Virtual Consultations

Pain Pharmacotherapeutics Service offers a pain therapeutics virtual consult service thru Pharmacist Consulting Services, PLLC and Remitigate Therapeutics. This assistance can be uniquely adapted  to the needs of any size individual family practice settings, pain specialty clinics, hospital outpatient settings, or others.

All of our clinicians are PharmDs that have trained and/or collaborated with Dr. Fudin, and have completed a general practice residency plus 1-year residency in advanced pain therapeutics focusing in outpatient (or equivalent post-PGY2 experience), with competencies in pain management, behavioral health, and addiction.

Files may be uploaded to a secure file share system, such as Citrix (or other) so that we all have access to any files uploaded by a patient, and/or provider, and/or any of us.  All will be encrypted for HIPAA compliance, and Remitigate will provide e-documents for patient and/or provider signature.  Other alternatives include to send files via fax, or to arrange direct electronic medical record access unique to a certain practice or healthcare system.  There will be a fee to receive these because all files will need to be retrieved and undergo “file recognition” conversion.

A standard consult form includes whether a unique provider is in agreement for the consultant to communicate with patient directly (or not). All written recommendations are the final decision of designated consulting provider and implementation of such will be between patients and provider, although the consultant will participate in recommending dosage adjustments after follow-up chart reviews.

Below is a list of activities that will be included:

Accurately assess opioid medication regimens; to determine if the patient should or should not be on an opioid; stratify risk; prescribe or recommend in-home naloxone; determine if patient on the best opioid or the wrong opioid; help transition them to a more appropriate opioid for their condition in collaboration with referring provider; recommend, monitor and interpret urine drug screens and medication blood levels; recommend and interpret pharmacogenetic tests; to anticipate otherwise unanticipated drug interactions due to Phase I, Phase II metabolisms and/or p-glycoproteins; to cost-effectively select the best medication based on insurance coverage; adjust doses based on kidney and hepatic function; comprehensively engage each patient’s third-party payer to justify required prior drug authorizations; review entire medication profile and make recommendations with focus on pain therapeutics including but not limited to the following:

  1. Practical pharmacokinetics (elderly, CKD, hepatic dysfunction, other – i.e. hypoalbuminemia)
  2. Antidepressants (by chemical class; TCA, SNRI, SARI, etc.)
  3. Anticonvulsants (by pharmacological class; Na channel, voltage-gated calcium channel, SGRI, etc.)
  4. Skeletal muscle relaxants
    • Baclofen
    • Benzodiazepines
    • Carisoprodol
    • Chlorzoxazone
    • Cyclobenzaprine
    • Dantrolene
    • Metaxalone
    • Methocarbamol
    • Orphenadrine
    • Tizanidine
  5. Anxiolytics / sedative-hypnotics
    • Benzodiazepines
    • Z-drugs (zopiclone, zaleplon, zolpidem)
    • Barbiturates
    • Others
  7. Antihistamines
  8. Non-traditional Opioids
    • Tramadol
    • Tapentadol
    • Buprenorphine
    • Pentazocine
  9. Adjuncts
    • Ketamine
    • clonidine
  10. Topicals (i.e. diclofenac patch, gel, etc., lidocaine, clonidine, compounded products and evidence (or lack thereof), etc.)
  11. Parenteral Options
    • Transdermal
    • Transmucosal
    • Depot injections
    • Subdermal implants
    • Spinal injections
    • Nerve blocks
    • Trigger point injections

Patient Initial and follow-up:

This service may or may not be reimbursable by health insurance provider and will vary by plan and by state.  A comprehensive invoice will be provided, but reimbursement and coverage of this service is the responsibility of the patient.