opioid medication management · 9/15/2015. case presentation •49 y.o. female presents with a...
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Opioid Medication Management
Denis G. Patterson, DO
University of Nevada, Reno
9/15/2015
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Case Presentation
• 49 y.o. female presents with a chief
complaint of low back pain x 10 years
• No significant PMHX
• Medications: Dilaudid 4mg q 4 hours prn
• PMP report confirms patient report
• Lumbar MRI shows minimal degenerative
changes
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How would you approach
this patient?
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Nevada Advanced Pain Specialists
Opioid Approach
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Nevada Advanced Pain Specialists
Opioid Approach
• Medication Agreement
• Sent out before the appointment
• Sets the “rules” before there can problems
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• Urine Drug screens
• Always done at first appointment
• Done randomly and when issues arise or
changes occur
Nevada Advanced Pain Specialists
Opioid Approach
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Nevada Advanced Pain Specialists
Opioid Approach
• Utilize the Nevada Task Force Inquiry
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Nevada Advanced Pain Specialists
Opioid Approach
• Only prescribe medications you feel
comfortable with
• I personally avoid Methadone, Oxycontin,
Soma, the D’s and Benzodiazepines
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Nevada Advanced Pain Specialists
Opioid Approach
• Try to manage pain with as little
medication as possible
• This includes the number of medications
and the number of pills
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Nevada Advanced Pain Specialists
Opioid Approach
• Consistency
• Consistency
• Consistency
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Case Presentation
• Patient informed that I do not prescribe
Dilaudid for chronic pain
• Alternatives discussed with patient to
better manage her pain
• Patient offered to be transitioned to
long acting opioid
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Case Presentation
• Short acting opioid decreased to twice a
day dosing as needed
• MSQS evaluation done at the end of the
appointment
• Patient will follow up in 4 weeks
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Questions?
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