pain (rogers) pt 4 Flashcards
2022 CDC clinical practice guideline for prescribing opioids for pain
includes 12 recommendations for clinicians providing pain care
includes
- outpatients > 18 yo
- acute pain ( < 1 month)
- subacute pain (1-3months)
- chronic pain (> 3 months)
does not include
- management of pain related to ___ disease
- mangement of ___ related pain
- ___ and ___ care
- sickle cell
- cancer
- palliative, end-of-life
12 recommendations are grouped into 4 areas of consideration
1) determining whether or not to ___ opioids for pain
2) selecting opioids and determining opioid ___
3) deciding ___ of initial opioid prescription and conducting follow-up
4) assessing ___ and addressing potential harms of opioid use
- initiate
- dosages
- duration
- risk
1) initiation?
recommendation 1
non-opioid therapies are at least as effect as opioids for many comon types of ___ pain
- ___ non-opioid use
recommendation 2
non-opioid therapies are preferred for ___ and ___ pain
- acute, maximize
- subacute, chronic
2) selecting med and chosing dosage?
recomendation 3
- when starting opioids for acute, subacute, or chronic pain, clinicians should prescribe ___ release opioids
recommendation 4
- clinicians should prescribe the ___ effect dosage
recommendation 5
- for patients already receiving opioid therapy, clinicians should carefully weigh benefits and risks and exercise care when ___ opioid dosage
- if benefits outweigh risks, clinicians should optimize ___ therapies while contiuing opioid
- if risks outweigh benefits, gradually ___ to lower dosages and possibly d/c
- immediate
- lowest
- changing
- non-opioid
- taper
3) deciding duration/following-up
recommendation 6
- when used for acute pain, clinicians should prescibe no greater quantity than expected duration of pain
recommendation 7
- clinicians should evaluate benefits and risks with patients within ___ - ___ weeks after starting therapy for subacute/chronic pain or increasing dose.
- regularly reevaluate benefits and risks
1-4 weeks
4) assessing risk/harm
recommendation 8
- implement strategies to mitigate risk, like offering ___ and asking about ___ use
recommendation 9
- review patient’s history of ___ substances to determine whether patient is receiving opioid dosages/combos that put pt at risk
recommendation 10
- consider risks and benefits of ___ testing
recommednation 11
- take caution with prescribing opioids and ___ together
recommednation 12
- offer treatment with evidence-based medications for OUD (3)
- ___ on its own is NOT recommended
- naloxone, EtOH
- controlled
- toxicology
- BZDs
- buprenorphine, methadone, naltrexone
- detoxification
When to Reduce/Taper Opioids
- pt requests dose reduction
- does not have improvement in pain and function
- is on dosages greater than ___ MME/day without beneful or combo with ___
- shows signs of SUD
- experiences overdose or serious AE
- shows earlt signs of overdose risk: confusion, sedation, slurred speech
- 50
- BZD
How to Reduce/Taper
- avoid abrupt ___ or sudden ___
- decrease dose by ___ % per ___ if patients on opioid for more than a year
- decrease dose by ___ % per ___ for patients who have taken opioids for a shorter time (weeks to months)
- once at lowest dose, the interval between doses can be extended. They can be stopped when taking less than once a day
- taper, d/c
- 10, month
- 10, week
Treatment of Acute Pain
PRN
- only administered when patient is in ___
- minimize exposure to limit ___
scheduled/around the clock (ATC) analgesia
- given at set interval
- may be beter option for ___ pain
- can still use breakthrough analgesia
- pain
- toxicity
- continual
Michigan Opioid Prescribing Engagement Network (OPEN)
due to excessive prescribing after procedures, OPEN made prescibing recommendations
Michigan Opioid Prescribing Engagement Network (OPEN)
recommend scheduled dosing of ___ and ___
- alternare ever ___ hours for ___ days
acetaminophen, ibuprofen
- 3, 3
Tretament of Acute Pain
- hospitalized patients may have multiple orders for pain medications
- can only have ___ order for each severity of pain
- 1
patient controlled analgesia (PCA)
- allows pt to decide when they will get a dose of pain medicine
- IV line is placed and a computerized pump allows pt to release pain medicine by pressing a handheld button
- prescriber sets parameters of dose and frequency which a patient can receive
- used for severe acute non-malignant pain: post-operative, ___ , ___ cell crisis
- pancreatitis
- sickle
Recommended treatments for lower back pain
Non-PCOL
- advise patients to remain active and limit bedrest
1st line
- ___
- ___
2nd line
- ___
- ___
- acetaminophen
- NSAIDs
- SNRIs
- TCAs
Recommended treatments for osteoarthritis
Non-PCOL
- exercise, weight loss
first line
- acetaminophen
- oral or ___ NSAIDs
2nd line
- intra-articular ___ acid
- ___
- topical
- hyaluronic
- capsaicin
