Balancing Pain Control with the Opioid Epidemic (Feat. Dr. Aubuchon)

Balancing Pain Control with the Opioid Epidemic
Authors: Aubuchon JD1, Yee A2
Published: March 8, 2018

AUTHOR INFORMATION
1 Department of Anesthesiology, Washington University, St. Louis, Missouri
2 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri

DISCLOSURE
No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.

ABSTRACT
Balancing pain control has a critical role for confronting the opioid epidemic and the Centers for Disease Control and Prevention (CDC) has issued guidelines for prescribing opioids. In this video lecture, Jacob Aubuchon provides an anesthesiologist’s perspective in pain management to providers and surgeons for addressing the epidemic. This lecture documents the history of opioid use, relevant definitions in pain, opioid pharmacology, epidemic statistics, and provider recommendations for controlling pain. More importantly, this lecture provides important considerations for providers when counseling patients in their use of opioids for pain relief.

TABLE OF CONTENTS
00:00 Introduction
00:14 OVERVIEW
00:40 HISTORY OF OPIOIDS
03:32 DEFINITIONS
03:40 Pain Definition
04:37 Tolerance Definition
04:58 Dependence Definition
05:21 Pseudoaddiction Definition
05:32 Opioid Use Disorder Definition
06:10 THE BASICS
06:20 Narcotics, Opioids, and Opiates
07:13 Opioid Pharmacology
07:47 Opioid Receptors
08:46 Indications
09:23 Side Effects
11:05 Equianalgesic Dosing
11:58 THE EPIDEMIC
12:11 World and United States
13:23 Pediatric Relevance
14:28 CDC Overdose Deaths Involving Opioids
15:03 THE PLAN
15:14 CDC Guideline for Prescribing Opioids for Chronic Pain
15:54 Determining When to Initiate or Continue Opioids for Chronic Pain
17:08 Opioid Selection, Dosage, Duration, Follow-up, and Discontinuation
18:29 Assessing Risk and Addressing Harms of Opioid Use
19:25 Risk Assessment
20:20 Prescription Monitoring Programs
21:03 Provider Considerations
21:10 What to Counsel the Patient On
22:19 How to Dispose of Unused Opioids
24:44 What If They Are On Chronic Opioids
26:40 How Many Pills Do I Give
27:31 Multimodal Analgesia
29:51 Other Considerations
30:47 Summary
32:10 Credits