Pain Exam 1: Mikus 2022 CDC Opioid Guidelines

Acute pain: <__ month

1

Subacute pain: __-___ months

1-3

Chronic pain: >__ months

3

The guidelines exclude:

1. ___ cell disease

2. ___-related pain treatment

3. palliative care

4. end of __ care

sickle, cancer, life

Patient "Rights"

-right ___

-right __

-right ___

-right ___

drug, dose, ROA, time

4 decisions when prescribing opioids

1. whether or not to __ opioids

initiate

4 decisions when prescribing opioids

2. ___ opioids and determining ___

selecting, doses

4 decisions when prescribing opioids

3. deciding __ of opioid prescription

duration

4 decisions when prescribing opioids

4. assessing __ and addressing potential __ of opioid use

risk, harms

Recommendation 1

-clinicians should maximize use of __ and __ pharmacologic therapies as appropriate for the specific condition

nonpharmacologic, nonopiod

Recommendation 1

-exception to starting with nonpharm/nonopioid =

-acute pain that may require opioids like severe traumatic ___ (car crash/burns) or invasive ___

injury, surgeries

Recommendation 2

-Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic ___ and known ___ of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be ___ if benefits do not outweigh risks.

benefits, risks, discontinued

Recommendation 2

-To guide patient-specific selection of therapy, clinicians should

evaluate patients and establish or confirm the diagnosis. ___ of pain is important: biomechanical, mechanical, neurological, psychological, non-mechanical !!

Etiology

Etiology of Pain

____: poor posture/movement,

patterned movements

biomechanical

Etiology of Pain

____: sprains, fractures, structural problem

Mechanical

Etiology of Pain

___: shingles, diabetes, tumors, medications

Neurological

Etiology of Pain

____: anxiety, depression,stress

Psychological

Etiology of Pain

__-___: infections, neoplasms,

atherosclerosis

Non-mechanical

Recommendation 3

When starting opioid therapy for acute, subacute, or chronic pain, clinicians should prescribe ___-release opioids instead of extended-release and long-acting (ER/LA) opioids.

immediate

ER/LA formulations ARE NOT for:

-___ pain

-___ use

-___ for subacute or chronic pain.

acute, prn, initiation

ER/LA formulations ARE for:

-subacute or chronic pain (but only after IR has been tried)

-continuous ___ pain (including malignant pain).

severe

Recommendation 4

-When opioids are initiated for opioid-naïve patients with acute, subacute, or chronic pain, clinicians should prescribe the ___ effective dosage

lowest

The ___ starting dose for opioid-naïve patients is often equivalent to a single dose of approximately 5-10 MME or a daily dosage of 20-30 MME/day

lowest

Recommendation 5

-If benefits outweigh risks of continued opioid therapy, clinicians should work closely with patients to ___ nonopioid therapies while continuing opioid therapy.

optimize

Recommendation 5

-If benefits do not outweigh risks of continued opioid therapy, clinicians should optimize other therapies and work closely with patients to gradually taper to ____ dosages or, if warranted based on the individual circumstances of the patient, appropriately taper and discontinue opioids.

lower

In situations where benefits and risks of continuing opioids are considered to be close or unclear, ___ decision-making with patients is particularly important.

shared

Patient ___ and interest in tapering is likely to be a key component of successful tapers!

agreement

Recommendation 6

When opioids are needed for acute pain, clinicians should prescribe no greater quantity than ____ for the expected duration of pain severe enough to require opioids.

needed

Patients should be evaluated at least every ___ weeks if they continue

to receive opioids for acute pain

2

Recommendation 7

-Clinicians should evaluate benefits and risks with patients within ___-__ weeks of starting opioid therapy for subacute or chronic pain or of dosage escalation

1-4

When initiating extended-release/long-acting (ER/LA) opioids or when total daily opioid dosage is >50 MME/day, clinicians should follow up on ___ end of 1-4 week range, because increased risk of overdose!

lower

Additionally, follow-up intervals (every 2-3 days for the first week) should be strongly considered when starting or increasing the dosage of ___

methadone

Recommendation 8

-Before starting and periodically during continuation of opioid therapy, clinicians should ____ risk for opioid-related harms and discuss risk with patients.

evaluate

Clinicians should ask patients about their ___ and ___ use

drug, alcohol

When considering initiating long-term opioid therapy, clinicians should ensure that treatment for depression and other ___ health conditions is optimized

mental

Special Populations to consider in terms of RISK:

-Patients with ___ apnea

-Patients that are ___ or postpartum

sleep, pregnant

Special Populations to consider in terms of RISK:

-Patients with hepatic/renal insufficiency

-Patients ≥___yo

65

Special Populations to consider in terms of RISK:

-Patients with safety critical ___

-Patients with ___ health conditions

jobs, mental

Special Populations to consider in terms of RISK:

-Patients with ___ use disorder

-Patients with previous ___ history

substance, overdose

Recommendation 9

-Review prescription drug monitoring data (____) before initiating opioids and periodically during chronic therapy to identify high-risk dosages or combinations that increase overdose risk.

PDMP

PDMP data should be reviewed ___ every opioid prescription for acute, subacute, or chronic pain and then every __ months or more frequently.

before, 3

Recommendation 10

-When prescribing opioids for subacute or chronic pain, clinicians should consider the benefits and risks of ___ testing to assess for prescribed medications as well as other prescribed and nonprescribed controlled

substances.

toxicology

Toxicology testing should not be used in a ___ manner but should be used in the context of other clinical information to inform and improve patient care.

punitive

Toxicology screening for a class of drugs might not detect all drugs in that ___. For example, fentanyl testing is not included in widely used toxicology assays that screen for opiates as a class.

class

Recommendation 11

-Clinicians should use particular caution when prescribing ___ pain medication and ___ concurrently and consider whether benefits outweigh risks of concurrent prescribing of opioids and other CNS depressants.

opioid, benzodiazepines

Recommendation 12

-Clinicians should offer or arrange treatment with ___-based medications to treat patients with opioid use disorder.

evidence

When determining dosing:

rule 1: do not use an online __

rule 2: use a reliable equianalgesic dosing chart

rule 3: ___ work multiple times

calculator, check

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