Medications Physician Training

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Doctors can call to schedule a 3 hour appointment for training in these medications. I do not train patients in prescribing. If you are a physician needing these treatments, please discuss with your treating physician and ask her/him to schedule a time.

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Patients with pain need to slowly taper off opioids and remain off for three weeks before starting. This is assuming good manual physical therapy and cognitive behavioral therapy is also prescribed.

 

Relevant medications can be started in one week for major depression or bipolar depression.

If for treatment resistant pain, these can be started in two or three weeks.

Medications may or may not include the following:

ketamine nasal spray – this may not be the most important medication. It takes a team.

naltrexone low dose  or  ultra low dose*****  one of the most valuable medications I have ever prescribed

dextromethorphan sustained release

oxytocin – a hormone. Your brain makes it, your heart makes it. It is NOT oxycontin.

memantine high dose – research in France has shown it may work for pain, exceeds the FDA approved 28 mg/day dose

lamotrigine an epilepsy drug

B complex – do not take more than 2 mg B6 as it is neurotoxic, creates burning pain and ataxia that may be irreversible

Vitamin D

Boswellia (migraine)

Others

They are not magic bullets, not cures. Experience comes in how and when to time the use of these medications to minimize risk of side effects and “clamp” pain and/or major depression. Thankfully, I do have patients whose “intractable” pain is in remission. Intractable means there has been no response to opioids or other medications or combinations tried so far.

Medications that I use are based on my focus on neuropharmacology, not on injections and spinal cord stimulators or ECT or rTMS which often have already been tried and failed to help.

Bear in mind, some physicians who do not use these medications may be unwilling to prescribe them. Some specialists limit their practice to procedures, others do not specialize in neuropharmacology. Most of my patients are complex and have usually been tried on a long list of medications and interventions that failed to help.

Use the search function on my website to read about some of the medications I prescribe or case studies, particularly note the articles posted May 26, 2009, for some of these medications and January 2011 to read some of the science of glia and inflammation that is present in chronic pain or in depression.

There is not a doctor on the planet who can predict what anyone’s response to treatment will be. If they do, you should avoid them for dishonest practices.

I cannot speculate what percentage of patients would be helped by my approach. To do that, you would need large numbers and placebo group to compare one person’s pain with another – no such standardized comparison exists. Research dollars are very limited and only one medication is tested at one time. However, if you get 10% result with 4 or 5 medications, you are noticing some change when one alone may do nothing noticeable.

Treatment and outcomes are individualized for every person with pain or Major Depression. Each person has a different pain threshold. Some lack a chromosome and/or have difficulty metabolizing medications.

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I do not recommend spinal cord stimulators because:

1. Most important, there are no long term studies showing lasting benefit;

2. they may cause complications, for example infection, paralysis, migration of the device or the leads, or new pain and scarring at the site of the external box, tethering to the cord itself;

3. for the rest of your life, you will never be able to have an MRI scan once the leads are in place, regardless of whether you have cancer or stroke;

4. there may be other ways to relieve intractable pain. Consider trying them first.

 

Patients who have had issues with substance abuse including alcoholism are not candidates for outpatient use of ketamine.

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Compounding Pharmacy

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LaVita Compounding Pharmacy 800-866-507-1990 open Monday – Friday until 5:00 P.M., has information and instructions on these medications if not used by your local compounder. LaVita ships to 11 or 12 states.

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Physical Therapy

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Bruce Inniss, P.T. at Inniss Physical Therapy, 1-619-287-4678, F 1-619-287-0350, 6475 Alvarado Rd, San Diego CA 92120. Bruce is an orthopedic physical therapist, a rare degree for therapists to achieve. Many of my treatment refractory patients who had no benefit from decades of physical therapy have found relief with Bruce and return two or three times a year even from London to see him. His office is 30 minutes from mine in good traffic. Besides the invaluable assessment and treatment, they are one of the first clinics west of Texas to introduce Unloaded Ambulation, partial Body Weight treadmill training and the first physical therapy clinic in San Diego to introduce isoinertial training and Norsk Sequence Training.

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Return to home page: Welcome to my Weblog on Pain Management!

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