5.7 non-malignant pain pt4 Flashcards
Are non-opioid therapies at least as effective as opioids for many common types of acute pain?
Yes
Which therapy is preferred for subacute and chronic pain?
Non-opioid therapies
When starting opioid therapy for pain, clinicians should prescribe what type?
IR opioids
What should be the dose of opioids when initiated for opioid-naive pts?
The lowest effective dosage
When opioids are needed for acute pain, clinicians should prescribe how much?
No greater quantity than needed for expected duration of pain severe enough to require opioids
How often should clinicians evaluate benefits and risks of opioid therapy?
- Within 1-4 wks of starting opioids
- Regularly re-evaluate in continued opioids
Is detoxification on its own for opioid use disorder recommended?
Not recommended for detox without meds for opioid use disorder
When should opioids be reduced/tapered?
- Does not have any clinically meaningful improvement in pain and fxn
- Is on dosages >= 50 MME/day without benefit or on opioids + benzos
- Shows signs of substance use disorder
- Experiences overdose or serious AEs
- Shows early signs of OD risk
How should opioids be reduced/tapered?
- Avoid abrupt tapering or sudden d/c of opioids
- Decrease dose by 10%/month if pts have taken opioids for >1 year
- Decrease dose by 10%/week if pts have taken opioids for weeks to months
- Once lowest available dose is reached, the interval between doses can be expanded
What does the 2017 Opioid 7 day prescribing limit say?
Initial opioid prescription for a pt may not be prescribed for more than a 7 day supply
What are exceptions to the 7 day limit?
- Cancer
- Medication assisted tx for substance abuse disorder
- Palliative care
- Professional judgment
What does the pain contract not legally prevent?
Does not legally prevent another provider from prescribing opioids or a pharmacy from filling opioids prescribed by diff provider
For tx of acute pain, can a pt have more than one order for each severity of pain?
No
What is patient controlled analgesia (PCA)?
Allows pt to decide when they will get a dose of pain medicine
When is patient controlled analgesia used?
Used for severe acute non-malignant pain:
- Post-operative
- Pancreatitis
- Sickle cell crisis
What are nonpharm txs for low back pain?
- Exercise
- CBT
- Interdisciplinary rehab
What meds are 1st line for low back pain?
- Acetaminophen
- NSAIDs
What meds are 2nd line for low back pain?
- SNRIs
- TCAs
What are nonpharm txs for osteoarthritis?
- Exercise
- Weight loss
- Pt education
What are 1st line meds for osteoarthritis?
- Acetaminophen
- Oral or topical NSAIDs
What are 2nd line meds for osteoarthritis?
- Intra-articular hyaluronic acid
- Capsaicin
What are nonpharm txs for fibromyalgia?
- Low impact aerobic exercise
- CBT
- Biofeedback
- Interdisciplinary rehab
Which meds are FDA approved for tx of fibromyalgia?
- Pregabalin
- Duloxetine
What are other med options for tx of fibromyalgia?
- TCAs
- Gabapentin
- Venlafaxine
What are 1st line meds for tx of neuropathic pain?
- SNRIs
- Gabapentin/pregabalin
What are 2nd line meds for tx of neuropathic pain?
- Topical lidocaine
- TCAs
In hospice care, how is pain and air hunger relieved?
- Morphine IV or solution (20 mg/ml) under tongue
- Could use fentanyl or hydromorphone
In hospice care, how is anxiety/agitation relieved?
Lorazepam IV or SL prn
In hospice care, how is nausea/vomiting relieved?
Ondansetron ODT
In hospice care, how is secretions relieved?
- Atropine ophthalmic drops under tongue
- Glycopyrrolate IV prn
- Scopolamine patch
