Main description:

In a recent survey, 400 Nurse Practitioners (NP) 50% indicated that their education did not adequately prepare them to treat patients with chronic pain. These nurse practitioners indicated that they often feel ill-equipped to prescribe opioids to patients. As suggested by the aforementioned statistic, fear of regulatory oversight and fear of potential addiction in patients often prevents nurse practitioners from prescribing opioids to those patients who could
benefit from them. Although addiction is a real concern for practitioners prescribing opioids (the rate of addiction in primary care patients on long-term opioids ranges from <1% to 3.87% (Flemming et al, 2007)), practitioner fear tends to disproportionally influence the amounts of opioids that are
prescribed. When faced with treating a patient suffering from a chronic condition, understanding safe prescribing guidelines can provide the practitioner with the both accurate information the and confidence necessary to treat pain patients safely and effectively.

Part of the Oxford American Pocket Notes series, this ultra concise pocket guide provides helpful information for prescribers in an easy-to-tab format. The introduction addresses practitioners' specific considerations while subsequent sections provide information on selecting and screening patients for opioid therapy. Moreover, the volume includes a special section on opioid prescription for patients who have a history of substance abuse. The author provides examples of patient opioid
agreements, an algorithm for treating chronic pain with long-term opioids and information on interpretation of urine screening results. Authored by two highly experienced nurse practitioners on the frontlines of patient care, this volume uses the most up-to-date information available in order to function as
a clinically focused tool for safe opioid prescribing.

Contents:

I. Issues surrounding safe prescribing (Introduction)
A. Treating chronic pain with opioids
B. Legal considerations
C. The need for an adequate knowledge base

II. Assessment: How to determine if the pain complaint needs opioid therapy
A. Using the brief Pain Impact Questionnaire (BPIQ)
B. Criteria for implementing opioid therapy

III. Screening for opioid risk
A. CAGE
B. Opioid Risk Tool (ORT)
C. COMM
D. SOAPP-R

IV. Prescribing opioids for chronic pain
A. Using universal precautions
B. Addiction, dependency, tolerance
C. Commonly prescribed opioids and equivalent doses
D. How to rotate opioids
E. Prescribing opioids for patients with a history of addiction or substance abuse

V. Developing a comprehensive treatment plan
A. Using an opioid treatment agreement
B Elements of the treatment agreement
C. Algorithm for treating chronic pain with opioids
D. Interpreting results of a urine screen
E. Enforcing the opioid treatment agreement and developing an exit strategy
F. Adding complementary methods to a treatment plan

VI. Documentation
A. Using the PADT
B. Using the four A"s for reassessment

VII. Recommended readings and websites