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 “SMART PILL” IN WORKS

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

DURAGESIC 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

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

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

ANTICONVULSANTS NEURONTIN TRILEPTAL TOPAMAX GABTRIL ZONEGRAN

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

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

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

IDET

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

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

SCS

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

VERTEBROPLASTY

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

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

OPEN DISCUSSION THANKS FOR COMING!