__________________ Effective Management of Acute and Chronic Pain with Opioid Analgesics, 2nd Edition
I. COMPONENTS OF AN EFFECTIVE TREATMENT PLAN 1. The goals of treatment, including the degree of improvement in pain and function when function has been impaired by pain 2. Possible constituents of the treatment plan, including nonpharmacologic approaches and pharmacologic therapies 3. Patient/prescriber/health care team interactions, including ‒ Patient responsibilities/compliance with the plan ‒ Responsibilities of the prescriber and health care team, including patient monitoring
4. Initial dosing, dose titration, dose tapering (when appropriate) for analgesia 5. Contraindications 6. Adverse events, with emphasis on labeled warnings 7. Drug interactions ― both pharmacodynamic and pharmacokinetic B. Opioid analgesic medications Opioid analgesic medications can be used successfully as a component of pain management. However, opioids carry risks not present with most non-opioid analgesics, specifically the risks of addiction, abuse and misuse, which can lead to respiratory depression, overdose and death. Therefore, it is the responsibility of HCPs to be knowledgeable, not just about the presence of such risks, but about how to weigh these risks before prescribing an opioid and about how to properly manage patients who are prescribed opioids, both for short- term and long-term use. When using opioid analgesics as part of pain management, HCPs should be knowledgeable about the following: 1. General precautions a. Even at prescribed doses, opioid analgesics carry the risk of misuse, abuse, opioid use disorder, overdose, and death b. Importance of the appropriate use of PDMPs [13] and their use as a clinical decision support tool c. DSM-5 (R) criteria (or the most recent version) for OUD and the concepts of abuse (taking an opioid to get high) vs. misuse (taking more than prescribed for pain or giving to someone else in pain) [14] d. The concepts of tolerance and physiological dependence and how they differ from OUD (addiction) e. Recognition that some opioid analgesics (e.g., Transmucosal Immediate Release Fentanyl products, some ER/LA products) are safe only for opioid-tolerant patients 2. Mechanism of action and analgesic effect 3. Types of opioids (full agonists, partial agonists) 4. Indications and uses for pain management 5. Range of opioid analgesic products available for pain
‒ Plans for reviewing functional goals ‒ Use of supplemental medication for intermittent increases in pain ‒ Use of PPAs II. GENERAL PRINCIPLES OF NONPHARMACOLOGIC APPROACHES
Pain can arise from a wide variety of causes. There are a number of nonpharmacologic and self-management treatment options that have been found to be effective alone or as part of a comprehensive pain management plan, particularly for musculoskeletal pain and chronic pain. Examples include, but are not limited to, psychological, physical rehabilitative, and surgical approaches, complementary therapies, [12]. and use of approved/cleared medical devices for pain management. HCPs should be knowledgeable about the range of treatment options available, the types of pain that may be responsive to those options, and when they should be used as part of a multidisciplinary approach to pain management. HCPs should also be aware that not all nonpharmacologic options have the same strength of evidence to support their utility in the management of pain, and some may be more applicable for some conditions than others. III. GENERAL PRINCIPLES OF PHARMACOLOGIC ANALGESIC THERAPY A variety of analgesics, including non-opioid and opioid medications, are available for use to manage pain symptoms. HCPs should be well informed about the range of analgesics available and the types of pain that may be responsive to those analgesics. A. Non-opioid medications When using non-opioid medications in pain management, HCPs should be knowledgeable about the following: 1. Mechanism of action of analgesic effect 2. Indications and uses for pain management 3. Routes of administration and formulations used in pain management
management and their related safety concerns a. Routes of administration including oral, transmucosal, transdermal b. Release characteristics of immediate release (IR), extended-release (ER), long-acting (LA) c. Abuse-deterrent formulations (ADFs)
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