Special Considerations


By now, you have realized that this tutorial often repeats similar points in different ways. This is not because I love to ramble on or hear myself talk (though my patients will tell you I do), but is intentional, as these are key points to this tutorial. Some research has shown that it takes multiple exposures to information for it to become engraved into your brain. Some experts say it takes 16-21 times to make something a habit!!!

Use opioid medications for acute or chronic pain only after determining that alternative therapies do not deliver adequate pain relief. The lowest effective dose of opioids should be used.

When starting you on opioid therapy, your physician will account for your opioid history, physical tolerance, and consideration of agents in mixed preparations, cross-tolerance, and conversion irregularities. It is always best to use caution when initiating and increasing opioid regimens.

There have been many debates as to the safe range with regards to opioid therapies. When talking about opioid medications, many often refer to what is known as morphine equivalent dose (MED).

Maximum safe dose is patient-specific and dependent on current and previous opioid exposure, as well as on whether the patient is using such medications chronically.

When using single-agent opioid preparations (non-combination products), there is no maximum dose when appropriately titrated; however at higher doses, the risk may become greater than the benefits thus creating a “maximum recommended dose”. Your doctor will slowly titrate up your dose until adequate pain relief is seen or side effects preclude further escalation.

The current guidelines do recommend consultation with a pain specialist if you are taking above a certain amount of opioid medications. If a patient’s dosage has increased over 120 mg MED per day, without substantial improvement in function and pain, they should consider seeking a consultation from a pain specialist.