On the other hand, post-traumatic pain syndrome may be less easily defined, with litigation and compensation often playing a role in the pain disorder. The otolaryngologist must be open-minded, compassionate, and understanding, yet cognizant of other elements that could be at play. Consultation with a pain management expert is usually very helpful, as is an honest discussion with the patient.
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April 2018The management of extended acute and chronic pain syndromes in otolaryngology-head and neck surgery can be both challenging and complicated. Balancing ethical principles in providing pain mitigation requires the otolaryngologist to be knowledgeable of current guidelines and best practices, while at the same time relying on a sense of responsibility to the patient and a duty to balance beneficence with nonmaleficence in the best interests and welfare of each patient.
Dr. Holt is professor emeritus in the department of otolaryngology–head and neck surgery at the University of Texas Health Science Center in San Antonio.
Highlights of the CDC 2016 Opioid Prescribing Guidelines
- Long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed.
- Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate.
- Clinicians should review the patient’s history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or dangerous combinations that increase the risk of overdose.