The Curbsiders Internal Medicine Podcast #146 NephMadness: Pain Meds in Chronic Kidney Disease
Apr 1, 2019
Explore the complexities of pain management in chronic kidney disease (CKD), including the risks and benefits of opioids, gabapentin, tramadol, and NSAIDs. The use of non-steroidal anti-inflammatory drugs (NSAIDs) in CKD is discussed, along with alternative options like topical NSAIDs. Discover pain management options for neuropathy and arthritis, and hear predictions and analysis of various pain meds in the NephMadness tournament.
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Pharmacy Student Mishears Product
- Dave Juurlink shared a story about a pharmacy student misunderstanding a product name "Second Debut."
- This taught him the importance of not jumping to conclusions and being patient with patients.
Opioids & CKD Metabolism Advice
- Check if the pain syndrome responds to opioids and understand opioid metabolism before prescribing.
- Avoid opioids with active renally cleared metabolites in CKD like morphine and codeine.
Opioid Dependence Can Mimic Benefit
- Benefits and harms of pain meds can blur over time, especially with opioids.
- Dependence can mimic benefit, leading patients to believe opioids still help when they mainly avoid withdrawal symptoms.