Treatment
➤ Tramadol taken up to three months may decrease pain, improve stiffness
and function and overall well-being in patients with osteoarthritis (W-M).
Remark: The range of tramadol dosing studied is 37.5 mg (combined with 325 mg of
acetaminophen) once daily to 400 mg in divided doses.
Consequences of Opioid Treatment
(e.g., misuse, substance use disorder, possible diversion)
➤ Prescribers should assess all patients for the possible risk of developing
the negative, unintended consequences of opioid treatment (e.g.,
misuse, diversion, addiction) prior to prescribing opioid analgesics for
the treatment of chronic pain (S-L).
Remark: A trial of opioid analgesics for the treatment of moderate-to-severe chronic pain
may be reasonable only when the potential benefits of chronic opioid therapy on pain
severity, physical function, and quality of life outweigh its potential harms.
➤ Routine monitoring of patients prescribed opioid analgesics for the
management of chronic pain is recommended (S-VL).
Remark: Opioid treatment agreements, urine drug testing (UDT), pill counts, and
prescription drug monitoring programs (PDMP) are commonly used tools to safeguard
against harms.
➤ An "opioid patient-prescriber agreement" is recommended as a tool
for shared decision making with all patients before receiving opioid
analgesics for chronic pain (S-L).
Remark: Patient-prescriber agreements consist of two components: informed consent and a
plan of care. When a patient's behavior is inconsistent with the patient-provider agreement,
the prescriber must carefully consider a broad differential diagnosis.
➤ The prescriber should understand the clinical uses and limitations of
UDT including test characteristics, indications for confirmatory testing,
and the differential diagnosis of abnormal results (S-L).
Remark: UDT results should never be used in isolation to discharge patients from care, but
rather, should be used in combination with other clinical data for periodic evaluation of the
current treatment plan and to support a clinical decision to safely continue opioid therapy.
➤ Controlled substances should be stored safely away from individuals at
risk of misuse and/or overdose.Family members should be educated on
the medications, the signs of overdose, and the poison control number
should be readily visible (S-L).
➤ Clinicians should teach patients and their caregivers about opioid
overdose and the use of naloxone to reverse overdose, and a naloxone
rescue kit should be readily available (S-M).
➤ Patient education is recommended to help patients avoid adverse events
related to pharmacological interactions (S-L).
