Testimonies from the Trenches Series - Safer Pain Management Practices for Patients with Opioid Use Disorder (On-Demand)-2022-02-10 - Safer Pain Management Practices - Dr Wessol

2022-02-10 - Safer Pain Management Practices - Dr Wessol - slides

Pdf Summary

This document discusses safer pain management practices for patients with opioid use disorder (OUD). It covers topics such as tolerance, physical dependence, and substance misuse, as well as the DSM-5 criteria for substance use disorder. The document emphasizes the importance of risk assessment for OUD and factors that influence the management of pain, such as family and personal history of SUD, pain catastrophizing scale, and biopsychosocial factors.<br /><br />Safer prescribing practices are also addressed, including the use of close follow-up, checking the Prescription Monitoring Program (PMP), reducing opioid dose to a minimum effective dose, and prescribing naloxone. The document suggests avoiding concurrent prescriptions of benzodiazepines and other CNS depressants, and utilizing non-pharmacologic therapies and multimodal pain management strategies. It also provides a list of non-opioid medication options for pain management.<br /><br />The document discusses opioid tapering and withdrawal management, providing guidelines for tapering patients on opioids for different durations and managing withdrawal symptoms. It also addresses pain management in the setting of medication-assisted treatment for OUD, as well as perioperative buprenorphine management.<br /><br />Treatment issues related to OUD and chronic pain are highlighted, including the stigma and judgment faced by patients with OUD. The document also mentions the misapplication of the CDC guidelines for opioid prescribing, particularly in populations outside the guideline's scope and the dosage recommendations.<br /><br />Finally, a case study is presented, discussing a patient with a history of substance use disorder who wants to leave the hospital against medical advice. The document suggests strategies for pain management, withdrawal management, and considering immediate treatment goals versus long-term goals, as well as factors like housing, insurance, support, and outpatient care.

Keywords

safer pain management

opioid use disorder

tolerance

physical dependence

risk assessment

safer prescribing practices

non-pharmacologic therapies

opioid tapering

withdrawal management

chronic pain