Chronic pain and the use of opioids are both rising epidemics. But since opioids can be used to manage chronic pain, it becomes challenging for physicians to control both situations.
Larry Greenblatt, MD, professor of medicine in the Department of Community and Family Medicine at Duke University School of Medicine in Durham, North Carolina explained that doctors should have an honest discussion with patients who exhibit red flags showing that they should not be given opioids. MD Magazine caught up with him at the American College of Physicians Internal Medicine Meeting (ACP 2017) in San Diego, California.
“Some of the red flags that we might look for would be a patient who’s really unwilling to participate in their care beyond taking medication,” Greenblatt explained, noting that physical therapy and cognitive therapy could be tried before prescribing opioids. Physicians may also want to keep a look out for patients with a history of uncontrolled mental health, such as depression or anxiety.
“For a patient who you don’t feel is a good candidate for opioid therapy on the basis of red flags, you certainly want to commit to that patient that you want to work with him or her to best manage their pain and to use other strategies that you feel are safe and would be effective,” Greenblatt said. “Just be frank with the patient, that you feel that you can’t responsibly prescribe opioids to that individual because you think you might be causing that person more harm than you would benefit them.”