Pain SHP

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.

Does Emily present with any risk factors for opioid abuse or misuse?

Emily's social and family history may present some concerns with prescribing an opioid. She admits to the occasional use of marijuana to help deal with her migraines. She also has two teenage children and so special precautions must be taken (such as the use of a medicine safe) to prevent the inappropriate use of opioids by the children or their friends. Studies have been conducted to identify patient risk factors for opioid misuse. The TROUP Study identified non-modifiable factors (i.e., younger age, back pain, multiple pain complaints, and substance abuse disorders) as well as modifiable factors (i.e., treatment with a high daily dose of opioid, and the use of a short-acting Schedule II opioid) for opioid misuse.7 A number of screening tools have been developed to predict aberrant drug-use behavior, though a combination of screening tool with an interview seems to be the most sensitive approach.8

References

Krantz MJ, Martin J, Stimmel B, et al. QTc screening in methadone treatment. Ann Intern Med. 2009;150:387-395. Article available at: http://www.annals.org/content/150/6/387.full.pdf+html.
Harvey WF, Hunter DJ. Pharmacologic intervention for osteoarthritis in older adults. Clin Geriatr Med. 2010;26:503-515. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/20699168.
Pauer L, Winkelmann A, Arsenault P, et al. An international, randomized, double-blind, placebo-controlled, phase III trial of pregabalin monotherapy in treatment of patients with fibromyalgia. J Rheumatol. 2011;38:2643-2652. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/21965636.
Recla JM. New and emerging therapeutic agents for the treatment of fibromyalgia: an update. J Pain Res. 2010;3:89-103. Article available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004640/pdf/jpr-3-089.pdf
de Leon-Casasola O. New developments in the treatment algorithm for peripheral neuropathic pain. Pain Med. 2011;12(Suppl 3):S100-108. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/21752181.
Kirsh KL, Fishman SM. Multimodal approaches to optimize outcomes of chronic opioid therapy in the management of chronic pain. Pain Med. 2011;12(Suppl 1):S1-11. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/21226840.
Sullivan MD, Edlund MJ, Fan MY, et al. Risks for possible and probable opioid misuse among recipients of chronic opioid therapy in commercial and Medicaid insurance plans: The TROUP Study. Pain. 2010;150:332-339. Article available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897915/pdf/nihms208554.pdf.
Moore TM, Jones T, Browder JH, et al. A comparison of common screening methods for predicting aberrant drug-related behavior among patients receiving opioids for chronic pain management. Pain Med. 2009;10:1426-1433. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/20021601.