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UPDATE IN PAIN MEDICINE

UPDATE IN PAIN MEDICINE. RICHARD A. DuBOSE, M.D. DIRECTOR, IDAHO PAIN CENTER BOISE, IDAHO. OXYCONTIN. DEATHS w/ POLY ABUSE ER INCIDENCE 30% RX, 5% OPIATES ABUSE POTENTIAL LOW IF USED CORRECTLY COMPANY PROVIDES EDUCATION SPECIAL MARKINGS TO TELL WHERE MEDS COME FROM

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UPDATE IN PAIN MEDICINE

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  1. UPDATE IN PAIN MEDICINE RICHARD A. DuBOSE, M.D. DIRECTOR, IDAHO PAIN CENTER BOISE, IDAHO

  2. OXYCONTIN • DEATHS w/ POLY ABUSE • ER INCIDENCE 30% RX, 5% OPIATES • ABUSE POTENTIAL LOW IF USED CORRECTLY • COMPANY PROVIDES EDUCATION • SPECIAL MARKINGS TO TELL WHERE MEDS COME FROM • “SMART PILL” IN WORKS

  3. METHADONE • VERY CHEAP (#90 X 10MGS= $17.49) • ALPHA HALF LIFE 8 HOURS • BETA HALF LIFE 30 HOURS • NMDA RECEPTOR ANTAGONIST • EQUIVALENT DOSING IV vs PO • NO FIRST PASS EFFECT • EQUIPOTENT WITH MORPHINE

  4. DURAGESIC • 12-18 HOURS TO “KICK IN” • 25, 50, 75, 100 UGS/HOUR • ACTIQ NOW AVAIABLE FOR B/T • MAY HAVE SOME ADDITIONAL EFFECTS IN NEUROPATHIC PAIN • NOT EASILY DEVERTED • GOOD FOR PATIENTS WITH GI PROBLEMS

  5. LOW-DOSE ANTAGONISTS • NALTREXONE • BUPRENORPHINE • SLOWS TOLERANCE • MAY HAVE EFFECTS AT VERY-LOW DOSES TO BLOCK PAIN RECEPTORS

  6. NMDA ANTAGONISTS • NEURO-EXCITATORY CHEMICAL • METHADONE • KETAMINE • TRAMADOL TO A MILD EXTENT

  7. ANTICONVULSANTS • NEURONTIN • TRILEPTAL • TOPAMAX • GABTRIL • ZONEGRAN

  8. ULTRACET • TRAMADOL 37.5 MG • ULTRAM TO BE PHASED OUT • TYLENOL 325 • MAY BE USEFUL • MILD NMDA EFFECT • REBOUNDING?

  9. ZANAFLEX • TIZANADINE • UNIQUE CENTRALLY ACTING MUSCLE RELAXANT • SEDATING • ALPHA AGONIST • PAIN RELIEVING ABILITY • CHECK LIVER FXN AT HIGH DOSES

  10. IDET PROCEDURE • DISCOGENIC LOW BACK PAIN • NOT GOOD FOR RADICULOPATHY • MUST HAVE FAILED 3-6 MOS OF TX • USUALLY GOOD FOR 1-2 LEVELS • WHERE FUSION IS NOT INDICATED • LONG RECOVERY • PROVIDERS/INSURANCE ISSUES

  11. IDET

  12. INTRATHECAL PUMPS • ORALS CAUSE TOO MANY SIDE AFFECTS • WHERE NEUROPATHIC PAIN IS MAJOR COMPONENT • EXCELLENT FOR SPASTICITY • BEST FOR MALIGNANT PAIN

  13. CORD SPINAL STIMULATORS • RSD • CAUSALAGIA • CLAUDICATION/VASCULAR DZ • RADICULOPATHY • FAILED BACK SYNDROME

  14. SCS

  15. SCS

  16. VERTEBROPLASTY • FOR COMPRESSION FXS • 1,000,000 PER YEAR • 85% -90% EFFECTIVE • METHYLMETHACRYLATE • PAIN RELIEF IN 5-10 MINUTES • RISK OF LEAKAGE OF “CEMENT”

  17. VERTEBROPLASTY

  18. BOTOX AND MYOBLOC • TORTICOLLIS • RECURRENT MUSCLE SPASMS • HEADACHES • HIGHER INCIDENCE OF ANTIBODIES WITH MYOBLOC • QUITE EXPENSIVE

  19. DUPLICATE LAW • CLASS III’S MORE ABUSED • LONG-ACTING LESS LIKELY TO BE ABUSED OR DIVERTED • ATTEMPT TO AVOID REINFORCEMENT DUE TO ASSOCIATED DOPAMINE WITH QUICK RELEASE DRUGS • IDAHO HAS CHANGED LAW

  20. OPEN DISCUSSION THANKS FOR COMING!

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