Common Pain Diagnoses
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Contents |
Course 8: Common Pain Causes
Addiction issues with treating common causes of pain with opioids in primary care. (back pain, osteoarthritis, headache, neuropathy)
Need
Many clinicians overprescribe opioids for common causes of pain. Furthermore, they often do not take the appropriate clinical steps to avoid triggering or contributing to an addiction problem when managing common causes of pain.
Physicians studied in a teaching hospital did not use a standard approach to common issues in addiction medicine and pain management (Merrill, et al, 2002).
Goal
The learner will manage the back pain, osteoarthritis, headache, neuropathy in primary care, in a way that avoids triggering or contributing to addiction problems.
Objectives
After completing this course, the learner will be able to:
Objective A. Use First-Line Treatments First
Treat common causes of pain using first line treatments
- Treat back pain using first line treatments
- Treat osteoarthritis using first line treatments
- Treat headache using first line treatments
- Treat neuropathy using first line treatments
Objective B. Limit Opioid Use
Use opioids in limited cases and appropriately when treating common causes of pain
- Use opioids for common causes of pain only after first-line treatments have failed
- Use non-opioid medications on a schedule rather than as needed before trying opioids
- When opioids are indicated, use in combination with other pharmacological and non-pharmacological therapies in order to minimize the dose and increase effectiveness
- Use non-scheduled and/or extended-release opioids before scheduled, high-potency opioids
Objective C. Monitor for Abuse
Recognize substance misuse in patients with common causes of pain
- Monitor total use of opioids for common causes of pain and compare to expected use for the diagnosis
- Identify "yellow flags" that are indicative of substance misuse
Objective D. Consult/Refer
Recognize when patients with common causes of pain require referral to a specialist
- Determine which type of pain or addiction specialist is appropriate
- Refer/consult regarding patients with pain who require opioid therapy and have "yellow flags" for addiction to a pain specialist
- Refer/consult regarding patients who have an addiction disorder for addiction treatment
- Refer patients to other medical and mental health specialists when appropriate
- Include all key patient information (history and current status) in referral report
Case Study/Simulated Patients
- IN DEVELOPMENT
New back pain patient
Back pain in a person in recovery
Core Courses: Initial Assessment • Initial Prescribing • Ongoing Management • Avoiding Diversion
Clinical Application Courses: Focus on Pain Conditions • Focus on Substance Use Problem
Standardized Patients: Pain and Addiction Standardized Patient Example 1
