By vgreene, 18 April, 2016 If harms outweigh benefits, optimize other tx & work w/ pt to taper opioids to lower dosage or taper off3 [A/4]; view CDC pocket guide4 for more info
By vgreene, 18 April, 2016 Assess for harms of tx (nausea, constipation, sedation, confusion, interrupted breathing during sleep, cravings, difficulty controlling use2)
By vgreene, 18 April, 2016 Re-eval for OD risks (eg, hx substance use/OD, higher opioid dosage, mental health dz, sleep apnea, on BZDs) or misuse (review hx of controlled-substance prescriptions via state PDMP) [A/4]
By vgreene, 18 April, 2016 Use nonpharmacologic tx/non-opioid pain meds if possible. If opioids used: Urine test 1st, combine w/ non-opioid/nonpharmacologic tx, re-eval in 1-4 wks
By vgreene, 18 April, 2016 Re-eval benefits/harms w/in 1-4 wks of starting or escalating opioids, then at least q3mo; match Rx duration to scheduled reassessment [A/4]
By vgreene, 18 April, 2016 Use lowest effective dose2 of immediate-release opioids; never use ER/LA opioids in opioid-naive pts [A/4]. Combine w/ nonpharmacologic + non-opioid tx [A/3]
By vgreene, 18 April, 2016 Prior to opioid tx: Assess baseline pain + fxn;1 set realistic goals and criteria for stopping if risks exceed benefits [A/4]. Discuss risks (eg, addiction, OD) & benefits [A/3]. Obtain urine drug screen for opioids, undisclosed Rx drugs, illicit drugs [B
By vgreene, 18 April, 2016 Opt for nonpharmacologic tx (eg, exercise, weight loss, CBT, intra-articular steroids) or non-opioid pain meds (eg. NSAIDs, TCAs, SNRIs, anticonvulsants) [A/3]. Consider opioids only if expected benefits for both pain + fxn anticipated to outweigh risks [