Protocols - Hemorio

Psychic Dependence or “addiction“ is caused by a behavioral change that comes with the individual. It
means, a genetic tendency that makes him predisposed to be dependent of anything. Then, in this case, it
is a neuro-pharmacological and psychological phenomenon.
There are psychological tests, developed in the United States, that may foreseen the kind of response to
the treatment, as well as to trace a psychological profile of the subject, foreseeing, even with the subject
not stating consciously, his tendency to the psychic dependence. Unfortunately, they are expensive,
because it demands a special training. In the practice, the easiest way is through regular appointments to
the outpatient clinic, where we must investigate on alcoholism, tabagism, the usage of any kind of drugs,
from the subject himself or his ascendant.
There are three situations in which, when there is the need to use the opioid, you must make a rigid
control:
1 - Subject without a previous history of dependence who becomes dependent after the usage of opioid;
2 - Subject who has a psychic dependence and has pain, needing opioid to treat the pain.
3 - Subject who has psychic dependence with pain, needing opioid to treat the pain, and divides his
medication to other psychic dependents.
In any of the cases, the subject needs to be treated. According to Portenoy, some recommendations
justify the usage of opioid in subjects with non-oncological chronic pain;
1 - The pain must cease with the usage of opioid, when used at the right dosage and intervals;
2 - The physician must have a purpose method in order to evaluate the results. The absence of the results
justifies to discontinue the treatment;
3 - The usage of opioid must produce an evident improvement at the functional capacity of the subject;
4 - The prescription must be done for a limited time (every 10-15 days), and with a constant control of
possible side effects;
5 - Just one physician must control the medication. The change of the physician responsible must
be done in written and with the acknowledgment both of the subject and both physicians.
OTHERS: Pruritus is most common when you use peridural path and the clonus is rare, but it may occur in
case of continuous usage for a long time of Methadone and/or Gabapentine. In this case, the dose must
be decreased or make a rotation to other drug.
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