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

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

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

4. So what is your plan???

5. \

6. Opioids

7. Seriously……..

9. 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)

11. Transduction
NSAIDS
Tylenol
Steroids
Regional anesthesia

12. Transmission
Neuropathic pain medicine
Regional anesthesia

13. Modulation
Regional Anesthesia
Opiates

14. Perception
Opiates

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

17. 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

18. Questions?