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
