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Tramadol goes to DEA SCH IV

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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.

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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.

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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

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Guest Paula

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. 

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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.

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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

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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.

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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?

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Guest Paula

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.  

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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.

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Guest Paula

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 

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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

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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.

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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

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Guest Paula

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...........

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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.

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