O deLeon-Casasola MD

Prof. #Anesthesiology and Medicine , Chief,#Pain #Med, at #Roswell Park #Cancer Institute, #Pain Expert Tweets not med advice

[O deLeon-Casasola MD @OscardeLeonMD]

@VUMC_Anes @JacksonHeatherJ @VUMChealth Congratulations, Heather!!!

[O deLeon-Casasola MD @OscardeLeonMD]

More importantly, Dr. Vallejos’ work suggests that electrical stimulation patterns DO make a difference in the therapeutic target of those impulses and in this case, the glial cells functioning in neuropathic pain.

[NANS-RFS & Young Neuromodulators @NANSRFS]

Really great to hear about Dr. Ricardo Vallejo’s work on role of glial cells in chronic pain, and how modulation of glial cels might better explain mechanism of action of SCS #INS2019

[O deLeon-Casasola MD @OscardeLeonMD]

I am not a golf fan, but I was impressed by Kevin Na’s gesture. After his 3rd career tour win at the Colonial Country Club, he gave his caddie a ‘73 Dodge Challenger that was to be awarded to the winner!! GENEROSITY, PASS IT ON!!!

[O deLeon-Casasola MD @OscardeLeonMD]

@clinicadolorqro Gracias por tu respuesta, Jorge. Siempre un gusto saber de ti. Ojalá nos podamos ver pronto. Abrazos.

[O deLeon-Casasola MD @OscardeLeonMD]

Muscle and bone pain after the use of “zumabs” is on the rise in cancer survivors. Long-term NSAIDs is not an option. One more reason why opioid therapy has increased in cancer survivors (J Am Geriatr Soc 2019;67:945). Monitoring for opioid use/abuse is needed in these patients.

[O deLeon-Casasola MD @OscardeLeonMD]

Considering the consequences of a late diagnosis, this is very useful information.

[Roswell Park @RoswellPark]

Many pancreatic cancer patients do not notice anything is wrong until the disease has impacted other areas of their body. Find out if you are eligible for screening: https://t.co/9TFK3Q1bdF

[O deLeon-Casasola MD @OscardeLeonMD]

@Veronic41752363 @painmednews They do prescribe opioids for their patients. However, the heterogeneity and variability in patient’s presentation rendered the unimodal approach unsuccessful. I suspect that this is what happened to Mr. Trebek. Thus, my original recommendation to get a pain specialist involved.

[O deLeon-Casasola MD @OscardeLeonMD]

I was disturbed reading that Alex Trebek suffered severe pain due to his pancreatic cancer. This is unacceptable in the 21st century because all the successful options that we have to treat cancer pain. Take home message: ask the oncologist for a referral to a pain specialist.

[O deLeon-Casasola MD @OscardeLeonMD]

@jperez_mcgill Absolutely.....in the hospital setting. Not sure if that would work for private practitioners though. Not their fault. We need to prove to them that we are not only about “needles” though. Multimodal, interdisciplinary approaches is the key.

[O deLeon-Casasola MD @OscardeLeonMD]

@rednelok Try the Pain Service at the University of Washington. There several renowned pain specialist there.

[O deLeon-Casasola MD @OscardeLeonMD]

@jattarab @ESchwenkMD @ChrisWahal_MD @JeffAnesthesia @RichWebsterTJUH This is very important. However, we need consensus on what are the key components of ERAS that will result in improved outcome. Everybody seems to have a different approach. Thus, data analysis is very hard.

[O deLeon-Casasola MD @OscardeLeonMD]

The CDC clarified that their management of chronic pain guidelines do not include patients with active cancer treatment, palliative care, and end-of-life care. Thus, the recommendations still apply to survivors who are treated for pain as a result of their cancer treatment.

[O deLeon-Casasola MD @OscardeLeonMD]

@PainPhysician Very true! It was (hope that it is not any longer) the biggest trap. Patient has neck problems after a deceleration car accident, has been going to a chiropractor, MRI showed a herniated disk at C7-8, TFESI done, and you know how the story ends. Thanks for bringing it up.

[O deLeon-Casasola MD @OscardeLeonMD]

@garyschwartzmd @ASRA_Society @drdanchoi @EMARIANOMD @amit_pawa @AmyPearsonMD @NarouzeMD @AlexAndersonMD @alifitmd @CNN He was lucky! If the vertebral artery dissection had occurred in his dominant side, he would have died shortly after that. At the risk of promoting my own work, I wrote about the pathophysiology of this problem after cervical TESI in RAPM. Here is the reference PMID 18299101.

[O deLeon-Casasola MD @OscardeLeonMD]

@EricaWittwer @RyanMarino Sure. The problem is that there is not enough awareness about OIAI. Thus, monitoring is for the most part non-existing. Tests mentioned in the original Tweet should help you make the diagnosis. Treatment is best handled by an endocrinologist.

[O deLeon-Casasola MD @OscardeLeonMD]

Consider opioid-induced adrenal insufficiency in patients experiencing fatigue, asthenia, muscle/abdominal pain, and headaches. Low morning cortisol, ACTH, DHEAS, and peak cortisol levels after cosyntropin stimulation test can be helpful, but there is no “gold standard”.

[O deLeon-Casasola MD @OscardeLeonMD]

Productive meeting with the FDA to discuss the problems that stemmed from their physician letter on compounding for Intrathecal Therapy. They suggested we meet again to discuss the next steps to preserve access for our patients. ASRA will continue to be “at the table”.

[O deLeon-Casasola MD @OscardeLeonMD]

Those using marijuana have FIVE TIME greater risk of developing psychosis-Lancet https://t.co/D8YtRVRzTg. Current “medical” marijuana TCH concentrations are 18-30% while in the 80’s, 10%. High potency marijuana has >10% THC. Time for warning labels and government responsibility.

[O deLeon-Casasola MD @OscardeLeonMD]

As a follow-up to my previous post, when dealing with herbals in pain management, one should be concerned with ginkgo biloba and St John’s Wort (risk of serotonin syndrome when co-administered with SNRI or TCAs), and the former and garlic also increasing the risk of bleeding.