The Ultimate Guide to Pain Management
The Ultimate Guide to Pain Management
Blog Article
“Everybody’s lungs get worse with age, but the rate of decline is much faster in people that smoke,” explains Dr. Solanki. “People who smoke actually have a lot of power to improve their health by stopping their habit.”
A careful history can indicate the types of pain involved and guide treatment plans. For example, if NSAIDs provide significant relief, an inflammatory component to pain is likely. Note whether other modalities and medications have helped or not, and incorporate that information into the treatment plan.
Deciding when to quit is the first step. Select a date in the next two weeks to allow for mental preparation. Tell family and friends so they can offer encouragement. Determine what triggers your smoking, like stress, coffee, or social situations, and decide how to cope with them.
Right shoulder pain in patients with cholecystitis or perforated PUD Kehr sign: left shoulder pain associated with diaphragmatic irritation resulting from hemoperitoneum (classically secondary to splenic rupture)
Requests for increases in medication. When patients request increases in opioid medication, perform a full reassessment of any new pain features and changes in psychosocial state. A request for additional opioids could indicate a new or worsened condition, increased tolerance, inappropriate opioid use, diversion, or opioid failure.
This guideline is intended to support clinicians in evaluating and managing patients with pain and in navigating the complex issues involved with the use of opioids for pain management.
If a patient was previously stable on an opioid but requests an increase in dose, assess for tolerance or opioid failure. Consider if tapering down the opioid dose or converting more info to buprenorphine may be indicated.
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Some evidence shows that patients with complex persistent dependence may tolerate transition to buprenorphine better than a tapering down of the opioid dose. When complex persistent dependence is suspected, a more clinically useful approach may be to transition to buprenorphine and then taper down the dose.
Monitor for respiratory depression in the first 72 hours after initiating or increasing the opioid dose.
Fentanyl. Do not prescribe fentanyl for opioid naïve patients. Only consider prescribing fentanyl in a few unusual situations. Possible examples include: transdermal when gut mu receptors should be avoided; in head and neck cancer when oral intake is challenging; end of life care; intravenous in a patient with intrathecal “pain pump”; buccal and sublingual for episodic and breakthrough end-stage cancer pain.
Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by opioids.
In the case of the thyroid, the ‘thermostat’ consists of a little gland, called the pituitary gland that lies underneath your brain in your skull. The pituitary senses the level of thyroid hormones in your bloodstream, just as the thermostat in your living room senses the temperature.
Medicolegal risk. A 2017 review of malpractice claims involving the use of opioids for chronic pain found that a variety of patient and clinician factors contribute to poor outcomes and litigation. Medical comorbidities such as obstructive sleep apnea and cardiopulmonary disease, when combined with a long-acting opioid prescription, was identified as a particularly dangerous combination.