Forming an Opioid Treatment Plan
You may be considering opioids as part of your pain management plan. These are strong medicines that work by blocking or suppressing how your body feels pain. While opioids can be very effective at treating pain, they do come with certain risks and side effects. Before prescribing opioids for your pain, your healthcare provider will work closely with you to form a treatment plan. This will help make sure you are getting the safest, most effective treatment for your pain. Your treatment plan will include discussions about your pain and health history and your treatment goals. If it is decided that opioids should be prescribed, your healthcare provider will then make a plan with you for how long to use the medicines and when to stop them. Regular follow-up and monitoring will also be needed.
Shared decision-making means that you and your healthcare team work together to make decisions about your care. It is important that you understand all of your options and choose the care and treatment that is right for you. When considering opioid medicines as part of a pain management plan you should make sure to:
Work with your healthcare team to create a plan to manage your pain.
Discuss ways to help manage your pain that don’t involve prescription opioids.
Understand the benefits, risks, and side effects of prescription opioid treatment.
Ask questions and discuss your concerns before starting and during your opioid treatment.
Before prescribing opioid medicines, your healthcare provider will evaluate your pain and overall health. This includes a physical exam and review of your pain history and health history. Your healthcare provider may also ask about your mental and emotional health and whether you have personal history or family history of substance abuse (such as drugs and alcohol). Be open and honest with your healthcare provider. This will help ensure that a safe and effective plan is developed.
Your healthcare provider may ask you:
To describe how your pain affects your life. This can include how it affects your relationships, work, and sleep.
To describe how long you have been having pain, how severe it is, and if it is getting better or worse
What you have done to treat your pain and what did and didn’t help
To discuss what medicines you take or have taken for pain. This includes all prescription, over-the-counter, herbal remedies, supplements, and illegal or street drugs.
To keep a diary to track your pain before starting any opioid medicines
Tests and screenings
To help determine whether opioid treatment is appropriate and safe for you, you may need certain tests and screenings. Depending on your risk for side effects, some tests and screenings may need to be repeated during the course of your treatment. Tests and screenings may include:
Urine or blood tests to screen for drugs
Blood tests including kidney and liver function tests
Testing for hepatitis C, HIV, and tuberculosis (TB)
Opioid medicines can help reduce your pain, but they often cannot provide complete relief. When you have pain, the goal of treatment is to relieve pain to an acceptable level for you, and to improve function in daily life. Understand that function can improve even when you still have some pain. And know that the benefits of long-term use of opioids for treating pain remain unclear. In general, you should only remain on opioids if they continue to improve pain and function without increasing the risks to your health. Be realistic about the possible benefits opioids may have on your quality of life. Make sure the goals you and your healthcare provider set are reasonable and reachable.
Stopping opioid treatment
To stop opioid treatment safely and to help manage withdrawal symptoms, you will need help from your healthcare provider. You and your healthcare provider will discuss a plan for stopping opioid treatment ahead of time. In most cases, the amount of medicine you take will be cut down, and you will be weaned off the medicine slowly.
Following up with your healthcare provider
You will need to see your healthcare provider for regular follow-up visits if you are prescribed opioids. It is very important that you see your healthcare provider as scheduled. These visits help you and your healthcare provider monitor how well treatment is meeting your goals and to evaluate for any side effects. This helps ensure the medicines are working well for you and being safely used.
November 18, 2017
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Honaker, Richard, MD, FAA,Zachariasen, Judy, PharmD