Chronic nonmalignant pain is a commonly encountered clinical scenario in primary care. Many medical professional organizations have issued guidelines indicating that opioid analgesics are reasonable to consider as part of the management of moderate-to-severe chronic nonmalignant pain with functional impairment. This lecture presents an approach to the assessment and follow-up of chronic nonmalignant pain with a focus upon the appropriate prescribing and monitoring of opioid analgesics. Topics covered include dose titration, adverse effects, detection of abuse and dependence, the use of pain management agreements, and regulatory oversight. This is a topic area that creates significant anxiety and frustration for residents in the clinic. Residents and medical students have responded very favorably to this discussion; this talk uniformly receives 4s and 5s on a 5-point Likert scale, with an average overall score of 4.9.
By the end of this lecture, participants will be able to:
- Develop an approach to the general assessment of chronic pain.
- Discuss patient historical factors and opioid characteristics that create a setting of greater risk for abuse or dependence.
- List the adverse effects commonly encountered with opioid analgesics, and discuss their management.
- Distinguish between opioid abuse and dependence and pseudoaddiction, and discuss their detection.
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© 2007 Brown and Brown.
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Brown R, Brown R. Primary care assessment & management of chronic non-cancer pain. MedEdPORTAL. 2007;3:606. https://doi.org/10.15766/mep_2374-8265.606