Opioid Therapy in Acute and Chronic Pain 2018, 00(0) 1–12 C 2018, the American College of Clinical Pharmacology DOI: 10.1002/Jcph.1276
Core Entrustables in Clinical Pharmacology: Pearls for Clinical Practice The Journal of Clinical Pharmacology Opioid Therapy in Acute and Chronic Pain 2018, 00(0) 1–12 C 2018, The American College of Clinical Pharmacology DOI: 10.1002/jcph.1276 Anne N. Nafziger, MD, PhD, MHS, FCP,1,2 and Robert L. Barkin, PharmD, MBA, FCP3,4 Abstract This is an article in the Core Entrustables in Clinical Pharmacology series that describes opioid therapy in acute and chronic pain. Opioid use during surgical procedures or anesthesia is not discussed. Basic pharmacokinetic and pharmacodynamic properties of opioids are reviewed. The safe and effective use of opioids, including clinical assessment and treatment plan, equianalgesic dosing, opioid rotation, opioid risks and side effects, and clinical adherence monitoring are discussed. Individualized opioid use can be a safe and effective component of a patient-specific multimodal treatment plan for acute or chronic pain. Adverse effects and risks can be prevented or effectively managed when anticipated and recognized. The article is followed by 4 clinical vignettes with discussions. Keywords Analgesics, Opioid, Pain management, Opioid-related disorders, Drug therapy, Treatment outcome After reading this article, the reader will be familiar strategy program) are among those organizations that with the common classes of opioid agonists and partial have issued guidelines to assist with opioid prescription agonists, the basics of pharmacokinetics and pharma- in the outpatient setting.3–8 codynamics of opioids, the risks of opioid therapy, and A serious public health problem has developed in the requirements for safe and effective use of opioids the United States because of the misuse, abuse, and in acute and chronic pain.