受診毎・毎回モニタリングや依存性チェックなど厳格化すべき
Opioids for chronic noncancer pain
Neurology September 30, 2014 vol. 83 no. 14 1277-1284
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Track pain and function at every visit using a brief, validated instrument, so that the practitioner is aware of the effectiveness of opioids at every step
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Document the daily MED in mg/d from all sources of opioids at every visit
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Access the state PDMP data (a) at the time of a first prescription for opioids, particularly if that visit is to an emergency department; (b) at the time of a decision as to whether to institute COAT; and (c) periodically during monitoring of COAT, with a frequency according to risk of abuse
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Screen for past and current substance abuse and for severe depression, anxiety, and posttraumatic stress disorder prior to initiation of COAT
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Use random urine drug screening prior to initiation of COAT and periodically during monitoring of COAT, with a frequency according to risk
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Use a patient treatment agreement, signed by both the patient and prescriber, that adequately addresses the risks of COAT and the responsibilities of the patient, at the initiation of COAT and annually
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Avoid escalating doses above 80–120 mg/d MED unless sustained meaningful improvement in pain and function is attained, and not without consultation with a pain management specialist
