Chronic Pain and Prescription Medication Misuse

Question 1

From where do people mostly acquire Rx opioids?

Answer 1

1: family or friend (medicine cabinet)

Question 2

chronic opioid use alters response to ___ and may lead to ___.

Answer 2

chronic opioid use alters response to PAIN and may lead to HYPERALGESIA.

Question 3

If taking opioids exactly as rx’d, DSM-V does not include _____ or _____ as criteria for substance use disorder

Answer 3

tolerance or withdrawal

Question 4

addiction

Answer 4

continued use despite negative consequences

Question 5

misuse

Answer 5

use contrary to the directed or rx’d pattern of use, regardless of presence or absence of harm or adverse affects

Question 6

diversion

Answer 6

• intentional removal of a medication from legitimate distribution and dispensing channels.
• sharing or purchasing of rx medication between family members and friends or individual theft from family and friends

Question 7

Pseudoaddiction

Answer 7

an iatrogenic misinterpretation of relief-seeking behaviors caused by under treatment of pain that is identified by the clinician as inappropriate drug-seeking behavior

behaviors cease when adequate pain relief is provided

*not a diagnosis, rather a description of a clinical interaction

Question 8

physical dependence

Answer 8

tolerance (need for inc amounts to achieve desired effect)

withdrawal (when [substance] decline in individual w/ prolonged and heavy use)

Question 9

hyperalgesia

Answer 9

hypersensitivity to painful stimuli (occurs w/ chronic opioid use)

Question 10

When are opioids indicated?

Answer 10

1. pain is SEVERE and has significant impact no function and quality of life
2. non-opioid tx tried and inadequate
3. potential benefits are greater than potential risks
4. pt is agreeable to close monitoring (pill counts, screens)

Question 11

Prior to prescribing opioids for pain management…

Answer 11

1. screen for risky substance use
2. check PMP
3. use opioid risk tool or SOAPP
4. urine tox screen
5. informed consent
6. OBTAIN SIGNED TX CONTRACT!!!
7. set realistic expectations

Question 12

Four As (for frequent assessment of pts receiving rx opioids)

Answer 12

Analgesia
Activities of daily activities
avoid Adverse events
avoid Aberrant medication-related behaviors

Question 13

CDC guidelines: when to initiate opioid therapy

Answer 13

1. non-pharm/non-opioid meds preferred
2. establish realistic goals prior to start
3. before/thru tx, explicitly discuss benefits/harms/alts of opioids
4. initiating tx: rx immediate-release opioids (not ER/LA opioids)
5. rx lowest effective dosage
6. use lowest/shortest effective course for acute pain
7. eval benefits/harms 1-4 weeks after initiation and dose changes
8. evaluate risk fx for opioid related harms
9. check PDMP
10. urine testing before tx and at least annually
11. avoid co-prescribing benzos
12. provide MAT for pts w/ opioid use disorder

Question 14

Predictors of prescription opiate abuse in chronic pain patients

Answer 14

1. Patients amplify pain symptoms and display medication-seeking behaviors (“doctor shop”)
2. The tendency to escalate dose of opioid
3. Preference for a specific route of administration
4. Also – focus on opioids, multiple phone calls, request for early refills, and dosage escalation

Question 15

Opiophobia

Answer 15

angst about prescribing opioids