How to Treat Patients Dependent on Opiates

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Presentation transcript:

How to Treat Patients Dependent on Opiates Christopher Chisholm, MD Poway, Escondido, La Jolla

Do you feel like this when dealing with chronic pain patient’s?

Addiction vs Dependance Addicts-reward pathways Compulsion Euphoria Dependant-Thalmus and Brainstem

So what is your plan???

\

Opioids

Seriously……..

Fundamentals of Pain Transduction: noxious stimuli are translated into electric activity at the nerve endings (receptor) Transmission: impulses are propagated through the sensory system (peripheral nerve) Modulation: nociceptive transmissions modified by neural influences (spinal cord) Perception: development of subjective, sensory and emotional experience (brain)

Transduction NSAIDS Tylenol Steroids Regional anesthesia

Transmission Neuropathic pain medicine Regional anesthesia

Modulation Regional Anesthesia Opiates

Perception Opiates

Addiction vs Dependance Addicts-reward pathways Compulsion Euphoria Dependant-Thalmus and Brainstem

What to do with Opiate dependent patients? Start Pre-op: Try to reduce opiate use Counsel them on appropriate expectations Have a plan before you schedule surgery Use regional techniques is possible Intra-Op: Make sure patient is “loaded” with opiates intra-op Post Op: Be aggressive in addressing pain scores post-op Base medication needs on activity no pain scores

Questions?