The Curbsiders Internal Medicine Podcast

#146 NephMadness: Pain Meds in Chronic Kidney Disease

April 1, 2019
84 min

Pain management in patients with chronic kidney disease (CKD) often goes something like this: NSAIDs are evil, acetaminophen hardly works, opioids are dangerous, and all the rest (tramadol, gabapentinoids, antidepressants) are messy. But, we tackle the complexities of pain management in patients with chronic kidney disease in this special @NephMadness 2019 episode that, on a scale of 1-10, will leave you feeling very relieved in addressing pain.

Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Earn CME and read about each region in NephMadness 2019 at AJKD blog.

Credits

  • Written and produced by: Justin Berk MD, Samantha Gelfand MD
  • NephMadness Pun Contest produced by: Hannah R Abrams MS3
  • Cover art by: Kate Grant MBChB, Dip GUMed
  • Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD
  • Edited by: Matthew Watto MD, Emi Okamoto MD
  • Guests:  Samantha Gelfand MD, Matthew Sparks MD, David Juurlink MD 

Time Stamps

  • 00:00 Kidney Pun
  • 01:19 Disclaimer, intro and guest bios
  • 06:30 Guest one-liners
  • 10:42 Books recommendations, staff picks and a patient complaint
  • 15:25 Clinical Case and Pain Management Disclaimer
  • 16:33 Modalities in pain medicine
  • 18:20 Opioids for pain and their metabolites
  • 20:44 Dave Juurlink reframes the question, “what is our real goal with pain management?”
  • 24:42 Matt Sparks reiterates the dangers of morphine and codeine in patients with advanced CKD
  • 27:44 Communicating meds that are contraindicated or relatively contraindicated in CKD
  • 30:40 Buprenorphine
  • 32:40 What about the WHO Pain Ladder for CKD?; 33:32 Should we use more cannabinoids? Ketamine?
  • 37:07 Dave Juurlink rants on Tramadol
  • 44:20 How to pick winners in NephMadness
  • 46:06 NSAIDS and CKD
  • 57:07 Gabapentinoids (gabapentin and pregabalin) for neuropathic pain and driving?!
  • 65:57 Estimating eGFR in CKD and AKI. Which equation is best?
  • 70:38 How would each of our experts treat this patient with CKD and knee pain
  • 75:20 NephMadness 2019 picks for the pain region
  • 82:55 Outro

Feedback on the new Podbay?
    1x
    15
    15
    00:00:00
      00:00:00