Example MME calculation Patients evaluated in the clinic report taking the following medication for their back pain: ● OxyContin: 20 mg twice daily. ● Oxycodone: 10 mg three times a day (usually). ● Flexeril: 10 mg three times a day. ● Xanax: 0.5 mg three times a day. Total amount of oxycodone per day: Since we are dealing with immediate-release oxycodone, the MME conversion factor remains the same as for OxyContin (1.5). Thus, the MME for oxycodone 10 mg three times a day would be: 10 mg x 3 (daily) x 1.5 = 45 MME/day So, the total MME for the provided medication regimen is: 60 MME/day (OxyContin) + 45 MME/day (oxycodone) = 105 MME/day Please note that MME calculations are approximate conversions used to compare the strength of different opioids to morphine. Table 4: Examples of 50 and 90 MME/day for Commonly Prescribed Opioids Opioid Strength 50 MME/ Day 90 MME/Day Hydrocodone- Acetamino- phen 5 mg/325 mg 50 mg (10 tablets) Exceeds
Table 3: Selected Opioid Oral MME Conversion Factors Oral Opioids (doses in mg/day except where noted)
Conversion Factor
Codeine
0.15
Fentanyl transdermal (mcg/hour)
2.4
Hydrocodone
1
Hydromorphone
4
Methadone:
1-20 mg/day
4
21-40 mg/day
8
41-60 mg/day
10
61-80 mg/day
12
Morphine
1
Oxycodone
1.5
Oxymorphone
3
Tramadol
0.1
IMPORTANT: Do not use the MME conversion factor or the MME amount determined for conversion from one opioid to another or to guide dosing medication or assisted treatment for opioid use disorder. The MME conversion factor and amount may overestimate the amount for conversion, resulting in serious adverse effects such as respiratory depression or death. To calculate a daily MME for a patient: 1. Determine the total daily amount of each opioid the patient takes. 2. Convert each amount to MME by multiplying the total daily amount by the appropriate conversion factor (see Table 3). 3. Total all MMEs to obtain the MME/day for the patient.
acetaminophen maximum daily dose
90 mg (9 tablets)
10 mg/325 mg
50 mg (5 tablets)
Oxycodone Sustained Release
60 mg (4 tablets) 60 mg (2 tablets) ~20 mg (4 tablets)
15 mg 33 mg
(~2 tablets)
30 mg 33 mg
(~1 tablet)
Methadone
5 mg
12 mg (<3 tablets)
Note . CDC, 2022c. PRESCRIBING OF OPIOIDS IN THE MANAGEMENT OF ACUTE AND CHRONIC NONCANCER PAIN IN ADULTS
The physiologic purpose of acute pain is to bring attention to potential or actual tissue damage so that appropriate action can alleviate the pain (e.g., remove your finger from the hot stove). The firing rate of peripheral neurons that detect painful stimuli, known as nociceptors , leads to the interpretation of pain intensity. However, the perception of nociceptor firing may influence the painful stimulus and the sensitization of the peripheral and central nervous systems. In most patients, acute pain resolves when the affected tissue heals; however, some patients progress from acute to chronic pain in a process called pain chronification . The underlying cause(s) is/are not established but may be related to central nervous system changes in pain facilitation and inhibition (Pak et al., 2018). Pain chronification is based on acute pain (e.g., low back, postsurgical, diabetic neuropathy) and social and psychological factors, including maladaptive pain coping behaviors, concurrent psychiatric illness, and pain catastrophizing. Other factors associated with chronic pain include female gender, increased age, and lower household
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (Cohen et al., 2021). It is critical to understand that pain is not only a neuronal response but also involves cognitive processes that make it a subjective experience that does not require identifiable tissue damage to be significant (Halpape et al., 2022). Pain perception may be related to the site of the pain, such as the face or eye pain. Pain in children and pregnant women has unique considerations that a specialist should evaluate. In addition, pain accompanied by other physical and psychological conditions needs to be evaluated. Masking a comorbid condition by simply treating the pain could result in exacerbating the condition. Chronic pain lasts beyond the average healing time for a given injury, operationalized as pain lasting greater than three months (Cohen et al., 2021). Chronic pain is often clinically distinguished as related to cancer (or other terminal illness) or noncancer/terminal illnesses.
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