Grey area of opioid prescribing

[deleted185747]

It seems like there is a wide gray area when it comes to appropriate patient selection for chronic opioid therapy. What are some acceptable diagnosis besides cancer?

Who are obvious candidates for COAT?
If you use the word "function" in your answer define what you are measuring, if not just another subjective item from the patient.

thanks

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[101N]

Move to private forum.

 

[drusso]

Have you read any clinical guidelines for prescribing opioids?

 

[deleted185747]

Yes and I follow the 2012 ASIPP guidelines which are vague.

I want black and white

The CDC and Washington State guidelines are for PCPs and say to refer to pain management as the end of the algorithm.

 

[SSdoc33]

Yes and I follow the 2012 ASIPP guidelines which are vague.

I want black and white

if you want black and white, here it is: no opioids for CNMP. otherwise, you wont get it from guidelines.

 

[drusso]

The CDC and Washington State guidelines are for PCPs and say to refer to pain management as the end of the algorithm.

Bingo. At the end of the day, you can't make guidelines for discernment, common-sense, and judgment. There's a lot of grey, contextual factors that gets factored into a decision to RX or not to RX. Most clinicians trying to make an apportionment of which pain issues seem centralized and which seem nociceptive in nature.

 

[SeniorWrangler]

I like the Chou 2009 opioid guidelines. The gray area is smaller than a lot of people think IMHO.

 

[joshmir]

check out oregon's guidelines, kinda more black and white

 

[bedrock]

Still move we discuss this further in private forum.