Key Hospitalist Clinical Practice Guidelines in 2017

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO

Disclosures

January 16, 2018

In This Article

Opioids for Noncancer Pain

American Society of Interventional Pain Physicians

Screen for opioid abuse to identify opioid abusers.

Utilize prescription drug monitoring programs (PDMPs).

Utilize urine drug testing (UDT).

Establish medical necessity based on average moderate to severe (on a scale of 0-10) pain and/or disability.

Stratify patients based on risk.

Establish treatment goals of opioid therapy with regard to pain relief and improvement in function.

Initiate opioid therapy with low dose, short-acting drugs, with appropriate monitoring.

Consider up to 40 morphine milligram equivalent (MME) as low dose, 41-90 MME as a moderate dose, and >91 MME as high dose.

Avoid long-acting opioids for the initiation of opioid therapy.

Recommend methadone only for use after failure of other opioid therapy and only by clinicians with specific training in its risks and uses, within FDA recommended doses.

There is similar effectiveness for long-acting and short-acting opioids, with increased adverse consequences of long-acting opioids.

Periodically assess pain relief and/or functional status improvement of ≥30% without adverse consequences.

Recommend long-acting or high-dose opioids only in specific circumstances with severe intractable pain.

Monitor for adherence, abuse, and noncompliance by UDT and PDMPs.

Monitor patients on methadone with an electrocardiogram periodically.

Monitor for side effects, including constipation and manage them appropriately, including discontinuation of opioids when indicated.

Discontinue opioid therapy for lack of response, adverse consequences, and abuse with rehabilitation.

Reference

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