Transdermal copyright (Duragesic and generic) has limited use for treatment of chronic pain. Transdermal copyright is a short-acting opioid packaged in a long-acting delivery system, making patients on it especially prone to development of opioid tolerance.
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Prior to prescribing a controlled substance, review the Controlled Substance Agreement (CSA) with the patient. During the review, educate the patient about potential benefits, limitations, and significant risks of the treatment and alternative treatments. Patients must acknowledge that risks exist, that they accept taking those risks, and that they understand what is expected of them if treatment is to be continued.
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Detoxification will likely be required in patients with continued uncontrolled pain on high doses of opioids. Often detoxification can be accomplished by conversion to buprenorphine.
Sublingual buprenorphine (Suboxone, Subutex and generic) may be prescribed off-label for pain with a regular DEA number. Sublingual buprenorphine has an evolving role, particularly in patients already treated with high dose opioid therapy who continue to complain of uncontrolled pain, and who may or may not have opioid use disorder.
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Nociceptive pain is caused by tissue damage due to injury or inflammation, rather than harm to the central or peripheral nervous system. This is the primary type of pain involved in patients with arthritis, musculoskeletal inflammatory disorders (tendinosis, bursitis), or structural spine pain.
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Consider methadone for its prolonged duration of effect, which is useful for longer term therapy and minimizes euphoria with low doses.
A Mediterranean-adjacent diet that focuses on antioxidants, fiber, and healthy fats is most likely to be liver protective and generally good for you. “That said, I always encourage my clients to follow the 80/20 rule: nourish your body with whole foods most of the time and leave room for flexibility and enjoyment without guilt,” says Dr. Morris-Stiff. “It’s about what you do consistently, not occasionally.”
Some evidence exists for methadone use in this population as well. However, it is less promising than buprenorphine.
Integrative medicine is an approach that combines and coordinates conventional medicine with evidence-informed practices that historically are not mainstream. Emerging evidence suggests a role for many less conventional treatments in the management of chronic pain due to their benefits and safety compared to opioid therapy.
Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred for the treatment of chronic pain.11 There is insufficient evidence to support the use of long-term opioid use for chronic pain. Opioids carry substantial risks of harm.