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The Curbsiders Internal Medicine Podcast

Supercharge your learning as these board-certified Internists interview the experts to bring you clinical pearls, practice changing knowledge, and a healthy dose of humor. 

Jun 24, 2019

Rethink how you’re diagnosing and managing chronic pain with high-yield tips from pain experts and primary care doctors Soraya Azari MD @azarimugs (UCSF), and Phoebe Cushman MD, MS (UMass Memorial). Because let’s face it, managing chronic pain can be very difficult. Expand your toolbox for management-- including the importance of activity, empowering your patient, risk stratification for patients prior to opioid initiation, how to identify opioid use disorder, and how to taper opioids. Plus, updates on recent practice changing articles in chronic pain.

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  • Written and produced by: Nora Taranto MD
  • Hosts: Nora Taranto MD, Paul Williams MD, Matthew Watto MD
  • Edited by: Emi Okamoto MD, Matthew Watto MD
  • Guests: Soraya Azari MD; Phoebe Cushman MD, MS


This episodes was recorded LIVE at #SGIM19 in Washington DC! Join the Society for General Internal Medicine today!

Time Stamps

  • 00:00 Intro, disclaimer, guest bios
  • 04:50 Guest one-liners, book recommendations, picks of the week, career advice
  • 14:50 A case of chronic pain; Group pain into 1 of 3 buckets
  • 18:48 Use of pain scales; and taking a pain history; affirming positive behaviors surrounding pain
  • 23:13 Nonpharmacologic measures for chronic pain
  • 26:30 Cognitive behavior therapy (CBT) for chronic pain; remote CBT vs traditional CBT
  • 30:32 Apps for Meditation, Affirmations
  • 31:53 Back to the case: Should we trial opioids for our patient’s chronic pain? Our guests give their recommendations and how they counsel patients about opioids
  • 34:55 Counseling about risk of opioids
  • 37:42 Risk stratifying patients requesting opioids; Some risk tools (COMM, Opioid Risk Tool, DIRE); Don’t forget to screen for mood disorders
  • 42:10 What to do if pain is not improved on high dose opioids; How to identify an opioid use disorder
  • 45:13  How to taper patients off opioids; Forced tapers and the CDC guidelines; how to taper the right way
  • 50:34 Buprenorphine for opioid use disorder and/or chronic pain
  • 57:38 Gabapentin and risk for misuse and/or unintentional overdose in patients also using opioids
  • 61:42 Plugs: Get your x-waiver, or better yet advocate for getting rid of the waiver