Pharmacology Book

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Chronic Narcotic GuidelineAka: Chronic Narcotic, Chronic Opioid

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  1. See Also
    1. Chronic Pain
    2. Somatization
  2. Contraindications (Relative for Chronic Pain)
    1. Substance Abuse (especially Narcotic Abuse)
    2. Severe character pathology or Personality Disorder
    3. Chaotic social environment
  3. Protocol: Chronic Opioid Use Guidelines in Non-Cancer Chronic Pain
    1. Observe for Narcotic Seeking Behavior
    2. Avoid confusing Pseudo-addiction for addiction
      1. Avoid inadequate treatment of pain
    3. Single clinician should primarily manage patient
    4. Consider Narcotic contract or informed consent
    5. Maintain Narcotic use flow sheet
    6. Titrate to pain relief and adverse effects
      1. Reevaluate on a 1-4 week basis
      2. Document pain level (scale of 1 to 10)
      3. Document functional status
    7. Convert short-acting Narcotics to long-acting Narcotics
      1. Use long-acting Narcotics around the clock
      2. Use short-acting Narcotics for breakthrough pain
    8. Use in combination with other therapy
      1. See Chronic Pain Management
      2. Non-Opioid Analgesics
      3. Make use of non-pharmacologic modalities
    9. Treat Narcotic adverse effects prophylactically
      1. See Bowel Regimen in Chronic Narcotic Use
  4. References
    1. Sokolove (2001) CMEA Medicine Lecture, San Diego

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