Author Hala Alaw

NSAIDs and Acetaminophen Scheduled NSAIDs + acetaminophen typically result in 30-40% reduction in opioid requirements for acute pain; this goes up even further if gabapentinoids are used. Ketorolac is an NSAID with high COX-1 selectivity that is indicated to treat moderate to severe pain. It is available in IV, IM, […]

4 general points to consider when treating acute or chronic pain with opioids: In opioid-naïve patients, treatment by a clinician who prescribes opioids more frequently than their peers is strongly correlated with subsequent long-term opioid use in patients. Treatment of acute severe pain with opioids may be appropriate. Follow the […]

One large fair-quality retrospective cohort study (Dunn et al, 2010) found that recent opioid use was associated with increased risk for any overdose events and also associated with serious overdose events when compared to patients not on opioids. This study also found that with higher doses risk increases. Compared to […]

A recent study was performed in Tennessee (see references) to compare all-cause mortality for patients with chronic non-cancer pain and no evidence of palliative or end-of-life care who were prescribed either long-acting opioids or alternative medications for moderate to severe chronic pain. Propensity score-matching was used to compare new episodes […]

References: Chang AK, Bijur PE, Esses D, et al. Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department: a randomized clinical trial. JAMA. 2017; 318(17):1661-1667 Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of mindfulness-based stress reduction vs cognitive […]

If a patient is given 3-10 day prescription but they have reaction to the medication, it is okay to prescribe a different opioid within the 10-day window as long as these conditions are met: Tenn. Code Ann. § 63-1-164 A patient shall not be treated with an opioid more frequently than every […]

Per the 2018 TN Together Opioid Prescribing Law (Tenn. Code Ann. § 53-10-310), “when prescribing a controlled substance, all healthcare practitioners, unless otherwise exempted under this part, shall check the controlled substance database prior to prescribing one (1) of the controlled substances identified in subdivision (e)(4) to a human patient at the […]

Exempt categories where the 2019 Amendments to the 2018 TN Together Opioid Law does not apply:  active cancer treatment  palliative care treatment  hospice care treatment  sickle cell disease  inpatients in the hospital  prescriptions issued by pain management specialists or under the collaborative direction of […]

Based on the CDC Guideline for Prescribing Opioids for Chronic Pain, literature supporting long-term opioid therapy for pain is limited; in fact, research shows increased risk for harm with long-term opioid use. Benefit for starting new patients on long-term opioid therapy should be individualized to the patient and the disease […]