Evidence-Based Practice: Is exercise effective in treating long-lasting low back pain?
Long-lasting (chronic) low back pain is a common cause of disability worldwide and is expensive in terms of healthcare costs and lost working hours. Exercise therapy aims to increase muscle and joint strength, improve muscle function and range of motion, reduce pain and disability, speed recovery, and return the patient to their usual activities. Examples of exercise therapies include general physical fitness programs delivered in a group setting, aerobic exercise in the form of walking programs, and strengthening specific muscles or groups of muscles to increase core stability. Hayden et al. (2021) conducted a systematic review. They found moderate-certainty evidence that exercise treatment is more effective than no treatment, usual care, or placebo for pain intensity and functional limitations outcomes. That is, exercise may be more effective for pain and is probably more effective for disability than common treatments in the short and medium term.
Special considerations for extended-release and long-acting (ER/LA) opioids The FDA advises that extended-release and long-acting (ER/LA) opioid analgesics be reserved for patients when alternative treatment options are ineffective, not tolerated,
● Life-threatening severe or fatal respiratory depression may occur. Monitor closely, primarily upon initiation or following a dose increase. Instruct patients to swallow ER/LA opioid analgesics to avoid exposure to/ingestion of a potentially fatal dose. ● Accidental ingestion of ER/LA opioid analgesics can result in a fatal overdose, especially in children. (Note: Accidental pet ingestion has also led to a deadly dose.) ● Prolonged ER/LA opioid analgesics use during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated. In prolonged opioid use in pregnant women, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure appropriate treatment will be available. ● Initiation of CYP 3A4 inhibitors (or discontinuation of medications that induce CYP 3A4) can result in a fatal overdose.
or inadequate to provide sufficient pain relief (FDA, 2018). Before prescribing these products, review FDA- approved REMS programs, medication guides, and black box warnings (BBW) (FDA, 2021). These products, listed in Table 7, are not for acute pain, pain that is mild or not expected to persist for an extended period, or use on an as-needed basis. In addition, the FDA-approved BBWs on these products advise clinicians of the following: ● ER/LA opioid analgesics expose users to addiction, abuse, and misuse risks, leading to overdose and death. Assess each patient’s risk before prescribing and regularly monitor the development of these behaviors and conditions.
Table 7: Common Opioids for Chronic Pain Management
Available Oral Strengths
Medication
Dosage
Clinical Considerations
Hydrocodone, extended-release tablets • Zohydro ER
Tablets: • 10 mg • 15 mg • 20 mg • 30 mg • 40 mg • 50 mg
Initiate: • 10 mg every 12 hours. • Titrate by 10 mg every 12 hours as needed every 7 to 10 days.
The conversion factor for daily oral opioids to Zohydro: • Hydrocodone: 1 • Oxycodone: 1 • Methadone: 1 • Oxymorphone: 2 • Hydromorphone: 2.67 • Morphine: 0.67 • Codeine: 0.1 Do not use it to convert Zohydro to other opioids, as it will result in overestimation and possible fatal overdose. During treatment with extended- release formulations, immediate- release formulations may be required for breakthrough pain. The conversion factor for daily oral opioids to Hysingia: • Hydrocodone: 1 • Oxycodone: 1 • Morphine: 0.5 • Codeine: 0.15 • Tramadol: 0.1 Do not use it to convert Hysingia to other opioids, as this will result in overestimation and possible fatal overdose. During treatment with extended- release formulations, immediate- release formulations may be required for breakthrough pain. • Methadone: 1.5 • Oxymorphone: 2 • Hydromorphone: 4
Hydrocodone, extended-release tablets • Hysingia ER
Tablets: • 20 mg • 30 mg • 40 mg • 60 mg • 80 mg • 100 mg • 120 mg
Initiate: • 20 mg every 24 hours. • Titrate dose by 10 to 20 mg every 3 to 5 days as needed.
Page 64
EliteLearning.com/Dental
Powered by FlippingBook