Mike Cooke’s Post

I got a question today: “The doctor ordered additional IV Dilaudid 0.5 mg. Is it going to provide similar pain relief compared to PO oxycodone 10 mg?” In surgical cases that require opioids, we often see both IV and PO opioids ordered. Sometimes the IV opioid has a higher oral morphine equivalent (OME) than the PO dose, and sometimes it’s the other way around. A logical question to ponder in such scenarios is: Should the OME of IV opioids be higher than PO? And does it matter if the IV opioid provides more pain relief than PO? If we assume that IV opioids must provide similar or better pain relief than PO opioids, we end up prioritizing IV opioids in the overall pain management. That’s a slippery slope. IV opioids often create unrealistic expectations for pain relief due to their fast onset. Even if pain is well controlled with IV opioids, patients will eventually need to transition to PO opioids for discharge—no one goes home with vials or syringes of opioids. Instead of thinking whether IV opioids should provide matching or better analgesia than oral opioids, consider them as an extra boost for when it’s absolutely necessary. They don’t need to be much. ——————— 💊Daily Pain Dose: It’s common to hear patients say, “Oral opioids don’t work, only IV does.” When you dig deeper, it’s often about the faster onset, not better efficacy. #PainMedicationManagement #PainManagement #Opioids

As I travel to the various pain conferences throughout the year, I notice that, for younger pain physicians just starting to explore advanced pain management options, intrathecal drug delivery (ITDD) often sounds complex—but it can be a game-changer for patients with chronic pain. Because ITDD delivers pain medication directly to the spinal canal, it allows lower analgesic doses with fewer systemic side effects, making it a powerful option for patients who don’t respond well to conventional therapies. What’s unique about ITDD is how it brings together a team: physicians, pharmacists, and device experts. We all work closely to personalize dosing, adjust as needed, and ensure the device performs optimally. I encourage physicians and practices that are new to the therapy to utilize this collaboration to the fullest, as it builds reliable systems that help avoid complications, ensure consistent dosing, and keep patient safety front and center. Intrathecal drug delivery might seem like a big leap—but ITDD isn’t a solo effort; it’s a team approach, and that teamwork is what ensures success. With the right support, it’s an incredibly rewarding tool for chronic pain patients and one that every pain physician, regardless of industry tenure, should consider. #ITDD #intrathecalpumps #hartleymedical #wearehartley

SUZETRIGINE: THE REVOLUTIONARY APPROACH TO PAIN TREATMENT Vertex’s suzetrigine (VX-548) is a potential first-in-class, exquisitely selective, oral NaV1.8 inhibitor that recently captured headlines for its positive Ph. III data in moderate-to-severe acute pain treatment https://lnkd.in/da3gNiEx With nearly 51.6 million adults in the US experiencing chronic pain each year, there is an urgent unmet medical need for non-addictive pain medications as alternatives to opioids. Vertex started working in the pain space soon after they acquired San Diego’s Aurora Biosciences in 2001. Now, they plan to file an NDA for VX-548 by mid-2024 for the treatment of moderate-to-severe acute pain which has further ignited industry interest in NaV1.8. #Suzetrigine #Vx548 #pain https://lnkd.in/d9ZqmnyY

Check out these fallacies before starting any sophisticated opioid regimen. ❌ Starting patient controlled analgesia (PCA) = better pain control ✅ PCA will only provide better pain control if the dosing is right, coordination of care is on point, and patient education is well received. Any failed component may lead to the opposite outcome. ❌ Starting a long acting opioid on top of short-acting = more stable pain control ✅ A long acting opioid simply lasts longer. But if it only accounts for a small fraction of the total daily dose from short acting opioids, it will barely manage the pain. Think of it like dosing insulin. ❌ Start a fentanyl patch during pain crisis from cancer = providing aggressive analgesia ✅ From the time of patch application to onset of analgesia, there is a lag time. If the baseline opioids are not adjusted while waiting for the fentanyl patch to take effect, the patient will suffer for a day or two. What other fallacies have you spotted in dosing opioids? ——————— 💊 Daily Pain Dose: All these concepts are from the opioid conversion book by Lynn McPherson, the one I’m doing a book club on. Did you DM me yet? #PainManagement #Opioids

VA research shows that service members who receive non-drug therapies as part of their pain treatment plans have lower long-term risks for alcohol and drug disorders, as well as self-induced injuries. Learn more at https://bit.ly/3qHOdsU #VA #drugfreepaintreatment

VA research shows that service members who receive non-drug therapies as part of their pain treatment plans have lower long-term risks for alcohol and drug disorders, as well as self-induced injuries. Learn more at https://bit.ly/3qHOdsU #VA #drugfreepaintreatment

Choosing Between Meloxicam and Ibuprofen: A Simple Breakdown 🌟 Understanding Pain Relief Choices: Meloxicam vs. Ibuprofen Confused about which pain reliever to choose? Let's break down these common NSAIDs! Meloxicam and ibuprofen serve different purposes in pain management. While meloxicam is your go-to for chronic conditions like arthritis with its convenient once-daily dosing, ibuprofen shines in treating acute pain with multiple doses throughout the day. Both medications are effective, but they're not one-size-fits-all! Your choice should depend on: • Type and duration of pain • Medical history • Current medications • Doctor's recommendations Remember: Always consult your healthcare provider before starting any new medication! 💊 Please read the full blog post for more detailed information and medical guidance. #PainManagement #Healthcare #MedicalAdvice #ChronicPain #Medication #Wellness #HealthyLiving #NSAIDs #PainRelief #PatientCare #MedicalEducation #HealthAwareness #MedicalTips #HealthcareBasics #PatientEducation #embraceinnerchaos #somdutt ⚠️ Important: This post is for informational purposes only and doesn't substitute professional medical advice.

HCPs, will you be in Chicago for the American Burn Association Annual Meeting? Sign up to for Vericel's presentation on NexoBrid for enzymatic eschar removal. A panel of HCPs will cover clinical trial data, product use considerations, case studies and more. Register here: https://bit.ly/3v6nkVj (For HCPs Only) NexoBrid® is used for eschar removal in adults w/ deep partial and/or full thickness thermal burns. See Limitations of Use. Contraindicated in patients w/ hypersensitivity to anacaulase-bcdb, bromelain, pineapples, papayas or papain. Common side effects inc. pruritus and pyrexia. See Prescribing Info for more Important Safety Info: bit.ly/ISIPI

VA research shows that service members who receive non-drug therapies as part of their pain treatment plans have lower long-term risks for alcohol and drug disorders, as well as self-induced injuries. Learn more at https://bit.ly/3qHOdsU #VA #drugfreepaintreatment

Its crucial to follow the modified WHO analgesic ladder in pain management : Four-Step Ladder: The modified ladder is a four-step approach to pain management, particularly for chronic non-cancer pain (CNCP). 📌Step 1: Non-opioid medications ± adjuvants. 📌Step 2: Weak opioids and non-opioids ± adjuvants. 📌Step 3: Interventional therapies (e.g., nerve blocks, radiofrequency ablation) and non-opioids ± weak opioids and adjuvants. 📌Step 4: Strong opioids ± adjuvants. #painmanagement #clinicalpharmacist #medicationmanagement #criticalcaremedicine