Hussein AI, Bekampis CF, Jermyn RT. Review of Opioid Prescribing in the Osteopathic and Ambulatory Setting. J Am Osteopath Assoc 2019;119(12):820–832. doi: https://doi.org/10.7556/jaoa.2019.134.
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The opioid epidemic in the United States is one of the largest modern health crises in the nation's history. The crisis has been cultivated in academic journals, driven by the medical-pharmaceutical complex, and fueled by campaigns representing the most prestigious health care organizations and advocacy groups. Comprehensive guidelines for proper prescribing have been released in addition to state-sponsored prescription drug–monitoring programs (PDMPs) in response to overprescribing habits. When considering opioid treatment for a patient, physicians should document a thorough history of pain, give an appropriate physical examination, and complete a risk assessment using the proper diagnostic tools. Considering the osteopathic philosophy and approach to chronic pain, physicians should account for an integrative treatment approach for improved patient outcomes when considering applying the osteopathic philosophy to chronic pain management. A successful treatment plan can integrate cognitive behavioral therapy and promote self-healing by treating somatic dysfunctions with osteopathic manipulative treatment. This literature review discusses how to treat patients with chronic pain and how to properly use and prescribe opioids. The researchers analyzed the history and current status of the opioid epidemic, examined opioid management in the outpatient setting, reviewed the current domestic and international opioid prescribing guidelines, and discussed the incorporation of the osteopathic philosophy to manage chronic pain.
a Determined by Opioid Risk Tool score.
Abbreviation: MME, morphine milliequivalents.
aAdapted from CDC Guidelines for Prescribing Opioids for Chronic Pain.26
Abbreviations: NSAIDs, nonsteroidal anti-inflammatory drugs; OMT, osteopathic manipulative treatment; SNRIs, serotonin-norepinephrine reuptake inhibitors; TCAs, tricyclic antidepressants.
a This table is adapted from Agency Medical Director's Group 2015 interagency guideline on prescribing opioids for pain.46
b Benzodiazepines should not be used.
Abbreviation: NSAIDs, nonsteroidal anti-inflammatory drugs.
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