How Do I Respond When My Patient Comes to the Clinic Asking for More Opioids Than Usual?

Le résumé fourni par la source

Abstract This chapter guides clinicians through a set of simple questions they may use in their clinical strategy for managing seemingly worsened outpatient sickle cell disease (SCD) pain, whether or not it is called a vaso-occlusive crisis (VOC) by the patient. The pain experience of people with SCD varies over time. Often, pain evolves from episodic VOCs in early life to chronic pain with superimposed VOCs later. Complications that are independently painful can also accumulate. Thus, deciding when and whether to apply an acute pain treatment paradigm versus a chronic pain treatment paradigm can be difficult. Treatment is even more fraught with difficulty by the neuropharmacological complexity and risks of opioids. This chapter suggests how to deliberately choose a specific treatment paradigm based on answers to the above simple questions; how to assess whether that paradigm worked, including when to declare failure of opioids; and how to manage treatment and other risks in this subset of patients.

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