VA/DoD CLINICAL PRACTICE GUIDELINE FOR OPIOID THERAPY FOR CHRONIC PAIN

Recommendations

Info

VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain 2010 Recommendation Location 18 2010 Recommendation Text 19 Module Section Number diagnosis of opioid dependence: a. SL buprenorphine is FDA-approved for treatment of opioid dependence and can only be prescribed by a qualified and DEA-waivered physician for this purpose b. Patients on SL buprenorphine should not receive full agonist opioids concomitantly for routine pain control c. Nonopioid and nonpharmacologic strategies for pain management should be maximized In the event of anticipated pain ( i.e., an elective procedure or surgery) SL buprenorphine should be stopped for 48 hr before the scheduled event e. For unanticipated pain (trauma, emergency surgery or procedure) the care team managing the acute pain should be notified that the patient is prescribed SL buprenorphine and when the last dose was taken. 9 X 1 Be vigilant for sleep apnea during OT. If clinical suspicion exists for the presence of sleep apnea in a patient on OT, sleep study should be considered. [B]. 9 X 2 Patients on OT who present with sleep disorder confirmed by a sleep study should be assessed for the appropriateness of continuing OT and should be evaluated for the risks (based on the severity of the sleep-disordered breathing) versus benefits of OT. If OT is continued, it should be titrated cautiously. Patients found to have sleep-disordered breathing should be followed with a repeated sleep study. [C] 9 X 3 Patient with abnormal sleep study should be educated about the significant additional risks including breathing disruption, and instructed to avoid alcohol, or any CNSdepressant medication. [A] 9 X 4 The type of sleep apnea should be evaluated to determine if it is obstructive or central. CPAP may worsen central sleep apnea. [D] 9 X 5 Patients with sleep apnea who are on OT may benefit from a reduction in the dose of their opioids. 2010 Grade 20 B C A D 2016 Recommendation (if Category 21 applicable) 22 Not reviewed, Deleted Not reviewed, Deleted Not reviewed, Deleted Not reviewed, Deleted None Not reviewed, Deleted 9 X 6 Discontinuation of opioid therapy should be considered if the sleep apnea is severe or None Not February 2017 Page 158 of 192
VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain 2010 Recommendation Location 18 2010 Recommendation Text 19 Module Section Number life threatening. 9 X 7 Consider more careful monitoring of OT in patients treated with methadone and/or benzodiazepines. [B] 2010 Grade 20 B 2016 Recommendation (if Category 21 applicable) 22 reviewed, Deleted Not reviewed, Deleted February 2017 Page 159 of 192
Page 1 and 2:
VA/DoD CLINICAL PRACTICE GUIDELINE
Page 3 and 4:
VA/DoD Clinical Practice Guideline
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Appendix D: Drug Tables A. Short-ac
Page 83 and 84:
Short-Acting Opioid Initial Oral Do
Page 85 and 86:
Short-Acting Opioid Initial Oral Do
Page 87 and 88:
Short-Acting Opioid Tramadol (alone
Page 89 and 90:
Long-Acting/ER Opioids 1 Buprenorph
Page 91 and 92:
Long-Acting/ER Opioids 1 Hydrocodon
Page 93 and 94:
Long-Acting/ER Opioids 1 Initial Do
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
3 CYP-3A4 inhibiting agents include
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108: VA/DoD Clinical Practice Guideline
Page 157: VA/DoD Clinical Practice Guideline
Page 163 and 164: DRAFT 3 - DO NOT DISTRIBUTE VA/DoD
show all

VA/DoD CLINICAL PRACTICE GUIDELINE FOR OPIOID THERAPY FOR CHRONIC PAIN

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?