“Everybody’s lungs get worse with age, but the rate of decline is much faster in people that smoke,” explains Dr. Solanki. “People who smoke actually have a lot of power to improve their health by stopping their habit.”
“This nutrient helps package and ship fat out of the liver,” she says, which could otherwise eventually lead to nonalcoholic fatty liver disease. “Keeping your choline levels up is a small move that makes a big difference in keeping your liver running clean and clear,” she says.
Buprenorphine can be prescribed for pain without an XDEA waiver, but the waiver is required to prescribe medication-assisted therapy for opioid use disorder.
Psychiatric comorbidities. Review the past medical history and assess the presence of psychiatric conditions that could affect the patient’s response to chronic pain, communications with the patient about chronic pain, or treatment.
The following information pertains to adults. See “Pain management in children” for pediatric recommendations.
Some health conditions — for example, kidney disease, low blood pressure, heart rhythm problems or a history of seizures — may limit your options. Also, prescription sleeping pills and nonprescription sleep aids may interact with other medicines.
Consider buprenorphine when a safer, lower side-effect profile medication is preferred over full agonist opioids or for patients with tolerance to other opioids.
Acute pain A warning signal indicating actual or potential tissue damage Antiestrogens that triggers a protective reaction
Consider buprenorphine. For patients with opioid use disorder, conversion from other opioids to buprenorphine can provide a safer alternative while still providing the benefits, if any, of opioid analgesia. This can be done by a prescriber with a XDEA, with input from other specialists as needed.
Each of these syndromes initially manifests as a symptom of another disease. After healing or successful treatment, chronic pain may sometimes continue and hence the chronic secondary pain diagnoses may remain and continue to guide treatment (Table 2).15
Opioid tolerant patients. Morphine is the default choice, unless contraindicated. Morphine can be prescribed by all routes, unlike oxycodone. It has a straightforward dose calculation with a predictable analgesic interchange and conversion between parenteral and oral dosing.
Discontinue all ineffective medications to avoid polypharmacy, minimize toxicity, and limit unrealistic beliefs about the benefit of medications.
To facilitate gathering information efficiently, use intake questionnaires or templates within the electronic health record. Consider how to involve clinical team members in the evaluation.
If you have a cigarette with your morning coffee or on your afternoon work break, rethink what you do during those times.