...James B. Talmage, MD The duration of opioid therapy after surgery is the strongest known predictor of ultimate misuse, and researchers have reported that the number of days for which medication was prescribed and the total number of postoperative prescriptions each predicts long-term use...

...James B. Talmage, MD; Robert B. Snyder, MD Evidence shows that chronic opioid therapy is usually not beneficial; weaning patients off opioids many times results in less pain and better function, and opioid-induced hyperalgesia is real and frequent. Further evidence suggests that surgical outcomes...

...Jennifer Christian, MD, MPH The author considers the hypothetical case of a worker disabled by an accident and spine fusion surgery that did not relieve the pain; he is offered opioids and spends his time in a recliner grieving the loss of his self-respect as a good husband, provider, and father...

... Spinal cord (dorsal column) stimulation (SCS) and intraspinal opioids (ISO) are treatments for patients in whom abnormal illness behavior is absent but who have an objective basis for severe, persistent pain that has not been adequately relieved by other interventions. Usually, physicians...

... to IMEs, identify strengths and weaknesses, and consider what can be done to improve efficiency and quality. © 2000 American Medical Association. All Rights Reserved. 2000 American Medical Association Spinal cord (dorsal column) stimulation (SCS) and intraspinal opioids (ISO) are treatments...

... overdoses nearly quintupled over a 20-year period (2001-2021) to 32.4 per 100,000. More than 70% of these fatalities were caused by opioid overdose, especially the synthetic drug, fentanyl. Despite an increase in substance abuse and dependency treatment, mortality and morbidity associated with opioid...

... in the evaluation report that the rating is being provided despite reasons to be concerned that the impairment is artificially inflated in a nonpermanent way by the unjustifiable narcotic prescription. Evaluators should not state that the impairment from side effects of the opioids is permanent. © 2011 American...

..., identifying the best treatment, and assessing the patient for recovery after treatment. Although recovery is usually identified as a physiologic measure (eg, joint range of motion), pain is also commonly assessed. However, the opioid crisis taught health care providers that measuring pain alone could have...

... nociceptive pain, with a decreased responsiveness to peripherally directed therapies such as anti-inflammatory drugs and opioids, surgery, or injections.” 8 If invasive treatment is being requested for chronic pain, and invasive treatment has the risk of significant potential complications...

.... Talmage JB , Snyder RB . Opioids: current science . AMA Guides Newsletter , 2021 ; 26 ( 5 ): 3 – 12 . doi: 10.1001/amaguidesnewsletters.2021.SeptOct01 . In future issues, we will revisit the term spasm regarding spinal impairment rating and treatment, and we will introduce the newly...

... the general population . Eur J Pain . 2004 ; 8 ( 1 ): 47 – 53 Angst MS , Clark JD . Opioid-induced hyperalgesia: a qualitative systematic review . Anesthesiology . 2006 ; 104 ( 3 ): 570 – 587 . Arnold LM , Hudson JI , Keck PE , Auchenbach MB , Javaras KN...

...); back injury; pain (acute and/or chronic); opioid use (current); delay between injury and first medical treatment (greater) ▪ Compensation factors: prior WC or disability claims (worker or significant other); prior sick leave ▪ Self-rated functional status (poor) ▪ The worker's self-reported...

.... Approximately 8 months ago, he had a partial third ray amputation, and thus a new impairment rating is needed. He has had significant problems with chronic foot pain and is on chronic opioids. He does not use a gait aid. His Pain Disability Questionnaire is 75. An amputation of the second toe...

... for cirrhosis, injuries, and ear–nose–throat/esophageal/liver cancer. 54 , 55 Substance abuse has been declared a national emergency because of the recent opioid epidemic and increasing number of deaths by overdose. Substance-using mothers have 8.4 times the mortality than that observed among US women...

... consideration of probable behavioral, personality, or other psychosocial issues. Prescription narcotics are a major obstacle to maximum medical improvement, 2 and the ongoing opioid use is likely contributing to his chronic pain. In those on daily analgesics, the most common cause of cephalgia is medication...

... Considering opioid use as acceptable treatment for chronic pain, 9 Accepting examinee-reported history as credible, 10 , 11 Diagnosing complex regional pain syndrome based on subjective complaints, 12 Equating subjective complaints to objective findings, 13 Basing causation...

... reflect your patient population by understanding the inclusion and exclusion criteria and baseline characteristics. While RCTs are important tools to help guide practitioners in treatment, such as whether ibuprofen is just as effective as an opioid for acute pain management, RCTs have practical...

...-blockers), may be used. Opioids should be avoided. There is no curative therapy, and there is a lack of high-quality evidence for an effective drug regimen. Interventional procedures may be provided independently but are best used to facilitate engagement in functional therapies and to improve quality...