September is Pain Awareness Month, a time to raise public awareness of issues in the area of pain and pain management for children and adolescents. Our president, Dr. Yuan-Chi Lin, shares a message for Pain Awareness as pain continues to be an issue that impacts the pediatric population.
QUESTION OF THE MONTH/VISUAL PEARLS/POLLS OF THE MONTH
SEPTEMBER 2024 QUESTION OF THE MONTH
A 17-year-old male with a history of degloving injury to his left lower extremity following a traumatic ATV accident who has undergone 3 separate reconstructive surgeries, complicated by ongoing burning pain to the left lateral leg/foot. He presents to your clinic for preoperative evaluation preceding his last and most involved surgery. In addition to his home regimen (acetaminophen, celecoxib, amitriptyline, pregabalin, and sometimes oxycodone), his previous perioperative analgesic regimen included sciatic nerve blocks with indwelling catheters, scheduled ketorolac, and oxycodone and IV hydromorphone as needed for breakthrough pain. Despite this, his acute-on-chronic pain has been difficult to treat post-operatively, interfering with his sleep and recovery.
You discuss the option of adding a ketamine infusion to his regimen but the patient is hesitant about receiving ketamine, citing its association with a highly-publicized death of a celebrity. He tearfully describes knowing friends who became mentally altered temporarily after taking ketamine tablets obtained online. You would like to educate your patient about ketamine use in treating pain.
Which of the following statements is TRUE?
A. Injectable ketamine is a treatment approved by the FDA for pain management.
B. Research indicates that ketamine is highly efficacious in treating non-neuropathic pain conditions including fibromyalgia, cancer pain, ischemic pain, and migraine headaches.
C. According to the 2018 ASRA guidelines, since ketamine is given at subanesthetic doses to treat chronic pain conditions, personnel in charge of its administration only require DEA licensure and ACLS training.
D. Ketamine is a non-addictive “street” drug popular for its euphoric and sensory-heightening properties.
E. Ketamine can be shipped to patients as oral and injectable forms when prescribed by a clinician with appropriate DEA prescribing privileges.
AUGUST 2024 VISUAL PEARL
