ASAM Review Course:  2000
Management of Chronic Pain in the Patient with a History of Addiction

Barriers to Opioid Pain Management

Medical Students Lack Addiction      Medicine Training

Pain

 Pain

"Chronic Pain"

Dorsal Horn Neuron (DHN)
 “Wind Up” Phenomenon

Addiction

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Triangle 0f the Disease of Addiction

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History of AA

Long-Term Opioid Therapy:
Assessment of Consequences and Risks

Abuse Potential of Opioid Medications

Abuse Potential of Opioid Medications

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Rate Hypothesis of Subjective Effects of Drugs of Abuse

Neurophysiologic Changes in
Steady-State Opioid Blood Levels

Clinical Study of Long- vs. Short-Acting Opioids in the Treatment of Non-Malignant Pain

Benefits of Long-Acting Opioids

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Implications of Methadone Maintenance for Theories of Narcotic Addiction

Pain Treatment

ATC Medications–Shortcomings

Break-Through Pain

Increasing Dose of ATC

Ideal Pain Medication

Pain Responses in Methadone-Maintained Opioid Abusers

Opioids Containing Acetaminophen

Risk of Kidney Failure Associated with the Use of Acetaminophen, and NSAIDs

Acetaminophen Toxicity in a County Hospital

Meperidine

Goal of Chronic Pain Specialist

"RECORD KEEPING"

Patient Characteristics for Opioid Use in Chronic Nonmalignant Pain

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Outcome Measures of Opioid Treatment

Differences Between a Chronic Pain Patient and Drug Seeking Behavior (Addicted Patient)

Differences Between a Chronic Pain Patient and Drug Seeking Behavior (Addicted Patient)

Differences Between a Pain Patient
and an Addicted Patient

      Preventing Diversion of  a Schedule    II CS

Non- Adherence to the Medical Plan

Three typical prescriptions are shown before and after being forged

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Interpretation of Urine         Toxicologies

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"codeine*"

Opiate Assay

Slide 58

How to Rule Out Poppy Seed Ingestion

Experience with Opioids in CNP

Federal Regulations For Prescribing a Schedule II Controlled Substance [CS]

Federal Regulations  [cont’d]

Federal Regulations  [cont’d]

      Federal Regulations  [cont’d]

Federal Regulations  [cont’d]

    Federal Regulations  [cont’d]

Federal Regulations  [cont’d]

      Federal Regulations   [cont’d]

      Federal Regulations  [cont’d]

      Federal Regulations  [cont’d]

     Federal Regulations  [cont’d]

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AA Serenity Prayer