Take the pain out of pain management with clinical pearls from addiction medicine specialists Dr. Stefan Kertesz at the University of Alabama at Birmingham School of Medicine and Dr. Ajay Manhapra from the VA Hampton Medical Center in Hampton, Virginia. They walk us through an approach to pain management in persons with a history of opioid use disorder (OUD), discuss treatment options for OUD, plus hot tips on how to interpret guidelines surrounding opioids, and more! What are you waiting for? Hit the play button! Special thanks to Elena Gibson, MD and Carolyn Chan, MD

Credits

Producer: Elena Gibson and Carolyn Chan
Writer: Carolyn Chan
Infographic: Elena Gibson
Cover Art: Elena Gibson
Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
Guest: Dr. Stefan Kertez and Dr. Ajay Manhapra

Time Stamps

00:00 Intro
01:58 Host picks of the week
04:10: Intro to the episode
04:35: Guest Bios
12:32: Case from Kashlak Memorial
13:40 Define substance dependence, substance use, unhealthy use
17:42 Where to go next conversation about pain control
17:54: Assessing risk of relapse
19:35 Screening Tools
20:10 Risk factors for developing OUD when initiating opioids.
25:10: CDC Guidelines length of prescription and risk of substance use disorder (7)
27:00: Defining optimal length of opioid after common surgical procedures (6)
30:30: Long term use of opioids
33:50: OUD treatment options
37:30: Duration of buprenorphine/naloxone treatment, tapering risks (8)
38:50: POATs: Prescription opioids (9)
40:05 Social support and mental health services for SUD treatment
41:10 Risk of abstinence and adverse outcomes
42:35 Protracted withdrawal
43:35: Editorial BMJ Golden Month of Opioid use disorder (10)
44:00 Overdose risk in patients on long term opioids
44:40 Op-Ed on the Hill (11)
45:40 Example of protracted withdrawal syndrome
47:40 Reducing Harms: Naloxone, who to prescribe to?
50:30 Take home points
53:40 Outro

#73: Opioid Addiction, Chronic Pain, and Abstinence

The Curbsiders Internal Medicine Podcast