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» This Changed My Practice » Pain

Pain

CPD_Illustration_Medication

Buprenorphine/naloxone for chronic non-cancer pain

By Dr. Katelyn Halpape on March 26, 2025

One in five Canadians live with chronic non-cancer pain (CNCP). Due to the historical role opioids had as a key component of CNCP treatment, a number of patients living with CNCP are on long-term opioid therapy (LTOT). I discuss the off-label use of buprenorphine/naloxone as a distinctive treatment option for CNCP and LTOT.

Spinal stenosis — practice tips

Spinal stenosis — practice tips

By Dr. Mark Adrian on April 19, 2023

Degenerative lumbar spinal stenosis refers to the narrowing of the spinal canal that can result in numbness, pain, and weakness of the lower extremities. Atypical presentations are common as are competing diagnoses. Top practice tips: distinguish the source of the symptoms, rule out competing disorders, send for imaging, encourage exercises that place the patient in a flexed position, and consider gabapentin, epidural steroid injections, and a referral for a surgical opinion.

CPD_Illustration_Medication

Ceiling doses of ketorolac and ibuprofen in acute pain management

By Dr. John van Bockxmeer, Dr. Vishal Varshney, and Anthony Lau, PharmD on February 15, 2023

I incorporate this ‘NSAID ceiling’ into my prescribing practice for anti-inflammatory medications. I typically prescribe maximum doses of 400 mg oral ibuprofen TID with meals and 10 mg intramuscular ketorolac. I counsel my patients to limit their NSAID use to a 5-day window when possible and encourage other non-pharmacological and multimodal analgesia.

It’s not the ear — how TMD can confound clinicians

It’s not the ear — how TMD can confound clinicians

By Dr. Arman Abdalkhani on July 15, 2022

Otolaryngologists receive many referrals for what is classified as Eustachian Tube Dysfunction, aural fullness, and subjective hearing loss. Practitioners frequently encounter ear fullness or subjective hearing loss, in the face of an otherwise normal exam. It may lead practitioners to “read into” their physical exam with abnormal tympanic membrane (TM) findings.

Can we identify patients at risk for Opioid Use Disorder when beginning opioid analgesics for pain from new or ongoing non-cancer causes?

Can we identify patients at risk for Opioid Use Disorder when beginning opioid analgesics for pain from new or ongoing non-cancer causes?

By Jan Klimas, PhD; Michee-Ana Hamilton, MSc; Malcolm Maclure, ScD; Rita McCracken, MD, CCFP, PhD on August 24, 2021

There is growing recognition that opioid prescribing can lead to prescription opioid use disorder (OUD). It is estimated that nearly 115,000 British Columbians have become addicted to opioids. There is a need to safely reduce the volume of new opioid prescriptions for opioid naïve patients.

A Refresher in Pelvic Pain

A Refresher in Pelvic Pain

By Dr. Colleen Dy, Zerlyn Lee, and Adrienne Sim on April 7, 2021

Individuals with Chronic Pelvic Pain (CPP) often experience disruptions in multiple aspects of their reproductive health care. Routine pelvic examinations often become extremely challenging due to pain.

Decreasing pain of osteoarthritic knees

Decreasing pain of osteoarthritic knees

By Dr. Muxin (Max) Sun on March 6, 2019

I have decreased my frequency of giving steroid injections for decreasing pain of osteoarthritic knees. I educate patients on evidence, placebo effects and risks. I recommend less invasive therapies including physiotherapy, exercise (quadriceps and hip abductor strengthening, Tai Chi), hot compress, antiinflammatory creams, weight loss, TENS machine, orthopedic & orthotic devices, etc.

Appendicitis

The Alvarado Score in Acute Appendicitis

By Dr. Kevin Fairbairn on April 13, 2016

Appendicitis can often present itself in the black box of abdominal pain. Fortunately at times the history and physical can give practitioners a clear window, straight through the fascia, to an unhappy appendix.

Advance care plan (ACP) for patients with multiple co-morbidities

Hope for patients with fatigue, pain, and unexplained symptoms

By Dr. Ric Arseneau on October 13, 2015

Fatigue, pain, and unexplained symptoms are commonly seen in physician offices, however they are often experienced as “unsatisfying” for doctors. Our patients need an explanatory model to help them understand their illness. If we don’t provide one, patients will create their own or seek one elsewhere.

Exercise during pregnancy

Exercise during pregnancy

By Dr. Karen Nordahl on September 30, 2015

It has been shown that 55% of pregnant patients reported some form of back pain during their pregnancy when questioned. Studies have demonstrated that if we get pregnant women moving, specifically working their pelvic floor with Kegel exercises and their ‘core’ they may have better pregnancy outcomes.

cyclical pelvic pain

Management of cyclical pelvic pain

By Dr. Catherine Allaire on September 2, 2015

Endometriosis is a very common condition affecting an estimated 10% of women of reproductive age. Severe dysmenorrhea is the most common symptom of endometriosis and the earliest one to occur.

Meniscectomy

Meniscectomy

By Dr. Stan Lubin on August 2, 2014

In the 1970’s if you had a suggestive history, physical exam, and no osteoarthritis you would probably have a complete meniscectomy. Often the knee pain persisted postoperatively. Then complete meniscectomy was shown to be associated with a significantly increased risk of osteoarthritis.

pills

Managing opioid withdrawal

By Dr. Pam Squire on June 9, 2014

Many people mistake the pain of withdrawal as their usual pain and assume their pain improved because the opioid was relieving their pain, when it was more often just relieving the pain associated with the induced withdrawal.

Headache

Managing the complicated somatoform disorder patient

By Dr. Andrew Howard on September 10, 2013

Somatoform and conversion disorders are common psychiatric presentations in general practice. When chronic, like most psychiatric conditions, they commonly cause leave from work, poor quality of life for patients and supports, and heavy burden on medical practices.

Patient care

Provoked vestibulodynia (PVD) needs holistic management and a chronic pain approach

By Dr. Rosemary Basson on June 10, 2013

How to manage PVD is an extremely common question. PVD affects 12 -15 % women most of whom are relatively young. The common co-morbidity of PVD strongly supports a chronic pain approach.

Spreading pain with neuropathic features may be induced by opioid medications

Spreading pain with neuropathic features may be induced by opioid medications

By Dr. Launette Rieb on September 12, 2011

It is worth considering OIPS in the differential diagnosis when pain appears to be spreading, especially when features of allodynia and hyperalgesia are present.


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