Rogers Pain Part 4 Flashcards
What is the first area of consideration on the 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain?
Determining whether or not to initiate opioids for pain
What is the second area of consideration on the 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain?
Selecting opioids and determining opioid dosages
What is the third area of consideration on the 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain?
Deciding duration of initial opioid prescription and conducting follow-up
What is the fourth area of consideration on the 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain?
Assessing risk and addressing potential harms of opioid use
When to reduce/taper opioids
-Requests dosage reduction
-Does not have clinically meaningful improvement in pain and function
-Is on dosages 50 MME or more/day without benefit or opioids are combined with benzodiazepines
-Shows signs of substance use disorder
-Experiences overdose or other serious adverse events
-Shows early warning signs for overdose risk such as confusion, sedation, or slurred speech
How to reduce/taper opioids
-Avoid abrupt tapering or sudden discontinuation of opioids
-Decrease dose by 10% per month if patients have taken opioids for more than a year
-Decrease dose by 10% per week for patients that have taken opioids for a shorter time
-Once lowest dose available is reached, the interval between doses can be extended. If discontinuing opioids, they may be stopped when taken less than once a day
What is the 2017 Opioid 7 day Prescribing Limit?
Physicians issuing initial opioid prescriptions for a patient may not prescribe more than a 7-day supply:
-Limit applies to that physicians first opioid prescription to that patient
-No specific exception for practitioners in the same practice
What are the exceptions to the 7-day limit?
-Cancer
-Medication assisted treatment (MAT) for a substance-abuse disorder
-Palliative care
-Personal judgement (must document that a non-opiate not appropriate a physician is using his or her professional judgement to prescribe more than a 7 day limit)
What is the 2019 INSPECT requirement
-Requires checking INSPECT each time before prescribing an opioid or benzodiazepine to any patient
-No exceptions for hospice, palliative care, or long term care patients
-Patients on pain management contract - check INSPECT every 90 day
What is a pain contract?
-A written agreement between the patient and prescriber
-Does not legally prevent another provider from prescribing opioids or a pharmacy from filling opioids prescribed by a different provider
-However, the patient would no longer receive opioid prescriptions from the original prescriber
What is as needed analgesia?
-Only administered when the patient is in pain
-Minimize exposure to limit toxicity
What is scheduled or around the clock analgesia?
-Given at a set interval
-May be better option for continual pain
-Can still use breakthrough analgesia
What is patient controlled analgesia?
-Allows patient to decide when they will get a dose of pain medicine
-IV line is placed into a patients veins. A computerized pump attached to the IV allows patient to release pain medicine by pressing a handheld button
When is patient controlled analgesia used?
-Post-operative
-Pancreatitis
-Sickle cell crisis
What are the treatments for lower back pain?
-Advise patients to remain active and limit bedrest
-Exercise
-Cognitive behavioral therapy
-Interdisciplinary rehabilitation
-Medications
