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For core clinical content designed to help you safely and effectively manage patients with chronic pain, when appropriate, with opioid analgesics, please visit our sister site, SCOPE of Pain.

 

  1. Massachusetts Laws
  2. Educational Program Making Sense of Massachusetts Opioid Prescribing Laws and State and National Guidelines Program CME Post-Test Evaluation
  1. Dental Pain
  2. Educational Program Safe Opioid Prescribing for
    Acute Dental Pain
    Program CME Post-Test Evaluation
  1. Prescribe to Prevent
  2. Educational Program Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists Information Program CME Post-Test Evaluation
  1. Military Modules
  2. Module 1 Military SCOPE of Pain: Safe and Competent Opioid Prescribing For Providers Working with Veterans and Military Service Personnel Information Video CME Post-Test Evaluation
  3. Module 2 Military SCOPE of Pain: Safe and Competent Opioid Prescribing For Providers Working with Veterans and Military Service Personnel Information Video CME Post-Test Evaluation
  1. Video Modules
  2. Module 1 Case Studies In Practice: Applying Principles
    of Safe Opioid Prescribing
    Information Introduction Cases Case I Case II Case III Certification CME Post-Test Evaluation
  3. Module 2 Complex Convrs. High Dose Opioids
    & Illicit Drug Use
    Information Introduction Cases Case I-A Case I-B Case II Certification CME Post-Test Evaluation
  4. Module 3 Using the PDMP PMP Questionable Activity Information Introduction Cases Case I Case II Certification CME Post-Test Evaluation

Case I-A: High Dose Opioids, Part 1 Case I-A: High Dose Opioids, Part 1

First visit
John Robertson is a 62 year old male, new patient, who presents for the first visit after moving from out of state in order to live with his sick mother. He has a 15 year history of chronic lower back, bilateral hip and knee pain.

Pain history:
His pain started after a major motor vehicle crash 15 years ago in Florida. He required many surgeries with complicated postoperative infections requiring 2 months in the intensive care unit followed by 3 months in a physical rehabilitation program. He has been unemployed and on high dose opioids ever since his accident.

Pain medications:
(by history and confirmed in old medical records supplied by patient)
• Fentanyl 100 mcg patch every 2 days
• ER morphine 100 mg 3 times a day
• IR oxycodone 30 mg every 3 hours

Other medical history:
He also has a history of COPD, well controlled hypertension and hyperlipidemia.

Substance use history:
He smokes 1-2 pack per day (50 pack year history), he drinks beers 2-3 times per year during the holidays. He denies drug use. No family history of substance abuse.

Social history:
He is a former electrician but has been unemployed on disability since his accident. He is single and now lives with his 87 year old mother.

Physical exam:
He ambulates using 2 canes. He grimaces when he gets in and out of the chair and has difficulty getting on and off the exam table. He has multiple well healed scars from his prior trauma/surgeries. His exam is otherwise unremarkable.

 

Will you prescribe the patients current regimen of fentanyl, morphine and oxycodone on this first visit?