Exercise regularly—at least 150 minutes per week—to maintain a healthy weight and avoid liver fat accumulation.
Read about symptoms of an underactive thyroid (hypothyroidism) and how this thyroid disorder is diagnosed and managed
Buprenorphine can be prescribed for pain without an XDEA waiver, but the waiver is required to prescribe medication-assisted therapy for opioid use disorder.
Herbal supplements. Patients frequently request information about herbal supplements. The evidence for the use of some supplements is growing. Many are safe and may be considered when patients are interested. See Table seis.
A chronic primary pain syndrome represents a disease that cannot be accounted for by another pain condition.
Sublingual buprenorphine (Suboxone, Subutex and generic) may be prescribed off-label for pain with a regular DEA number. Sublingual buprenorphine has an evolving role, particularly in patients already treated with high dose opioid therapy who continue to complain of uncontrolled pain, and who may or may not have opioid use disorder.
Marijuana. Evidence regarding benefits and harms is currently insufficient to recommend using “medical” marijuana for chronic pain. Some data support cannabidiol (CBD) alone as being relatively safe.
Remember the facts: Smoking can kill you. And think about how much better you’ll feel once smoking is out of your life.
Understand regulations for prescribing controlled substances. Know state and federal regulations regarding controlled substance prescriptions. Key features include:
Advantages of buprenorphine include its effectiveness, and lack of development of tolerance to it. As a Schedule III drug, it may be written with refills for up to seis months. Disadvantages include occasional problems with rash from transdermal patch use, and greater expense.
Focus on opioids. The patient displays an overwhelming focus on opioids during visits. This focus occupies a significant proportion of the clinic visit time and impedes progress on other issues regarding the patient’s pain. This behavior must persist beyond the third clinic treatment session.
The autoimmune form of hypothyroidism is called Hashimoto’s thyroiditis. The autoimmune form of hyperthyroidism is called Graves’ disease. You may find that other members of your family have thyroid problems or another autoimmune disorder.
Continued opioid use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
Have a frank but supportive discussion with the patient about the fears of a worse lifestyle and risk for overdose. Offer support more info and addiction treatment.