__________________ Effective Management of Acute and Chronic Pain with Opioid Analgesics, 2nd Edition
C. Ongoing management of patients on opioid analgesics 1. Periodic review of pain and functional goals 2. Review adverse events at each visit
G. Medically directed opioid tapering HCPs should be knowledgeable about how to safely taper opioid analgesics, including how to recognize and manage signs and symptoms of opioid withdrawal. HCPs should be knowledgeable about the particular risks associated with tapering during pregnancy. H. Importance of patient education HCPs should recognize their role in reducing the risks associated with opioid analgesics through patient education at initiation of an opioid and throughout long-term management. 1. Inform patients about pain management expectations and managing pain through different pharmacologic and nonpharmacologic modalities. 2. Use the Patient Counseling Guide: What You Need to Know About Opioid Pain 3. Medicines as part of discussion with patients and caregivers when prescribing opioid analgesics. 4. Counsel the patient about the following: a. Importance of adherence to prescribed dosing regimen b. Patients should use the least amount of medication necessary to treat pain and for the shortest amount of time c. The risk of serious adverse events that can lead to death d. The risk of addiction that can occur even when product is used as recommended e. Known risk factors for serious adverse events, including signs and symptoms of overdose and opioid-induced respiratory depression, GI obstruction, and allergic reactions, among others f. The most common side effects, along with the risk of falls, working with heavy machinery, and driving g. When to call the prescriber (e.g., managing adverse events, ongoing pain) h. How to handle missed doses i. The importance of full disclosure of all medications and supplements to all HCPs and the risks associated with the use of alcohol and other opioids/benzodiazepines j. Product-specific concerns, such as not to crush
‒ Eliciting signs or symptoms of opioid abuse ‒ Screening for endocrine function may be recommended ‒ Importance of adverse event reporting and mechanisms to report
3. Review refill history/review PDMP 4. How to determine when an opioid analgesic is no longer necessary/beneficial D. Long-term management 1. Evaluation of the patient with worsening pain for changes in underlying condition and for signs of OUD before increasing opioid dosage 2. Changing opioid medications ‒ Concept of incomplete cross-tolerance when converting patients from one opioid to another ‒ Concepts and limitations of the conversion charts in labeling and the limitations of relative potency or equianalgesic dosing tables in literature 3. Monitoring of patient adherence to the treatment plan, especially regarding misuse and abuse: ‒ Perform medication reconciliation ― recognize, document, and address aberrant drug-related behavior ‒ Determine if nonadherence is due to inadequate pain management ‒ Understand the utility and interpretation of urine drug testing (e.g., screening and confirmatory tests) and use as indicated ‒ Screen and refer for substance use disorder treatment when concerns arise E. How to recognize and intervene upon suspicion or identification of an OUD HCPs should understand how to monitor patients taking opioid analgesics and identify the signs and symptoms of opioid misuse, abuse, and OUD and be knowledgeable about how to begin the process of intervention upon suspicion of an OUD. F. When to consult with a pain specialist HCPs should be knowledgeable about when referral to a pain management specialist is indicated, including identifying patients at high risk for OUD and patients unable to achieve adequate pain management.
or chew ER products; transdermal systems and buccal films should not be cut, torn, or damaged before use, etc. k. How to safely taper dose to avoid withdrawal symptoms
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