[Verse 1] Diabetic neuropathy, burning like a circuit fused, CKD in the picture, gotta pick the meds you use, Depression riding shotgun, triple threat on board, Stepwise regimen, let's lay it on the floor — First line: SNRIs, duloxetine's your call, Treats the nerve pain AND the mood, one drug handles all, Renally dosed with caution when the GFR drops low, Pregabalin's your adjunct but you ease it slow — Gabapentinoids accumulate when kidneys can't excrete, Dose-reduce or toxicity'll knock the patient off their feet, Topical lidocaine, capsaicin on the skin, Localized relief, no systemic origin, Tramadol? Hold up — serotonin syndrome risk, With duloxetine on deck, that combo's too brisk, TCAs like amitriptyline? Anticholinergic load, CKD and elderly don't need that heavy road [Chorus] ¡Escucha bien, no es complicado! Duloxetine primero, renalmente dosificado, Pregabalin second, titrate it slow, Topicals for local pain, that's how we go — Stepwise, stepwise, build the scaffold right, CKD plus depression, you gotta be precise tonight — ¡Dale con cuidado, trata el dolor con arte! Kidney function guides every single part [Verse 2] Now flip the chart — fibromyalgia walks in the room, Central sensitization, pain amplified in the gloom, The patient asks for opioids, "Doc, I need the strong stuff," Here's where education is the sharpest clinical bluff — Opioids in fibromyalgia worsen central gain, Opioid-induced hyperalgesia — MORE drug, MORE pain, The mu-receptor flooding throws the descending system off, The inhibitory pathways weaken, and the suffering stays aloft — Allopathic logic fails when the mechanism's central, You can't peripheral-block a signal that's neurological, sequential — The brain's alarm won't quiet down with morphine in the veins, It amplifies the crosstalk through the dorsal horn domains [Chorus] ¡Escucha bien, no es complicado! Duloxetine primero, renalmente dosificado, Pregabalin second, titrate it slow, Topicals for local pain, that's how we go — Stepwise, stepwise, build the scaffold right, CKD plus depression, you gotta be precise tonight — ¡Dale con cuidado, trata el dolor con arte! Kidney function guides every single part [Bridge] Here's your rare word for the day — hyperkatifeia, The emotional agony of opioid withdrawal's sequela, When you stop the opioids cold, dysphoria sweeps in hard, That's hyperkatifeia — suffering leaving its scar — For fibromyalgia patients, that exit cost is steep, Dependency builds fast while pain relief stays weak — Exercise and CBT restructure the central map, SNRIs and pregabalin close the sensitization gap, No opioids — say it clearly — no opioids for this, The mechanism doesn't match, the evidence won't miss
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