Non-Malignant Pain part 4 Flashcards
CDC Clinical Practice Guideline for Prescribing Opioids for Pain includes the following recommendations
Outpatients >18 years old
Acute pain (<1 month)
Subacute pain (1-3 months)
Chronic pain (>3 months
CDC Clinical Practice Guideline for Prescribing Opioids for Pain does not include the following recommendations
Management of pain related to sickle cell disease
Management of cancer-related pain
Palliative Care
End-of-life care
What is the process of deciding on a treatment
- Determining whether or not to initiate opioids for pain
* Recommendations 1, 2 - Selecting opioids and determining opioid dosages
* Recommendations 3, 4, 5 - Deciding duration of initial opioid prescription and
conducting follow-up Recommendations 6, 7 - Assessing risk and addressing potential harms of opioid use Recommendations 8, 9, 10, 11, 12
What is recommendation 1
Nonopioid therapies are at least as effective as opioids for many common types of acute pain.
Maximize use of nonpharmacologic and nonopioid pharmacologic therapies
what are the non-opioid therapies
acetaminophen, non-steroidal anti- inflammatory drugs (NSAIDs), and selected antidepressants and anticonvulsants
What is recommendation 2
Nonopioid therapies are preferred for subacute and chronic pain.
Maximize use of nonpharmacologic and nonopioid pharmacologic therapies
What is recommendation 3
When starting opioid therapy for acute, subacute, or chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release and long-acting opioids.
What is recommendation 4
When opioids are initiated for opioid-naïve patients with acute, subacute, or chronic pain, clinicians should prescribe the lowest effective dosage.
What is recommendation 5
For patients already receiving opioid therapy, clinicians should carefully weigh benefits and risks and exercise care when changing opioid dosage
T or F: If benefits outweigh risks of continued opioid therapy, clinicians should work closely with patients to optimize non opioid therapies while continuing opioid therapy. (rec 5)
T
T or F: If benefits do not outweigh risks of continued opioid therapy,
clinicians should optimize other therapies and work closely with
patients to gradually taper to lower dosages or, if warranted based
on the individual circumstances of the patient, appropriately taper
and discontinue opioids
T
What is recommendation 6
When opioids are needed for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.
What is recommendation 7
Clinicians should evaluate benefits and risks with patients within 1–4 weeks of starting opioid therapy for subacute or chronic pain or of dosage escalation. Clinicians should regularly reevaluate benefits and risks of continued opioid therapy with patients
what is recommendation 8
Clinicians should work with patients to incorporate into the
management plan strategies to mitigate risk. This may include
offering naloxone, asking patients about drug and alcohol use to
assess for substance use disorders, and/or using PDMP data and
toxicology screening to assess for concurrent controlled substance
use.
what is recommendation 9
When prescribing initial opioid therapy for acute, subacute, or
chronic pain, and periodically during opioid therapy for chronic
pain, clinicians should review the patient’s history of controlled
substance prescriptions using state prescription drug monitoring
program (PDMP) data to determine whether the patient is
receiving opioid dosages or combinations that put the patient at
high risk for overdose.
What is recommendation 10
When prescribing opioids for subacute or chronic pain, clinicians
should consider the benefits and risks of toxicology
testing to assess for prescribed medications as well as other
prescribed and non prescribed controlled substances.
What is recommendation 11
Clinicians should use particular caution when prescribing opioid
pain medication and benzodiazepines concurrently and consider
whether benefits outweigh risks of concurrent prescribing of opioids
and other central nervous system depressants.
What is recommendation 12
Clinicians should offer or arrange treatment with evidence-based
medications to treat patients with opioid use disorder.
Detoxification on its own, without medications for opioid use
disorder, is not recommended for opioid use disorder because of
increased risks for resuming drug use, overdose, and overdose
death.
FDA-approved medications indicated for the treatment of opioid use
disorder include buprenorphine, methadone, and naltrexone.
When to reduce and taper opioids
Requests dosage reduction
Does not have clinically meaningful improvement in pain and function (e.g., at least 30% improvement on the 3-item PEG scale)
Is on dosages ≥ 50 MME*/day without benefit or opioids are combined with benzodiazepines
Shows signs of substance use disorder (e.g. work or family problems related to opioid use, difficulty controlling use)
Experiences overdose or other serious adverse event
Shows early warning signs for overdose risk such as confusion, sedation, or slurred speech
T or F: you should abruptly discontinue opioids
False you should avoid abrupt tapering or sudden discontinuation of opioids
How much should you decrease opioid dose each month when reducing or tapering?
A. 5%/month
B. 10%/month
C.15%/month
D.20%/month
B.
can also decrease dose by 10% each week for patients that have taken opioids for a shorter time (weeks/months)
T or F Once lowest available dose is reached, the interval between doses can be extended. If discontinuing opioids, they may be stopped when taken less than once a day.
T
look at lecture for opioid laws
see part 4
What is the 7 day prescribing limit
physicians issuing initial opioid prescription for a patient may not prescribe more than a 7 day supply (exceptions cancer,MAT for substance abuse, palliative care, proffesional judgement
