Moderator EMEDPA Posted July 12, 2014 Moderator Share Posted July 12, 2014 http://www.clinician1.com/posts/article/dea_reschedules_tramadol_as_a_schedule_iv_drug/ Link to comment Share on other sites More sharing options...
primadonna22274 Posted July 12, 2014 Share Posted July 12, 2014 I wonder if this will change for veterinary formulations too? I guess so as vets also rx under DEA licenses. I found it amazing that an otherwise fairly useless pain rx worked wonders for my dog when she was end-of-life with severe arthritis pain. Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 13, 2014 Moderator Share Posted July 13, 2014 good So tired of explaining to patients it is a narcotic! Link to comment Share on other sites More sharing options...
LKPAC Posted July 15, 2014 Share Posted July 15, 2014 crap! Now I can't rx it electronically! Link to comment Share on other sites More sharing options...
SocialMedicine Posted July 15, 2014 Share Posted July 15, 2014 not enough people understand the adverse effect and dependence/addiction potential of this medication. smart move in my opinion. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 15, 2014 Author Moderator Share Posted July 15, 2014 not enough people understand the adverse effect and dependence/addiction potential of this medication. smart move in my opinion. yup, it really is a bad drug. doesn't work well for pain, lots of drug interactions,lowers seizure threshold, etc. Pretty much the only thing I use it for is dental pain as our hospital has a "no opiates for dental or chronic pain" policy and everyone who shows up at 2 am already says they get no relief from tylenol and nsaids. Link to comment Share on other sites More sharing options...
Dunedain Posted July 15, 2014 Share Posted July 15, 2014 Even when it's ordered I don't even mention it to patient's as a PRN drug. All around it rarely works well and is pretty harsh on the kidneys/liver Link to comment Share on other sites More sharing options...
Guest Paula Posted July 16, 2014 Share Posted July 16, 2014 You may not believe this but I attended a 16 week tele-seminar on pain management and tramadol was discussed to use for fibromyalgia along with qhs low dose gabapentin. I have a few patients on it for that reason and it is the only thing that has worked when the pt. fail cymbalta, lyrica or savella. Not to be used in pts. with seizure history and my pts. have all signed drug agreements, are monitored and if anyone fails their contract they are discontinued from the tramadol. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 16, 2014 Author Moderator Share Posted July 16, 2014 tramadol was discussed to use for fibromyalgia along with qhs low dose gabapentin. pseudo drugs for pseudo disorders? Link to comment Share on other sites More sharing options...
LKPAC Posted July 16, 2014 Share Posted July 16, 2014 pseudo drugs for pseudo disorders? I laughed so hard, I just spit! Link to comment Share on other sites More sharing options...
rcdavis Posted July 16, 2014 Share Posted July 16, 2014 Dunno.. I recently had a chest wall pain with 3 ribs fractured. Did not want to take oxy or hydro or t3.. And found the best thing for me, especially at night, was combo ultracet and zanaflex.. Allowed me to sleep and not awaken with every rapid rib cage movement due to coughing, rolling over, etc. For someone like me, who does not take much pain meds, is a pretty effective analgesic. Link to comment Share on other sites More sharing options...
primadonna22274 Posted July 16, 2014 Share Posted July 16, 2014 I figure that's why it worked so well for my dog. Helped her a lot. Hope you're feeling better ???? Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted July 16, 2014 Moderator Share Posted July 16, 2014 You may not believe this but I attended a 16 week tele-seminar on pain management and tramadol was discussed to use for fibromyalgia along with qhs low dose gabapentin. I have a few patients on it for that reason and it is the only thing that has worked when the pt. fail cymbalta, lyrica or savella. Not to be used in pts. with seizure history and my pts. have all signed drug agreements, are monitored and if anyone fails their contract they are discontinued from the tramadol. Just out of curiosity, what about IV infusions of lidocaine for fibromyalgia flares? I'm being serious Link to comment Share on other sites More sharing options...
primadonna22274 Posted July 16, 2014 Share Posted July 16, 2014 Oh god no...can we say risk mismanagement?! Trigger point lido injections, sure. I like marcaine better though. Plenty of evidence that dry needling and saline work almost as well...not different in theory than acupressure and osteopathic techniques...they work by intercepting the somatic neural pathways. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 16, 2014 Author Moderator Share Posted July 16, 2014 Just out of curiosity, what about IV infusions of lidocaine for fibromyalgia flares? I'm being serious remember the pain management guy at sempa a few years ago in Tuscon who seriously advocated for areas inside ERs for treating fibro and other chronic pain pts with ketamine infusions? Link to comment Share on other sites More sharing options...
