Establishing the Need for Opioid Treatment Programs Establishing Chronic Pain for Opioid Treatment Programs Nociceptive Pain Neuropathic Pain Establishing Cancer Pain for Opioid Treatment Programs Nociceptive pain Neuropathic pain Establishing Chronic Pain for Opioid Treatment Programs History and physical examination Check all investigations Second opinion- neurologist, neurosurgeon, orthopedic surgeon, Rehab Physical medicine specialist and Psychiatrist. Consider history of previous drug abuse- alcohol, cocaine, heroine, sedatives, stimulants Detail history of present addiction Pre-Existing Conditions for Opioid Treatment Programs History of drug abuse- avoid opioids, if risk benefit suggest opioid treatment is advised physician will consider close monitoring, involve addictionologist and psychiatrist in ongoing treatment plan. Family history of drug abuse- physician will consider detail discussion of risk and benefits, close monitoring and family conference with close family members. Personality disorder- psychiatrist opinion and risk/benefit consideration Psychiatric disorder- psychiatrist opinion and risk/benefit consideration Medications- if prescribed for other diseases then drug interaction and side effects will be considered, consultation with pharmacist will be considered. Consider Opioid Medications Only If: Non-opioid Medications- failed or severe side effects contraindicated medications. Physical therapy – failed or not indicated. Interventional pain therapy- failed or not indicated. Surgery- failed or not indicated. Benefits and Risks of Opioid Treatment Programs Schedule Treatment for Opioids Trial of opioid therapy. Titration of dose- start low dose, titrate slow. Short acting and long acting medications. Short acting opioid- safer. Long acting opioids: Lower risk of addiction. Round the clock dosage necessary to prevent withdrawal symptoms and achieve optimum pain relief. Overdosage of long acting opioid if taken additional pills for breakthrough pain. Breakthrough pain may need to be treated with short acting opioids. Previous opioid treatment- failed or inadequate pain relief, may need higher dosage to begin opioid therapy. Resistance- patient may have higher resistance and need higher dosage. Tolerance- patient may have developed tolerance and need higher dosage. Diagnostic Tests for Opioid Treatment Programs Establish diagnosis X-Ray, CAT scan, MRI, EMG, Blood Examination or any other test. Establish urine drug test. MAPS. Assessment of Risk for Opioid Treatment Programs Drug abuse- alcohol, cocaine, heroine, sedatives, stimulants. Addiction Misuse Diversion Psychosocial factor Family history Risk of Opioid Prescription: Drug abuse Addiction Misuse Diversion Overdose Sexual dysfunction Sleep apnea Respiratory depression Adverse Effects of Opioid Treatment Programs Opioid Screening Tools Follow up history Same pharmacy Pill counts Family discussion MAPS Urine drug test No refill or one refill Informed Consent Potential risk Alternatives Policies Goal Expectation Was this article helpful? Yes No
Written, Edited or Reviewed By: , M.D., FFARCSI, DA Pain Assist Inc. Pramod Kerkar This article does not provide medical advice. See disclaimer Last Modified On: September 21, 2018
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