Question

53 yo M is evaluated for possible opioid therapy initiation for a several year history of chest and back pain. Both types of pain significantly impair his ability to sleep, and he has not been able to work for the last 6 months.Most appropriate management?

Answer 1

Appropriate management for a 53-year-old male patient seeking opioid therapy for pain should involve exploring non-opioid and non-pharmacological treatments first due to high addiction and overdose risks with opioids. If opioids are necessary, they must be prescribed cautiously and monitored closely.

Step-by-step explanation:

The most appropriate management for a 53-year-old male considering opioid therapy for chronic chest and back pain should be a comprehensive assessment of pain and function, a consideration of non-opioid medications and non-pharmacological treatments, and a thorough evaluation of the risks of dependency and addiction associated with opioid use. The initiation of opioid therapy must be cautious, especially given the history of the opioid crisis, which demonstrated that opioids can be highly addictive even when used as prescribed, with a risk of addiction and overdose. Given the potential risks, it is important to explore all other treatment options, such as acetaminophen, NSAIDs, physical therapy, and possibly referral to a pain specialist before considering opioids. If opioids are deemed necessary, they should be prescribed at the lowest effective dose and for the shortest duration possible, with close monitoring for signs of misuse and addiction.