Module 6

Question 1

brief, identifiable cause, finite <3 months 
Diagnostics:
xray/CT/MRI if applicable
Refer to specialist
Treatment:
Start with NSAIDs
Limit amount of opioid use

Answer 1

Acute Pain

Question 2

Persistent pain >3 mos; recurrent pain; HARD to tx

Initial visit…
Thorough hx
Old records, diagnostic, tx plan, controlled substance database
What is the diagnosis
Pt appropriate for primary care mgmt? Is the pt appropriate for you to manage?
No requirement for rx opioids even if they have been taking them

ALWAYS establish a pain contract with patient; UDS
follow-up

Answer 2

Chronic Pain

Question 3

Risks: GI bleed, CV risk, interactions
Benefit: cheap, available; multiple classes; anti-inflammatory; topical routes available

Answer 3

NSAIDs

Question 4

Start low, go slow
Immediate release FIRST
Weak opioids: tramadol, codeine, dihydrocodeine (not used often)
Continue to assess/reassess → don’t need to be on it forever
What is the threshold for referral?

Answer 4

Opioids

Question 5

Morphine Precautions

Answer 5

No more than 90 ME/day per CDC
If need more → refer to pain mgmt
Narcan at home
Evaluation and documentation
Methadone

Question 6

Opioids and Pediatric Pain

Answer 6

Codeine is now not recommended in children
Hydrocodone may be best choice, but dose not well established,
Burns recommends 0.1‒0.2 mg/kg/dose q 4‒6, remember acetaminophen dose

Hydromorphone, methadone, oxycodone, and morphine are all applicable for severe pain, but typically never used in outpatient setting or without pain control specialist involvement

Question 7

how to dx Substance Use Disorder

Answer 7

@ least two of the following occurring within a 12-month period
The substance is often taken in larger amounts or over a longer period than was intended
There is a persistent desire or unsuccessful efforts to cut down or control use of the substance
A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects
Craving, or a strong desire or urge to use the substance
Recurrent use resulting in a failure to fulfill major role obligations at work, school, or home
Continued use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by its effects
Important social, occupational, or recreational activities are given up or reduced because of use
Recurrent use in situations in which it is physically hazardous
Use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
Tolerance
Withdrawal