1 September 2021 - Pain
Teaching this week will be on Microsoft Teams:
Program
1000—1015: Recap — Rex Gavan
1015—1045: Neck Pain — Gemma Ridley
1045—1100: Image of (Last) Week — Rachel Goh
1100—1200: Pain Q&A — Harry Eamon (Pain Specialist)
1200—1215: Break
1215—1300: Journal Club — Hamed Akhlaghi, Ezra Limm, Andrew Catran
1300—1315: ECG & Image of the Week — Luke Bayley
1315—1345: What Is A Leader? — Jacqueline Maplesden & Sarah Ward
1300—1400 Fellowship Written Group with Alex Handrinos (Zoom Meeting link) — Rachel Goh, Andrew West, Roshetha Bansal, Matthew Kilmurray
1400—1500: COVID Intubation Sim with Stuart Dilley (Main Simulation Room in Education Centre) — Rachel Goh, Gemma Ridley, Roshetha Bansal
1345—1445: Ultrasound with Mark Rugless — Phil Ward
Dr Harry Eeman’s favourite opioids for chronic pain
Caveat: Drugs usually don’t work well in chronic pain.
Lower risk in terms of addiction and dependence:
Morphine sulphate XR (24hr release) — daily pick-up at pharmacy
Tapentadol SR — always start at 50mg BD, add 50mg every 3rd day (max dose 250mg BD)
Can be used to get patients off oxycodone (instead of methadone or suboxone). When starting tapentadol SR, you can decrease oxycodone by 20mg per 50mg BD increments.
Non-opioid options:
Dry needling trigger points (can also use lignocaine 1% 1mL)
Amitriptyline 5-10mg/night, 3 hours before bed (NB: nortriptyline has less anticholinergic side effects)
Clonidine 25 microg one-off dose (non-benzo “chill pill”)
Ketamine infusion
Resources:
ANZCA’s “Acute Pain Management: Scientific Evidence”:
https://www.anzca.edu.au/getattachment/4c3b03b7-52bf-4c10-9115-83d827c0fc38/Acute-Pain-Management-Scientific-Evidence“Explain Pain, Supercharged” by David Butler & Lorimer Moseley
ECG & Image of the Week (combined this week!)
20yo lady referred to ED by GP for bilateral pleural effusions and consolidation on her CXR done today. Reporting 1 week of increasing SOB, not improving with salbutamol. Hx of asthma.
BP 120/80. HR 125. SpO2 98% RA => 88% RA when talking or moving. RR 22. T 36.3.
