1. UPDATE IN PAIN MEDICINE RICHARD A. DuBOSE, M.D. DIRECTOR, IDAHO PAIN CENTER BOISE, IDAHO

2. OXYCONTIN DEATHS w/ POLY ABUSE ER INCIDENCE 30% RX, 5% OPIATES ABUSE POTENTIAL LOW IF USED CORRECTLY COMPANY PROVIDES EDUCATION SPECIAL MARKINGS TO TELL WHERE MEDS COME FROM “SMART PILL” IN WORKS

3. METHADONE VERY CHEAP (#90 X 10MGS= $17.49) ALPHA HALF LIFE 8 HOURS BETA HALF LIFE 30 HOURS NMDA RECEPTOR ANTAGONIST EQUIVALENT DOSING IV vs PO NO FIRST PASS EFFECT EQUIPOTENT WITH MORPHINE

4. DURAGESIC 12-18 HOURS TO “KICK IN” 25, 50, 75, 100 UGS/HOUR ACTIQ NOW AVAIABLE FOR B/T MAY HAVE SOME ADDITIONAL EFFECTS IN NEUROPATHIC PAIN NOT EASILY DEVERTED GOOD FOR PATIENTS WITH GI PROBLEMS

5. LOW-DOSE ANTAGONISTS NALTREXONE BUPRENORPHINE SLOWS TOLERANCE MAY HAVE EFFECTS AT VERY-LOW DOSES TO BLOCK PAIN RECEPTORS

6. NMDA ANTAGONISTS NEURO-EXCITATORY CHEMICAL METHADONE KETAMINE TRAMADOL TO A MILD EXTENT

7. ANTICONVULSANTS NEURONTIN TRILEPTAL TOPAMAX GABTRIL ZONEGRAN

8. ULTRACET TRAMADOL 37.5 MG ULTRAM TO BE PHASED OUT TYLENOL 325 MAY BE USEFUL MILD NMDA EFFECT REBOUNDING?

9. ZANAFLEX TIZANADINE UNIQUE CENTRALLY ACTING MUSCLE RELAXANT SEDATING ALPHA AGONIST PAIN RELIEVING ABILITY CHECK LIVER FXN AT HIGH DOSES

10. IDET PROCEDURE DISCOGENIC LOW BACK PAIN NOT GOOD FOR RADICULOPATHY MUST HAVE FAILED 3-6 MOS OF TX USUALLY GOOD FOR 1-2 LEVELS WHERE FUSION IS NOT INDICATED LONG RECOVERY PROVIDERS/INSURANCE ISSUES

11. IDET

12. INTRATHECAL PUMPS ORALS CAUSE TOO MANY SIDE AFFECTS WHERE NEUROPATHIC PAIN IS MAJOR COMPONENT EXCELLENT FOR SPASTICITY BEST FOR MALIGNANT PAIN

13. CORD SPINAL STIMULATORS RSD CAUSALAGIA CLAUDICATION/VASCULAR DZ RADICULOPATHY FAILED BACK SYNDROME

14. SCS

16. VERTEBROPLASTY FOR COMPRESSION FXS 1,000,000 PER YEAR 85% -90% EFFECTIVE METHYLMETHACRYLATE PAIN RELIEF IN 5-10 MINUTES RISK OF LEAKAGE OF “CEMENT”

17. VERTEBROPLASTY

18. BOTOX AND MYOBLOC TORTICOLLIS RECURRENT MUSCLE SPASMS HEADACHES HIGHER INCIDENCE OF ANTIBODIES WITH MYOBLOC QUITE EXPENSIVE

19. DUPLICATE LAW CLASS III’S MORE ABUSED LONG-ACTING LESS LIKELY TO BE ABUSED OR DIVERTED ATTEMPT TO AVOID REINFORCEMENT DUE TO ASSOCIATED DOPAMINE WITH QUICK RELEASE DRUGS IDAHO HAS CHANGED LAW

20. OPEN DISCUSSION THANKS FOR COMING!