The online tutorial series with a case reinforces practical
application of tools and competencies acquired during the
live activity. Each tool is a combination of essentials in
clinical practice, links to relevant scientific publications, and
printable handout material for reference. Clinical Case
following the online tutorials gives the learners an opportunity
to earn extra CE credit upon completion.
- Differentiating Types of Pain
- Assessment of Pain
- Know Your Drugs: Non-Opioids
- Know Your Drugs: Opioids
- Minimizing Adverse Effects
- Clinical Case
Minimizing Adverse Effects
The long-term use of opioids is associated with several adverse effects and clinicians
should be prepared to anticipate, identify, and treat these occurrences. The most common
opioid associated adverse effects include:
- Nausea and vomiting
- Sexual dysfunction
Opioid-induced hyperalgesia (OIH) can also severely impact the effectiveness of opioid
treatment and can result in either increased sensitivity to pain, aggravation of
pre-existing pain, or expression of novel pain symptoms. Some strategies to prevent
OIH from occurring include:
- Use of adjuvant therapies for "opioid sparing" effect (e.g., use of anticonvulsants or antidepressants)
- Opioid rotation to take advantage of "incomplete cross tolerance"
- Use a combination of an opioid and low-dose mu receptor antagonist (e.g., buprenorphine and naltrexone)
- Blockade of the NMDA receptor (e.g., use of ketamine)
The use of methadone may prolong the rate-corrected QT interval and result in torsades
de pointes. Therefore, clinicians should take precautions prior to initiating
methadone treatment for their patients.
- Disclosure: Clinicians should inform patients of arrhythmia risk when they prescribe methadone
- Clinical History: Clinicians should ask patients about any history of structural heart
disease, arrhythmia, and syncope
- Screening: Obtain a pretreatment electrocardiogram for all patients to measure the QTc
interval and a follow-up EKG within 30 days and annually.
- Additional EKG is recommended if the methadone dose exceeds 100 mg/day or patients have
unexplained syncope or seizures.
- Drug Interactions: Clinicians should be aware of interactions between methadone and other
drugs that possess QT interval prolongation properties or slow the elimination of methadone