PainNP

mi geo,
HEADACHE: CEPHALGIA
r/o lesion, a/v malforms: thunderclap: MRI
let neuro dx migraine: if they fein like fibro its better underdiagnosed. if "they hide": its probably meningeal, check temp/if its unilateral its prob vascular
if its too casual/couch all day headache it prob rebound to stress, allergy, etoh, or cluster unpatterned.
butorphanol is a great drug for cephalgia! I like it after you try
ABATEMENT now: check CVDs, PVDs, CVAs: a free dose of the tryptans/usually in the closet:
then try other rx
DEHYDRATION IS THE BIGGEST OFFENDER IN ILL PTS. CHECK ORTHOSTATICS
check caffeine use, triggers/excitotoxins: cocoa, CHEESE?, toba, wine, INSOMNIA:stress(moving day, divorce)
fioracet is asa/caffiene/butorphenol: great stuff unless overuse: abuse: MEDICOMENTOSIS: REBOUND
topomax: suppression/membrane stabilize TCA:amitrypt anemias/Fe++, heavy metals at hs: magnesium and calcium stabilize O2, CO2, vitB(neurons) complex: metanx is script
butorphanol is great if you can snort it/like tryptans/ avoid gi irritation and overtaking meds...why not rx ocean spray too! and nasonex while your at it
ice collar and a thick sweater plus rest is great if you have the time and is great for nausea too! reglan a must (85% seretonin stored in parietal cells of gut), IM: promethazine, vistaril + benadryl blocks histamines a potent vasoactive agent. loretadine is nondrowsy, less bang for the buck.

NSAID: ANTIINFLAME: KETOPROFEN/ Ketorolac:IM IS EXPENSIVE, RELAFEN, MOBIC, LODINE, IF MEDICAID: IB, NAPROX, OR PIROXICAM
SUPPRESSION: METOPROLOL, VERAPAMIL: BLACK FEMALES? CHECK PREGNANCY and BCPills/hormones (you know)
check meningeal signs: curled baseball caps, sunglasses, smirking looks: shady people are often photosensitive. look paler than the average bear.
feel em up: cervicogenic cephalgia is big, muscle spasm: flexeril
Grtr Occipt Blocks: 5cc 0.25% bupivicaine a basilar ridge upward.


Suspicion of Drug-Seeking Behavior: DONNAS FAV RX: ORDER EVERYTHING RECTAL: GASTROPARESIS: WHAT EVER CAN GO PO CAN GO RECTAL ALSO! CONSULT TO NEURO:DRIVE-BY MRI! CAROTID STUDIES ARE GOOD TOO! neuro changes: paresthesia, vision, speech :turf yesterday

agonist-antagonist class (e.g., nalbuphine [Nubain] or butorphanol [Stadol]). These drugs work well as analgesic agents without creating much of the euphoria that opioid abusers may seek. Another approach is to tell patients they will be receiving a potent opioid analgesic agent that has very few side effects except in persons addicted to opioids, in which case it precipitates withdrawal symptoms.

Brown and Croupin: damned if you dont: IN THIS DAY AND AGE OF 3 MONTH SCRIPTS we rethink: 2 week scripts only! pts need close control mechs. Addiction is something they are suing for. Documentation is the key. Chronic (persistent) pain needs to be charted with VAS0-10/10 and FUNCTION: "with pain control I expect I will be doing...XYZ..."
If they dont achieve improved function then the drug: narcotic or not is not right for them. First dose of anything in Pain Mngmt is TRIAL. Failure to improve function is a drug failure:we wouldn’t want to think it was a provider or patient failure! I LOVE MY JOB AS THE OPIOID SPARING NP (aka:narcotic natzi). paiNPs watch SE and ADRs and can be the bad guy and the MD I have around can save the day!

I loved writing this
how bout you?
I say
when in doubt, ship em out: neuro consult
db






On Sun, 19 Nov 2006 08:46:46 -0800 (PST)
Bad wrote:
> Congratulation. Speaking of "pain", I had a new
>migraine patient that want a refill on her STADOL. Do
>you know anything about that drug? I think I saw an add
>from Brown & Crouppon (?sp) about that drug. GPainNP