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Use of opioids in the management of chronic pain in adults
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SUMMARY AND RECOMMENDATIONS
INTRODUCTION
OPIOID THERAPY IN THE CONTEXT OF THE OPIOID EPIDEMIC
OPIOIDS
Mechanism of action
Opioid formulations
-
Short-acting
-
Long-acting
-
Abuse deterrent
INDICATIONS FOR OPIOID THERAPY
EVALUATION OF RISK PRIOR TO INITIATING THERAPY
Risk assessment
-
Risk assessment tools
Risk stratification
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Low risk
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Moderate risk
-
High risk
INITIATING A TRIAL OF OPIOID THERAPY
Setting patient responsibilities, expectations, and treatment goals
-
Opioid agreement/consent form
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Establishing driving safety
Choice of agent and dose
Monitoring for adverse effects
Risks of misuse and overdose
Drug interactions
Co-prescription of naloxone
Follow-up during trial
Monitoring and risk management strategies during trial
CHRONIC OPIOID THERAPY
Choice of agent and dosing for chronic therapy
-
Converting from IR/SA to ER/LA
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Buprenorphine for chronic pain
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Methadone and fentanyl
Follow-up and monitoring during chronic opioid therapy
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Ongoing risk assessment and management
-
Other issues
PATIENTS WITH ABERRANT BEHAVIORS
DISCONTINUING THERAPY
REFRACTORY PAIN
SPECIAL POPULATIONS
Older patients
Kidney disease
Liver failure
Patients with cancer
SOCIETY GUIDELINE LINKS
SUMMARY AND RECOMMENDATIONS
REFERENCES
GRAPHICS
Tables
-
CDC Guideline for prescribing opioids for pain 2022
-
Properties of opioid receptors
-
Class opioids pain mgmt
-
IR oral opioids for chronic pain in opioid naive adults
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Extended-release opioids (chronic pain, adults)
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CDC checklist for prescribing opioids for chronic pain
-
US scheds controlled drugs
-
SOAPP tool
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SOAPP-R tool
-
Cytochrome P450 3A inhibitors and inducers
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Long acting oral and transdermal opioids chronic pain adults
-
Cytochrome P450 2D6 (CYP2D6) inhibitors
-
Principles of risk management during opioid treatment for pain
-
Approximate oral equianalgesic doses for commonly used opioids
-
Guidelines for opioid rotation
-
Current Opioid Misuse Measure (COMM)
-
DIRE score
-
Addiction Behaviors Checklist (ABC)
-
Approximate opioid dose conversions and oral total daily MMEs
Forms
-
Opioid Risk Tool (ORT)
-
SOAPP (scoring instructions)
-
SOAPP-R (scoring instructions)
-
Current Opioid Misuse Measure (scoring instructions)
RELATED PATHWAYS
Morphine milligram equivalent calculator for adults with chronic non-cancer pain
RELATED TOPICS
Abuse-deterrent opioids
Acute opioid intoxication in adults
Adjusting pain medications in adult patients with cirrhosis
Approach to the management of chronic non-cancer pain in adults
Cancer pain management with opioids: Optimizing analgesia
Chronic pancreatitis: Management
Evaluation of chronic pain in adults
Fibromyalgia: Treatment in adults
Interventional therapies for chronic pain
Management of acute pain in patients with opioid use disorder
Management of acute pain in the patient chronically using opioids for non-cancer pain
Management of chronic pain in advanced chronic kidney disease
Management of diabetic neuropathy
Morphine milligram equivalent calculator for adults with chronic non-cancer pain
Opioid tapering for patients with chronic pain
Opioid use disorder: Epidemiology, clinical features, health consequences, screening, and assessment
Opioid use disorder: Pharmacologic management
Overview of cancer pain: General principles of management and pain syndromes
Overview of pharmacogenomics
Overview of pharmacologic management of chronic pain in adults
Prescription drug misuse: Epidemiology, prevention, identification, and management
Prevention and management of side effects in patients receiving opioids for chronic pain
Prevention of lethal opioid overdose in the community
Risk of long term opioid use and misuse after prescription of opioids for pain
Serotonin syndrome (serotonin toxicity)
Sleep-disordered breathing in patients chronically using opioids
Society guideline links: Chronic pain management
Subacute and chronic low back pain: Management
Substance use disorders: Clinical assessment
Treatment of chronic non-cancer pain in older adults
Urine drug testing
Urine drug testing for patients with chronic pain
Manageengine Endpoint Central License Crack Today
Here's some general information:
Topic Feedback
Tables
Recommendations from the 2022 CDC Guideline for prescribing opioids for pain
Properties of opioid receptors
Classification of opioids for pain management
Immediate-release oral opioids for chronic pain in adults
Extended-release opioid preparations for chronic pain
Centers for Disease Control and Prevention checklist for prescribing opioids for chronic pain
Schedules of controlled substances in the United States*
Screener and Opioid Assessment for Patients with Pain (SOAPP)
Revised Screener and Opioid Assessment for Patients with Pain (SOAPP-R)
Cytochrome P450 3A (including 3A4) inhibitors and inducers
Commonly used, oral and transdermal, long-acting pure mu-opioid agonists for chronic pain in adults (refer to notes)
Cytochrome P450 2D6 (CYP2D6) inhibitors
Principles of risk management during opioid treatment for pain
Approximate oral equianalgesic doses for commonly used opioids
Guidelines for opioid rotation
Current Opioid Misuse Measure (COMM)
DIRE Score: Patient selection for chronic opioid analgesia
Addiction Behaviors Checklist (ABC)
Approximate opioid dose conversions and oral total daily morphine milligram equivalents (MMEs; refer to important notes below)
Recommendations from the 2022 CDC Guideline for prescribing opioids for pain
Properties of opioid receptors
Classification of opioids for pain management
Immediate-release oral opioids for chronic pain in adults
Extended-release opioid preparations for chronic pain
Centers for Disease Control and Prevention checklist for prescribing opioids for chronic pain
Schedules of controlled substances in the United States*
Screener and Opioid Assessment for Patients with Pain (SOAPP)
Revised Screener and Opioid Assessment for Patients with Pain (SOAPP-R)
Cytochrome P450 3A (including 3A4) inhibitors and inducers
Commonly used, oral and transdermal, long-acting pure mu-opioid agonists for chronic pain in adults (refer to notes)
Cytochrome P450 2D6 (CYP2D6) inhibitors
Principles of risk management during opioid treatment for pain
Approximate oral equianalgesic doses for commonly used opioids
Guidelines for opioid rotation
Current Opioid Misuse Measure (COMM)
DIRE Score: Patient selection for chronic opioid analgesia
Addiction Behaviors Checklist (ABC)
Approximate opioid dose conversions and oral total daily morphine milligram equivalents (MMEs; refer to important notes below)
Forms
Opioid Risk Tool (ORT)
Scoring instructions for Screener and Opioid Assessment for Patients with Pain (SOAPP)
Revised Screener and Opioid Assessment for Patients with Pain (SOAPP-R) (scoring instructions)
Current Opioid Misuse Measure (scoring instructions)
Opioid Risk Tool (ORT)
Scoring instructions for Screener and Opioid Assessment for Patients with Pain (SOAPP)
Revised Screener and Opioid Assessment for Patients with Pain (SOAPP-R) (scoring instructions)
Current Opioid Misuse Measure (scoring instructions)
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