This week's case is about a patient, John, currently prescribed OxyContin 40 mg every 12 hours and hydrocodone/acetaminophen 10-325 mg, two tablets three times daily, totaling approximately 180 MMEs per day. The patient is being considered for a transition to buprenorphine for chronic pain management using a standard rotation approach. We'll walk through the clinical reasoning, dosing strategy, and the transition protocol.

This week’s case is about Edward, who is a 45 y/o male patient experiencing chronic abdominal pain for over five years. The patient has had multiple CT scans, endoscopies, and other procedures without clear etiology of pain – his GI doctor has diagnosed him with irritable bowel syndrome and painful, daily chronic abdominal migraines. The patient has tried multiple medications – and is currently on a fentanyl patch and oxycodone for breakthrough pain. On exam, the patient has TTP out of proportion and complains of poor function and pain management. He also complains of significant anxiety and depression due to his pain. In today’s microlearning, we are going to discuss the concept of nociplastic pain, how to make the diagnosis, and how treatment of these pain types differs from other types of pain management.

This week’s case features Greg, a 42-year-old male patient, who while lifting a box at work developed sudden lumbar back pain, which is non-radiating but debilitating. The patient was seen in the ER, where he was diagnosed with a back strain, and provided with prescriptions for cyclobenzaprine and lidocaine patches. In addition, the patient has been using over-the-counter NSAIDS and Acetaminophen – with mild relief. He sees you in clinic, concerned about his continued pain and asking what else can be done. On exam, the patient has areas that are exquisitely TTP at his left SI joint and left perilumbar region around L4-5. This is the perfect patient to possibly receive in office trigger point injections, an effective and safe intervention – and the subject of today’s microlearning.