Greetings.
What do you say to your patients, who arent really looking for opioids, but have side effects to gabapentin, lyrica, nortyptiline and cymbalta...
They do say that ibuprofen works, etc...
lets take chronic lumbar radicular pain not responsive to ESIs in a 64 year old patient as an example. lets say that the patient does not want surgery or SCS trial or "anything invasive" - which I personally understand also. a lot of my elderly patients are reluctant to this, and also do not want to repeat many ESIs. Majority of the times they are concerned about acute rise in BG because of their DM.
Its always this mixed picture. There are characteristics of these patients which do not make me suspect any addiction or drug seeking behavior, nor their history would suggest - but then I am lost as to what to do next in regards to "non narcotic options". Often times, esp. the elderly with normal psychosocial profile, I have given them tramadol or vicodin, because they have tried everything else...injections which work and they want to repeat them, PT, and are now refractory to meds. Often they do not want to undergo surgery.
How do you approach this. And how does your management change between a young-ish patient (<45) vs. elderly. Or do you say flat out no?
What do you say to your patients, who arent really looking for opioids, but have side effects to gabapentin, lyrica, nortyptiline and cymbalta...
They do say that ibuprofen works, etc...
lets take chronic lumbar radicular pain not responsive to ESIs in a 64 year old patient as an example. lets say that the patient does not want surgery or SCS trial or "anything invasive" - which I personally understand also. a lot of my elderly patients are reluctant to this, and also do not want to repeat many ESIs. Majority of the times they are concerned about acute rise in BG because of their DM.
Its always this mixed picture. There are characteristics of these patients which do not make me suspect any addiction or drug seeking behavior, nor their history would suggest - but then I am lost as to what to do next in regards to "non narcotic options". Often times, esp. the elderly with normal psychosocial profile, I have given them tramadol or vicodin, because they have tried everything else...injections which work and they want to repeat them, PT, and are now refractory to meds. Often they do not want to undergo surgery.
How do you approach this. And how does your management change between a young-ish patient (<45) vs. elderly. Or do you say flat out no?