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Tolerance, as defined by either of the following: (a) a need for markedly increased amounts of opioids to achieve intoxication or desired effect, or (b) markedly diminished effect with continued use of the same amount of an opioid.

Prior to prescribing a controlled substance, review the Controlled Substance Agreement (CSA) with the patient. During the review, educate the patient about potential benefits, limitations, and significant risks of the treatment and alternative treatments. Patients must acknowledge that risks exist, that they accept taking those risks, and that they understand what is expected of them if treatment is to be continued.

The differing pathophysiology for acute pain and chronic pain requires different approaches to their diagnosis and treatment. Effective acute pain management has been shown to improve both patient satisfaction and treatment outcomes, and reduce the risk of developing chronic pain.

The foundation of quitting smoking successfully lies in a strong will. Recognizing that smoking is harmful is important, but committing to quit is what truly matters. Once you make up your mind, stay determined and remind yourself why you started this journey.

By the clock: regular administration at fixed times, rather than on demand By the ladder (symptom-oriented): if the patient is still in pain, it is necessary to go up a step

Chronic pain differs from acute pain. Chronic pain is not acute pain that failed to resolve. It is a distinct condition that is better understood as a disease process than as a symptom. Use a biopsychosocial approach in assessment and management.

A logical rationale for an intervention does not ensure the patient’s acceptance and participation in it. A patient’s acceptance of therapy is influenced by several complex factors, including characteristics of illness and identity.

Failing urine drug screening tests. Some jobs require a negative urine drug screen, and employment may not be compatible with opioid therapy. Patient can be harmed financially and professionally if they screen positive for an opioid, even when prescribed and monitored by a clinician.

If appropriate, modify opioid dosing. Always use the minimum effective opioid dose, or attempt to taper down the dose. If an increased dose is to be tried, titrate the dose gradually, and do not exceed 50 MME/day unless clear evidence of benefit outweighs the risk.

A Mediterranean-adjacent diet that focuses on antioxidants, fiber, and healthy fats is most likely to be liver protective and generally good for you. “That said, I always encourage my clients to follow the 80/20 Buy Now rule: nourish your body with whole foods most of the time and leave room for flexibility and enjoyment without guilt,” says Dr. Morris-Stiff. “It’s about what you do consistently, not occasionally.”

Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by opioids.

The current nation-wide opioid epidemic adds another layer of complexity in the management of chronic pain. Opioids carry substantial risk for harm, and are not recommended for the majority of patients with chronic pain. However, due to high rates of opioid prescribing over the last 20-30 years, there are still many patients who remain on chronic opioid therapy. With the widespread adoption of the CDC opioid-prescribing guidelines in 201611, rates of opioid prescriptions have decreased.

Treatment. In the treatment plan, address both the underlying cause and the associated acute pain. In developing a treatment plan for the acute pain, consider the degree of tissue trauma, the patient’s situation, and any unique patient factors.