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Prescription Drug Safety Information

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At the Pain and Wellness Institute we create an individualized treatment plan for each patient. We look at all available treatments that target a particular diagnosis or condition. It is important to be comprehensive since pain has such an enormous impact on the quality of life.

Prescription pain medications are used for a variety of acute and chronic pain conditions. These medications can be an effective component of pain management but must be used with caution and safeguarded from inappropriate use by others.

There are a variety of medications and categories of pharmacologic therapies available to help individuals with both acute and chronic pain. These categories include:

• Anti-inflammatory medications

• Muscle relaxants

• Anti-depressants

• Anti-convulsants

• Analgesics

Analgesics (medications whose primary function is to relieve pain) are divided into two main subgroups, i.e., opioids (narcotics) and non-opioid forms. Opioids are currently the most potent, and in some instances the most effective, analgesic used to treat both acute and chronic pain. However, not all musculoskeletal pain syndromes require opioid medication, either because the severity of the pain does not justify the use of narcotics or in some instances the pain syndrome may simply be unresponsive or poorly responsive to opioid medication.

In our view, a prescription for opioid medication must be considered as part of the overall pain management plan, including interventional pain management techniques when applicable and other pharmacologic approaches.

The hallmark of opioid therapy is the need to individualize treatment for each patient. In so doing, we follow a number of important steps and guidelines:

• Define the indication for opioid treatment.

• Need for aggressive intervention for moderate to severe disabling pain.

• Failure of non-opioid therapy.

• Comprehensive assessment and treatment.

• Define diagnosis to be treated.

• Evaluate risk factors (psychosocial factors, mood, history of substance abuse, among others).

• Obtain a signed “opioid contract” or prescribing agreement.

• Review potential side effects – constipation, drowsiness, nausea, etc.

• Explain grounds for tapering or discontinuing opioid medications altogether.

• Set goals of treatment with opioids focusing on pain reduction, improved functioning and enhanced ability to cope with pain.

• Provide overdose education to high risk patients and their families and prescribe naloxone.

• Maintenance and follow-up (appointments for prescription refills are at least every 2 months).

Aberrant drug behaviors are grounds for discontinuation of opioid therapy and may lead to dismissal from our practice. These include obtaining prescriptions from multiple providers or from non-medical sources. It also includes non-approved dose escalation by the patient, lost or stolen prescriptions (these will not be replaced), forged prescriptions, and impulsive drug use. Opioid therapy will be discontinued at any time if the risks outweigh the benefits of continued therapy.

For more information about Medical Treatment for Opioid dependence please visit: