. Asides from that, you only need about 75-100 mg of tramadol to experience euphoria.
 
It won't nuke your liver if you take it correctly. So you have nothing to worry about. The APAP is easier on your liver than the NSAIDS blasting your kidneys.
 
Sparda29 said:
Called him up, requested to remove the APAP, he removed it. Yay! $30 cheaper anyway.
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Ah yes the price argument is best, I should have thought of that first! :smack:

Be sure to avoid those narc-seeking stereotypical behaviors so he doesn't get douchey again in a few weeks!
 
docs are so afraid of pain meds. I have fibromyalgia and I can't even get up steps without pain. I have been to 4 different doctors and each visit has been more humilating than the last. I have gotten cyclobenzaprine and that's it. The rest tell me to take baths and take tylenol and NSAIDS. Baths don't help much at work and when I cannot move. I don't have a history of drug abuse and don't want to abuse these drugs, instead, I just want to be able to move and get back to the way things were before.
 
nafcillin said:
docs are so afraid of pain meds. I have fibromyalgia and I can't even get up steps without pain. I have been to 4 different doctors and each visit has been more humilating than the last. I have gotten cyclobenzaprine and that's it. The rest tell me to take baths and take tylenol and NSAIDS. Baths don't help much at work and when I cannot move. I don't have a history of drug abuse and don't want to abuse these drugs, instead, I just want to be able to move and get back to the way things were before.
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🙁

Fibromyalgia has more skeptics than probably ADHD at this point among community docs. It's hard for them to differentiate between the drug seekers utilizing certain behaviors and fibromyalgia patients using those same behaviors but genuinely.

Hopefully we figure this one out because it's definitely a pretty terrible disease. Maybe viruses play a role, like Xenotropic murine leukemia virus-related virus in chronic fatigue syndrome.
 
Sparda29 said:
Yeah, no refills go figure.
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You should set up an appointment and tell him your concerns, maybe being honest will help. You hate to get in the "zero refills -> call pharmacy -> pharmacy faxes refill request -> doc denies as pt NTBS -> pt calls doc and sets up appointment -> doc oks one time -> repeat ad nauseam" cycle.
 
nafcillin said:
docs are so afraid of pain meds. I have fibromyalgia and I can't even get up steps without pain. I have been to 4 different doctors and each visit has been more humilating than the last. I have gotten cyclobenzaprine and that's it. The rest tell me to take baths and take tylenol and NSAIDS. Baths don't help much at work and when I cannot move. I don't have a history of drug abuse and don't want to abuse these drugs, instead, I just want to be able to move and get back to the way things were before.
Click to expand...

Both opiods and NSAIDs don't provide much benefit for fibromyalgia at all. I'm surprised he didn't give you Savella, Cymbalta or Lyrica if it is that serious (all approved).
 
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