"I Won't Go Down!" - What To Do When All Else Fails?

Course Description:

Who amongst us, as clinicians, have managed patients with chronic, long-term pain resistant to any and all treatment modalities tried? What do we do in those situations? Refer out to a different pain management group, again? Try the same medication already tried and failed by the patient to see if, by some miracle, it will work? Or, do we just give up and counsel the patient that their pain is too difficult to treat? That there isn’t anything else we can do?

This seminar intends to set up the discussion of how we handle these types of complicated cases when there appears to be no end in sight. We will review assessment strategies to verify what exact modalities have failed in the past, as not all failures are created equally. We will also delineate between ‘last line’ treatment modalities that may be used when all others fail. Some specific treatments of interest include IV lidocaine infusions, last line anticonvulsants, pain pumps, and NMDA antagonists.

This lecture will empower clinicians of all types to do as Rocky; continue fighting and refuse to go down.

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Jeffrey J. Bettinger, PharmD

Pain Management Clinical Pharmacist
Saratoga Hospital Medical Group
Schenectady, New York

Dr. Jeffrey J. Bettinger, PharmD, is a Pain Management Clinical Pharmacist with Saratoga Hospital Medical Group in Saratoga, NY, as well as the Senior Strategy Consultant and Therapeutics Associate for Remitigate, LLC. He also served as an invited expert panel member for the FDA during their public workshop Morphine Milligram Equivalents: Current Applications and Knowledge Gaps, Research Opportunities, and Future Directions in 2021. He earned his PharmD from Albany College of Pharmacy and Health Sciences in 2017 with a concentration in nephrology. Following his doctoral training, he completed a PGY1 general practice residency at the Stratton VA Medical Center in Albany, NY. Immediately following his general practice residency, he trained with Drs. Jeff Fudin and Erica Wegrzyn and completed a PGY2 Pain and Palliative Care residency at the same institution.

Dr. Bettinger’s current position with Saratoga Hospital Medical group involves him working alongside primary care providers throughout ten different primary care clinics where he specializes in complex and high-risk pain medication management through direct patient care and electronic consult services. He remains fortified in academia as he continues publishing in peer-reviewed journals, presenting at regional and national meetings, and teaching various pain classes at different colleges of pharmacy. He also mentors students and residents at his clinical sites of practice.


Charles E. Argoff, MD

Professor of Neurology and Director of Comprehensive Pain Program
Albany Medical Center
Albany Medical Center
Albany, NY

Professor of Neurology, Albany Medical College. Director, Comprehensive Pain Center, Albany Medical Center. Director, Pain Management Fellowship, Albany Medical Center. VIce President for Scientific Affiars, American Academy of Pain Medicine. President, American Academy of Pain Medicine Foundation. Co-Editor, Pain Management Secrets, 4th edition. Co-Ediotr, Practical Management of Pain, 6th edition.



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