Guest Paula Posted July 17, 2014 Share Posted July 17, 2014 Just out of curiosity, what about IV infusions of lidocaine for fibromyalgia flares? I'm being serious I admit I have not heard of that treatment so it proves I don't know what I don't know except now I know so I know what I know. We have acupuncture at my clinic for smoking cessation. I will send my fibro- smokers there for treatment. C'mon people, Fibro is real. Except no rheumatologist in our area will take a fibro patient on an on-going basis. We can handle it in PC. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 17, 2014 Author Moderator Share Posted July 17, 2014 C'mon people, Fibro is real. show me a patient with fibromyalgia who isn't depressed and wasn't depressed before their fibro dx. I believe these folks have pain, but I believe it is a somatic manifestation of their mental health issue. These folks generally get better on antidepressants. Link to comment Share on other sites More sharing options...
Guest Paula Posted July 17, 2014 Share Posted July 17, 2014 I'm so proud of myself. I just realized I made over 1,000 posts on the Forum. I know I'm still in last place and EMEDPA/Andersen/Contrarian are tough competitors Link to comment Share on other sites More sharing options...
Dunedain Posted July 17, 2014 Share Posted July 17, 2014 show me a patient with fibromyalgia who isn't depressed and wasn't depressed before their fibro dx. I believe these folks have pain, but I believe it is a somatic manifestation of their mental health issue. These folks generally get better on antidepressants. 90% of the time: When I was in the ED for a bit fibro flares were a daily occurrence and when they come to the floor for their other issues it's hell to manage with multiple chronic pain problems...knees/back Middle-aged Female Obese/overweight Depression Bipolar/personality disorder Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 17, 2014 Author Moderator Share Posted July 17, 2014 has anyone ever seen a young(20s or 30s) happy, athletic individual of appropriate weight who loves their job, life, and family struck down in the prime of their life by a dx of fibromyalgia from out of left field? I've never seen it. Cancer, sure. Coag d/o, etc yup. But never fibro. all the fibro folks I have met are as described above. overweight, middle aged, depressed, and hating their lives for a variety of reasons. These folks can be really hard for me to be around. I just don't have the patience to try to fix them if they don't want to take steps to fix themselves.yes, your knees and your back hurt. it's probably because you weigh 300 lbs and always have a 48 oz pepsi and a slice of pizza in your hand and spend your days watching keeping up with the kardashians instead of trying to take positive steps to remedy things. the answer is not oxycontin, it's lifestyle change. I love reading stories of folks who got their act together, lost 200 lbs, and now take no medications for htn and dm. these folks are role models and the things they do are simple.eat less, exercise more, stop smoking, get out of the house, find something in your life to be passionate about. want to live to see your grandkids graduate from high school? take steps to make sure you can. some things are harder to change than others but at least try...when I first started running one of my running partners was a guy in his 60s who had lost 150 lbs and quit smoking 3 packs/day and started running. he was so passionate and trained so hard he frequently beat me in distance races despite being 30 yrs my senior. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted July 18, 2014 Moderator Share Posted July 18, 2014 remember the pain management guy at sempa a few years ago in Tuscon who seriously advocated for areas inside ERs for treating fibro and other chronic pain pts with ketamine infusions? That's what I was referring to. I remember joking with my old boss after that presentation about setting up a special area in our Obs unit for such infusions Link to comment Share on other sites More sharing options...
Guest Paula Posted July 18, 2014 Share Posted July 18, 2014 I told one of my fibro patients yesterday that I can't do anything more for her. Stay on cymbalta, stop drinking, exercise, lose weight, get counseling, stop drinking, find a job, stop drinking......etc. Another one today came in for SURPRISE not fibro flare. No c/o pain, looked well and c/o a rash. Made me wonder if her disability determination came through. She fits the profile. Oh, oh......I'm profiling........... Link to comment Share on other sites More sharing options...
kkvanlan Posted September 23, 2014 Share Posted September 23, 2014 crap! Now I can't rx it electronically! Yes you can. But you have to have the approved software for controlled substances. Unless your state has added restrictions. On March 31, 2010, DEA's Interim Final Rule with Request for Comment titled "Electronic Prescriptions for Controlled Substances" [Docket No. DEA-218, RIN 1117-AA61] was published in the Federal Register. The rule became effective June 1, 2010. The rule revises DEA regulations to provide practitioners with the option of writing prescriptions for controlled substances electronically. The regulations also permit pharmacies to receive, dispense, and archive these electronic prescriptions. These regulations are an addition to, not a replacement of, the existing rules. The regulations provide pharmacies, hospitals, and practitioners with the ability to use modern technology for controlled substance prescriptions while maintaining the closed system of controls on controlled substances. Link to comment Share on other sites More sharing options...
Acromion Posted September 24, 2014 Share Posted September 24, 2014 A nurse at my ER calls it "fibromyblahblahblah" Link to comment Share on other sites More sharing options...
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