Protocols - Hemorio

HOW TO PRESCRIBE OPIOID:
SPECIAL CARES:
OPIOID AT A NON-ONCOLOGICAL ORIGIN PAIN: Being correctly made, there is no problem to use it.
Subjects with a chronic pain with a non-oncological origin frequently have a long survival and may have
their pain controlled or even cured, and the opioid may be removed.
Subjects that present intense pains of any origin, if they are not treated correctly, need analgesic, because
the pain is an alarm sign, but it also causes serious damages to the body. An episode of intense pain or
multiple episodes of non-treated or incorrectly-treated acute pain, may lead to the development of a
chronic pain.
SPECIAL CARES IN ORDER TO AVOID THE DEPENDENCE:
- the physician must supervise and provide the drug in accordance to the functional and psychological
result
- the physician must control the number of tablets
- only the physician will prescribe a psychotropic
- distrust the subject who looks for some medication before his appointment day, or through a relative or
through another physician, or when the drug ends up before the foreseen time.
- the physician must indicate a physiotherapy, psychotherapy and an occupation therapy for the
improvement of the functional capacity of the subject, with the absence of adhesion of the subject
justifying the discontinuation of the treatment.
DISCONTINUATION OF OPIOID: In order to avoid the physical dependence, the removal must be
gradual, if it is being administered for more than two weeks and in the following form:
After the resolution of what has motivated the pain (for instance, at the algic crisis of Falciform Disease),
the daily total dose will be decreased in 20 - 25% every day, until it reaches the minimum dosage of 5mg
every 4 h, then increasing the interval for every 6 h, every 8 h, every 12 h, until the total removal.
Depending on the time of usage, the removal may be faster or slower, using as a guide the symptoms of
the abstinence syndrome.
MORPHINE AND DISPNEIA: In the cases of breathing distress at rest and tachypnea, by tumoral
invasion, and by other neoplastic causes, unproductive cough, you may use the opioid. If the subject is
already using morphine or codeine, you may increase the dose around 50%, keeping the time interval
characteristic of the drug’s pharmacokinetic, i.e., every 4 h. If the subject does not opioid yet, you may
make an initial dose, for instance, codeine 30mg every 4 h or morphine 5-10mg every 4 h and adjust
according to the response.
202