By vgreene, 4 November, 2019 Pain mgmt: Integrate safe, effective nonopioid & nonpharmacologic3,4 approaches
By vgreene, 4 November, 2019 Risks: (↑w/ rapid taper, physical dependence, noncollaborative pt) acute w/d, pain exac, insomnia, anxiety/depression, psych distress, suicidality/self-harm, broken trust, high-risk/illicit opioid-seeking
By vgreene, 4 November, 2019 Benefits: improved function, sleep, anxiety, mood; stable or even reduced pain
By vgreene, 4 November, 2019 HHS Guide for Clinicians on Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics. U.S. Department of Health and Human Services. October 2019.
By vgreene, 4 November, 2019 Avoid reduction if cancer-related/end-of-life pain, or when analgesia benefits outweigh risk. Avoid if physically dependent pt is noncollaborative, given ↑risk of w/d & serious adverse events
By vgreene, 4 November, 2019 Consider reduction if: pain improves, higher doses don’t improve pain/function, side effects ↓function/QOL, OD/serious event, misuse suspected, ↑risk from concurrent comorbidities1 or meds (eg, BZD2), benefit vs harm unclear after long-term tx,