Lecture Notes
Opiate Prescribing: The Acute Pain Perspective – Dr Caroline McCombie

Dr Caroline McCombie has been the head of the Acute Pain Team at Shoalhaven District Memorial Hospital for the last 2.5 years. Demand for her team’s input continues to escalate. They also have increasingly complex challenges from the rising numbers of patients on chronic opioids coming into hospital for acute illness or elective procedures. Currently 45% of our patients leave the surgical ward with a script for opioids, despite many not using any opioids in the 24h prior to discharge. Many of these patients are still taking their discharge dose of analgesia 3 months down the track. Clearly we need strategies to reduce these problems.

Suggested strategies:

  • Multimodal analgesia
    • including continuing antidepressants, antianxiolytics and neuropathic pain medications during the perioperative period  (don’t cease these regular medications when fasting)
  • Multidisciplinary team care, including input from mental health, alcohol and drug services as required
  • Consistent approaches across inpatient and community care providers
  • Nonpharmacological techniques
  • Acknowledge and address opioid-induced hyperalgesia
  • Set time limitations, ceilings of treatments and use clear communication with patients
  • Address psychosocial factors, especially sleep deprivation
  • Don’t use acute analgesia prescriptions to treat chronic pain, i.e. ensure that patients return to baseline following the resolution of their acute pathology

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