3. Which of the following is the best treatment for patients who received opioid analgesics for a legitimate pain complaint and who went on to have an opioid use disorder?
C. Cognitive-behavioral therapy (CBT)
D. None of the above
Discussion: Although there have been calls for increased treatment ofpatients with opioid use disorder with methadone and buprenorphine, there is little evidence that these medications or CBT are beneficial for patients for whom opioids were prescribed for legitimate pain complaints.2
Answer: D. None of the above
4. True or false? Urine drug testing (UDT) is sufficient to identify those patients who take opioids prescribed for legitimate pain complaints and who have or who are at risk for opioid use disorder.
Discussion: Although UDT is widely recommended for all patients who take prescription opioids, there is little evidence that it has value in identifying patients in whom an opioid use disorder will develop.2 At best it can identify patients whose opioids have been discontinued, but who continue to use one of these drugs or who use medications different from those prescribed by the physician.
Answer: B. False
1. Compton WM, Jones CM, Baldwin GT. Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med. 2016;374:154-163.
2. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain: United States, 2016. MMWR. 2016;65:1-150.
3. Sullivan MD, Ballantyne JC. Must we reduce pain intensity to treat chronic pain? Pain. 2016;157:65-69.
4. Gilron I, Tu D, Holden RR, et al. Combination of morphine with nortriptyline for neuropathic pain. Pain. 2015;156:1440-1448.
5. Smith TJ, Saiki CB. Cancer pain management. Mayo Clin Proc. 2015;90:1428-1439.