Opioid Medication Management

Denis G. Patterson, DO

University of Nevada, Reno

9/15/2015

Case Presentation

• 49 y.o. female presents with a chief

complaint of low back pain x 10 years

• No significant PMHX

• Medications: Dilaudid 4mg q 4 hours prn

• PMP report confirms patient report

• Lumbar MRI shows minimal degenerative

changes

How would you approach

this patient?

Nevada Advanced Pain Specialists

Opioid Approach

Nevada Advanced Pain Specialists

Opioid Approach

• Medication Agreement

• Sent out before the appointment

• Sets the “rules” before there can problems

• Urine Drug screens

• Always done at first appointment

• Done randomly and when issues arise or

changes occur

Nevada Advanced Pain Specialists

Opioid Approach

Nevada Advanced Pain Specialists

Opioid Approach

• Utilize the Nevada Task Force Inquiry

Nevada Advanced Pain Specialists

Opioid Approach

• Only prescribe medications you feel

comfortable with

• I personally avoid Methadone, Oxycontin,

Soma, the D’s and Benzodiazepines

Nevada Advanced Pain Specialists

Opioid Approach

• Try to manage pain with as little

medication as possible

• This includes the number of medications

and the number of pills

Nevada Advanced Pain Specialists

Opioid Approach

• Consistency

• Consistency

• Consistency

Case Presentation

• Patient informed that I do not prescribe

Dilaudid for chronic pain

• Alternatives discussed with patient to

better manage her pain

• Patient offered to be transitioned to

long acting opioid

Case Presentation

• Short acting opioid decreased to twice a

day dosing as needed

• MSQS evaluation done at the end of the

appointment

• Patient will follow up in 4 weeks

Questions?