Unused narcotics are a risk to children and the community, so be sure to talk about proper disposal. “Every patient you give an opioid to, instruct them how to dispose of excess ones,” said John Pang, MD, a head and neck surgery resident at UC San Diego Health and a coauthor of the JAMA Otolaryngology–Head & Neck Surgery paper regarding opioid use among patients with head and neck cancer. Your local pharmacist can help you and your patients figure out how to safely dispose of unneeded opioids.
Explore This IssueDecember 2017
5. Patients Who Want Refills Should Be Referred to Pain Management Specialists
A patient who continues to complain of pain and wants additional opioids after an initial prescription should be seen in the office. “Number one, you need to make sure that there are no complications that are causing pain,” Dr. Gavi said. “Do a good exam and listen to the patient.”
If no physical explanation for the continued pain can be found, Dr. Gavi has a conversation with the patient. “I say, ‘I can’t explain why you have this much pain; that’s unusual. I don’t have a good explanation for your pain, so I would rather you talk to a pain specialist,’” he said.
Consider involving a pain specialist in cases involving any patient who seems to have more pain than expected. “We don’t understand why some patients have more pain than others,” said Joshua Smith, MD. a chronic pain physician at Greenville Health System in South Carolina. “Maybe there is some drug-seeking behavior, but it’s not fair to our patients to chalk it all up to that.” A pain specialist can help identify and untangle factors that may be causing increased pain, and develop a multi-disciplinary treatment plan.
Jennifer Fink is a freelance medical writer based in Wisconsin.