
Reply: knee pain
Bob, There are a number of different anti-inflamatories that can be used, some more...
Posted by David Maine, MD
Bob, There are a number of different anti-inflamatories that can be used, some more effective than others. You should discuss this with your docotor. PT can actually be very helpful for knee pain. Lastly, an injection can be used to help treat the pain but I would reserve this only if other conservative options fail. Ultimately, if indeed a torn menicus is the problem and pain persist, an MRI will be required. Best of luck.View Thread
Posted byDavid Maine, MD
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Reply: any advice is welcome!!
There are a number of immediate release medications that can be used for chronic...
Posted by David Maine, MD
There are a number of immediate release medications that can be used for chronic pain. I would discuss this with your prescribing doctor. You should be able to find an alternative that provides effective relief. Roxicodone (made by Xanodyne pharmaceuticals) is a name brand for oxycodone. You should be able to get a generic of this as well. Good luck.View Thread
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Reply: Frustrated in Springfield, Missouri
Hang in there. Just try to focus initially on establishing a trusting relationship...
Posted by David Maine, MD
Hang in there. Just try to focus initially on establishing a trusting relationship with the provider. Hopefully an effective pain management plan will evolve out of this. Best of luck.View Thread
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Reply: Chronic back pain and Butrans
Butrans is a transdermal formulation of Buprenorphine. It is a partial agonist...
Posted by David Maine, MD
Butrans is a transdermal formulation of Buprenorphine. It is a partial agonist (binder) and the mu and delta opioid receptor but a blocker at the Kappa receptor. The clinical effects are because of it opioid receptor activity. Unfortunately there is not good data comparing Buprenorphine to other opioids (equianalgesic data). Thus, converting the medication is based somewhat on experience. That being said, you likely could be placed on a medication (alternative opioid) that is between the Opana dosing and the Butrans dosing you describe. Side effects can hopefully be managed by changing the dose but it sounds like the drop from high dose Opana to 20mcg of Butrans was probably a bit much as it is not providing effective pain relief. You should discuss these issues with your provider to come up with an optimal dosing (it does not have to be one or the other). Good luck.View Thread
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Reply: crps
There are a number of great support groups. I would recommend ...
Posted by David Maine, MD
There are a number of great support groups. I would recommend http://www.rsds.org/4/support_groups/index.html .
They have great resources. Please know that there are a number of treatment options available and most of the time we can get control of this syndrome. Hang in there. Let us know if you have any other questions.View Thread
Posted byDavid Maine, MD
They have great resources. Please know that there are a number of treatment options available and most of the time we can get control of this syndrome. Hang in there. Let us know if you have any other questions.View Thread
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Reply: Frustrated in Springfield, Missouri
I am so sorry to hear for your wife's struggle. I am sure your support means the...
Posted by David Maine, MD
I am so sorry to hear for your wife's struggle. I am sure your support means the world to her. This is a difficult situation. First, make sure you are comfortable with your doctor. You have to trust that they are making the best treatment plan for you. If you did not, then I would seek another provider. Next, listen to the plan they are suggesting. The doctor may wish to change the medications or alter the regimen. Perhaps this will be beneficial. As you establish trust and a better patient-physician relationship then I a think a comfortable treatment plan can evolve. Lastly - you should never feel forced into a procedure or any treatment for that matter. Your wife is the patient and she ultimately needs to make the decision for elective treatments as you describe. I wish you and your wife the well and hope things improve quickly. Please let us know if you have any further questions.View Thread
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Reply: MIddle trap pain - vicodin/skellaxin not enough, w...
Thank you for the update. Hang in there!
Posted by David Maine, MD
Thank you for the update. Hang in there!View Thread
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Reply: long term pain management questions
Tim, Thank you for your post. Methadone has been looked at extensively and now...
Posted by David Maine, MD
Tim,
Thank you for your post. Methadone has been looked at extensively and now there are prescribing practice guidelines to minimize risk with using the drug. The risk of QT prolongation is real and increases with higher doses. Periodic EKGs to monitor QT interval and education on medication that can interact and heighten this risk is typically all that is needed to make this a safe treatment option. I would sit down with your doctor and discuss all of these concerns. Hopefully through this you can be reassured. You should address what is underlying the panic attacks and then hopefully the panic attacks will subside. Good luck.View Thread
Posted byDavid Maine, MD
Thank you for your post. Methadone has been looked at extensively and now there are prescribing practice guidelines to minimize risk with using the drug. The risk of QT prolongation is real and increases with higher doses. Periodic EKGs to monitor QT interval and education on medication that can interact and heighten this risk is typically all that is needed to make this a safe treatment option. I would sit down with your doctor and discuss all of these concerns. Hopefully through this you can be reassured. You should address what is underlying the panic attacks and then hopefully the panic attacks will subside. Good luck.View Thread
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Reply: treatment option
It sounds like you are referring to a radiologic finding (MRI) termed Modic...
Posted by David Maine, MD
It sounds like you are referring to a radiologic finding (MRI) termed Modic Changes. Modic changes are a fairly common observation in MR imaging. They are signal intensity changes in vertebral body marrow adjacent to the endplates (top and bottom) of degenerative discs. The type of Modic change can help one identify a more acute process or chronic process. This is only a radiologic finding and clinical decisions should be based on presenting symptoms. You should discuss all this with your doctor. If you have any more specific questions please feel free to let us know. Good luck.View Thread
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Reply: Burning the nerves
A lumbar facet rhizotomy can be used as treatment for low back pain. This procedure...
Posted by David Maine, MD
A lumbar facet rhizotomy can be used as treatment for low back pain. This procedure will not generally help if pain is radiating into the extremities past the knees. We generally look for physical exam findings and correlating imaging to suggest the facets as a possible pain generator. Often prior to doing a rhizotomy a diagnostic block is first completed to evaluate the response. Success rates of a lumbar facet rhizotomy in the setting of a successful diagnostic block is estimated to be around 60% for 6-9 months of relief. Good luck and let us know if you have any more questions.View Thread
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