Respond to suspicion of opioid misuse or diversion by collecting more information and discussing with the patient.
Monitor all patients on controlled substances by checking the state prescription drug monitoring program report with each prescription. Perform periodic urine drug testing. Pill counts are appropriate for the highest risk patients.
Educate patients, family, and friends about when and how to use intranasal naloxone and steps after administration.
Chronic NSAID use poses significant risks for gastrointestinal bleeding, acute kidney injury or chronic kidney disease, and platelet dysfunction. Older age adds particular risk. Older adults receiving daily NSAIDs for six months or more face a seis-9% risk for upper gastrointestinal bleeding requiring hospitalization.
In some cases, the cause is not immediately obvious, but the category of pain is. For example, burning pain starting in the neck and radiating into the fingers could be associated with acute cervical radiculopathy or may evolve to reveal zoster.
Combining alcohol with certain sleeping pills can lead to dangerously slowed breathing or unresponsiveness. And alcohol can actually cause insomnia.
Marijuana. Evidence regarding benefits and harms is currently insufficient to recommend using “medical” marijuana for chronic pain. Some data support cannabidiol (CBD) alone as being relatively safe.
Remember the facts: Smoking can kill you. And think about how much better you’ll feel once smoking is out of your life.
Assess potential misuse of opioids. Use established criteria to evaluate misuse of opioids by chronic pain patients receiving long-term opioid more info therapy.101 Meeting 3 or more of the following criteria is defined as misuse.
Each of these syndromes initially manifests as a symptom of another disease. After healing or successful treatment, chronic pain may sometimes continue and hence the chronic secondary pain diagnoses may remain and continue to guide treatment (Table 2).15
Patients should understand that reducing pain intensity will not be the sole focus of evaluation or management. This requires a shift in expectations for many patients accustomed to an acute pain management model.
The autoimmune form of hypothyroidism is called Hashimoto’s thyroiditis. The autoimmune form of hyperthyroidism is called Graves’ disease. You may find that other members of your family have thyroid problems or another autoimmune disorder.
Longer duration affects dose titration. Methadone has a prolonged terminal half-life, so the degree of potential adverse effects can increase over several days after an initial dose or a change of dosage.
Have a frank but supportive discussion with the patient about the fears of a worse lifestyle and risk for overdose. Offer support and addiction treatment.