Happy Early Thanksgiving 🦃   Every now and then I would recommend using a different pain scale than a numeric pain score if patients are non verbal or having cognitive impairment.   The scale is called Pain Assessment in Advanced Dementia Scale (PAIN-AD).   It makes sense to use it if we look at some of the grading of this scale   Breathing Negative vocalization Facial expression Body language Consolability   All the grading are not self reported, so it relies less on the ab

Hey there👋🏻 I picked up an interesting book two weeks ago called When Everyone Knows that Everyone Knows . The core concept of the book boils down to something called common knowledge, which the author defines as: When A knows that B knows, and B knows that A knows that B knows, and so on. A good example is language. I’m writing this newsletter in English knowing my readers know English, and my readers know that I know they know how to read in English. So that got me thinki

Hey there 👋🏻 Remember that poll I did about the confusing morphine renal adjustment instructions? I started thinking, if I had to explain that to a first year medical, pharmacy, or nursing student, how would I go about it? What kind of context would I need to fill in for it to make sense? So let me try that this week. How to interpret “Administer 25–50% of the usual initial dose” if we’re referring to IV morphine? There are two technical steps here: a. You need to understa

Hey 🍂 We just moved the time an hour back, and I can feel the weather changing. I hope you’re excited if you enjoy wearing layers and having a cup of hot chocolate on a chilly morning. This is also around the time residency applications start. I remember back then everyone was doing one of these things: Comparing what programs others were applying to Reaching out to upperclassmen about their residency experiences Feeling excited yet overwhelmed about the application while st

Hey 🎃 Every now and then, I hear debates about how oral morphine equivalent (OME) or morphine milligram equivalent (MME) can be flawed. And I get it. But there are times you just can’t get away from the concept of OME/ MME, or you’d have no guidance. Maybe you could still guess the dose right without it. But there’s one principle that will instantly upset a patient: Start low, go slow. Here are 7 scenarios that have everything to do with OME/MME: A cancer patient on a stable

Hi there 👋🏻 I’ve always had a love hate relationship with patient controlled analgesia(PCA). It’s such a powerful tool, but the dosing can get complicated fast. One of the biggest reasons PCA causes problems is that many clinicians start it with this assumption: “Oh yea! Their pain isn’t controlled. The PCA lets them press the button whenever they want, and therefore they’ll have better pain relief.” Jinx? That’s why I wrote this week’s newsletter. Before starting a PCA, yo

Hey there 👋🏻 The other day I made a post about dosing the fentanyl 12mcg patch. Technically, I should really be calling it the fentanyl 12mcg/hr patch. But did you know it doesn’t actually deliver 12mcg per hour? If you look at the package insert, you’ll see two asterisks next to the 12mcg dose: Source: https://www.accessdata.fda.gov/drugsatfda_docs/label/2005/19813s039lbl.pdf Nominal delivery rate is 12.5 mcg/hr. That’s right! The fentanyl 12mcg patch actually delivers 12

Hi there 👋🏻 We just released our latest video on 7-OH. If you’re curious about the compound that’s been making headlines and want to...

Hey there 👋🏻 If you read the last newsletter, you know this week is the birthday special edition. 🎂 Yes, getting another year older as...

Hey there 👋🏻 We have something exciting coming up. We’re working hard on our next video about kratom and 7-OH. If you haven’t watched...

Hey there 👋🏻 Every year, I have about two students who sign up to do a pain management rotation with my colleagues and me. I usually...

Hey there 👋🏻 I did a survey last week to answer this very question: where do we stand on “higher dose” when Suboxone is involved in...

Hey there 👋🏻 A few of my colleagues and I just published an article on how to have a difficult conversation. It’s a topic I wish I’d...

Hey there 👋🏻 If you work in the inpatient setting and want to avoid some common mistakes you might already be making, check out our...

Hey there 👋🏻 If you haven’t watched our first VuMedi video on the 5 common inpatient pain management oversights, you may want to...

Hey there 👋🏻 Why aren’t clinical surveillance software companies advertising their potential for opioid stewardship, and only...

Hey there 👋🏻 I recently finished two books by Oliver Burkeman: Meditations for Mortals and 4000 Weeks. Both fall under a similar...

Hey there 👋🏻 I have a million dollar question: How do we go about dosing a patient controlled analgesia (PCA)? And don’t be confused...

Hey there 👋🏻 I recently came across an interesting survey on MedCentral about the new pain medication suzetrigine. In case you haven’t...