Clroilc Pain Control: Wlatfs Adequate-and Appropriate? 10 Questions Physicians Often Ask

摘要

The results of diagnostic tests do not correlate well with the presence and severity of pain. To avoid missing a serious underlying condition, look for "red flags," such as unexplained weight loss or acute bladder or bowel function changes in a patient with low back pain. Nonopiold medications can be more effective than oplolds for certain types of pain (for example, antidepressants or anticon-vulsants for neuropathic pain and fibrsmyalgia). When NSAIDs are indicated, the nonacetylated NSAIDs or celecoxib may be better choices for patients who are at risk for GI problems or who are receiving anticoagulants. The tricyclk antidepressants and other serotonin-norepinephrine reup-take inhibitors are more effective as analgesics than selective serotonin reupfake inhibitors. When opioids are Indicated, start with what are generally classified as the less potent agents (codeine, oxycodone, hydrocodone, oxymorphone) and then progress to stronger ones (hydrsmorphone, fentanyl, methadone, morphine) if needed.