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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 10341
Experience:  14 years as clinician in the field of Family Practice
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THIS is meant specifically who treat patients with chronic

Customer Question

THIS is meant specifically for those who treat patients with chronic pain using medications including opioid.
My wife is 66 yrs old and has failed surgery low back pain syndrome due to spinal stenosis and polyradiculopathy. Over the the last 5 yrs her opiods doses are cut down by 90% despite increased pain and diability. Yet her doctor keeps pressing her to further cut
the pain med further. She has 100
percent compliance record for 9yrs
What is the for this insistence by
doc. What are the current guide Lin
-enes for opiods therapy when all
Options have been exhausted ?
Submitted: 1 year ago.
Category: Health
Expert:  Anthony Bray, MD replied 1 year ago.


Based on her history she should be referred to a pain management specialist . These are usually anesthesia specialists whom specialize in the care of chronic pain. ..

....more to come...temporary interuption....

Expert:  Anthony Bray, MD replied 1 year ago.

It is recognized that many people may have chronic pain conditions BUT the DEA does not consider it appropriate for primary care doctors or orthopedic specialists even to prescribe narcotics CHRONICALLY....

If a person has say a broken leg and his doctor prescribed Percocet for 2 months >> no big deal

The long term use is where the DEA puts much pressure to avoid is due to the potential abuse / addiction potential / accidental overdose / illegal sale

A pain specialist is advised to be the one to oversee the chronic use of pain meds when chronic narcotics are used. ( They have patients sign contracts and have testing protocols to ensure that they are being used properly)

Chronic pain may be treated with strong narcotics such as Fentanyl / morphine / Nucenta or many other options

Adjunts to help pain also include meds that reduce the central nervous system processing of pain such as Lyrica / Neurontin/ Cymbalta

Other techniques may be used such as nerve blocks to spinal nerves such as the case of a back condition ...

I hope that this information is helpful for you

Let me know if you have further questions or concerns

I will be happy to get back with you

If my answer has been helpful and to your satisfaction then please remember to leave positive feedback

Thank you and Best Regards,

Anthony Bray MD

Customer: replied 1 year ago.
Dear Dr Bray,
She is under the care of pain specialist. She 3 courses of epidural and 1 course of facet block. Nerve root injections were never recommended by Hopkins Sinai & 3 pain specialists. She has been treated by all the medications that you mentioned &
quite a few more. Accupuncter and intra-
-thecal morphine pump and surgery were recommended at Hopkins but declined by insurance. With due respect and thanking you for response, my questionsister can only be answered by doctors who specialize in pain management.
Gratefully yours,
DB Shah. Husband of patient.
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

Ok I was hoping to be helpful for you. I will opt out. Perhaps another physician on this site may have further ideas to be helpful. It sounds that the appropriate type steps have been tried. Good luck to you and your wife. I hope that she receives excellent care and feels better!

Take care

Anthony Bray MD