We tackle the complexities of pain management in patients with chronic kidney disease in this reboot from @NephMadness 2019 that, on a scale of 1-10, will leave you feeling very relieved in addressing pain. Topics: Opioids, gabapentinoids, NSAIDS, pain ladders, why tramadol is tramadont, and more!

Credits

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

Show Segments

Kidney Pun
Disclaimer, intro and guest bios
Guest one-liners
Clinical Case and Pain Management Disclaimer
Modalities for pain meds in ckd
Opioids for pain and their metabolites
Dave Juurlink reframes the question, “what is our real goal with pain management?”
Matt Sparks reiterates the dangers of morphine and codeine in patients with advanced CKD
Communicating meds that are contraindicated or relatively contraindicated in CKD
Buprenorphine
What about the WHO Pain Ladder for CKD?
Should we use more cannabinoids? Ketamine?
Dave Juurlink rants on Tramadol
NSAIDS and CKD
Gabapentinoids (gabapentin and pregabalin) for neuropathic pain and driving?!
Estimating eGFR in CKD and AKI. Which equation is best?
How would each of our experts treat this patient with CKD and knee pain
Outro

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REBOOT #146 Pain Meds in CKD

The Curbsiders Internal Medicine Podcast