In this episode we talk to Eric Brush about hyperalgesia, when opiate use leads to increased pain. We’ll also talk to Steve Bird about some strategies to use when treating acute pain in patients who chronically use opiates. A must listen for anyone who sees patients on chronic opioids, treats pain in patients with chronic pain, or knows someone who does. A link to Dr. Brush’s article can be found here and the review of Ketamine as an adjuvant can be found here.
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This episode received a shoutout from our friends at The Poison Review, an excellent site that covers all things medical toxicology. http://www.thepoisonreview.com/2013/04/06/weekly-review-2-toxicology-on-the-blogosphere/
I really enjoyed this episode and the information about opiod induced hyperalgesia. During the episode, you mentioned the difficulties with ketamine and emergence reactions, particularly in the IVDU population. I am a big proponent of ketamine for procedural sedation and borrow from the psychedelic literature as far as set and setting. The typical IVDU is in considerable pain, is coming in for an unpleasant procedure and tend to be in both a bad set and setting. Compared to kids, who view hallucinations as another version of TV and are generally not troubled by bizarre visions.
My tendency is to use propofol/ketamine combination in anyone who is troubled by anxiety or seems to have a more precarious mental state at the beginnning of the procedure.
[…] When Morphine Hurts – A must listen for anyone who sees patients on chronic opioids, treats pain in patients with chronic pain, or knows someone who does. […]