Prescribe a sleeping pill for a limited period of time to determine the benefits and side effects for you

Read how psychological symptoms can accompany thyroid disorders and possible treatment and management options

Expected functional benefits of opioid use should be clear, with the continuation of opioid therapy dependent on achieving them. While improved sleep and mood are somewhat subjective and should be noted, seek more objective evidence of benefit in order to prescribe and continue opioid therapy.

Massage therapy. Consider massage therapy as part of a multimodal treatment plan. Massage therapy is manual manipulation of muscles and connective tissue to enhance physical rehabilitation and improve relaxation.

A chronic primary pain syndrome represents a disease that cannot be accounted for by another pain condition.

Many patients are aware that methadone is often associated with opioid addiction therapy. Patients may need additional counseling that methadone is an effective analgesic, not merely a treatment for opioid addiction.

Transdermal buprenorphine (Butrans and generic) is FDA-approved for treating pain. It does not require an XDEA number or training to prescribe. The transdermal form is a good alternative for patients who have developed tolerance to other opioids, had a benefit from opioid treatment but wish to escalate treatment, and are taking ≤ 80 MME/day. Start with a 5 or 10 mcg patch (changed weekly), and discontinue other opioids.

Nociceptive pain is caused by tissue damage due to injury or inflammation, rather than harm to the central or peripheral nervous system. This is the primary type of pain involved in patients with arthritis, musculoskeletal inflammatory disorders (tendinosis, bursitis), or structural spine pain.

Chronic peripheral pain disorders can be a significant driver to the sensitization of central nociceptive neurons Usually continues even after the initial injury has healed

Special safety hazard and unique advantages. Methadone is unique among opioids, with both increased safety concerns and advantages in long-term therapy. The safe use of methadone requires knowledge of its particular pharmacologic properties. Methadone’s duration of adverse effects far exceeds its analgesic half-life, making it dangerous when combined inappropriately with other controlled substances.

Fentanyl. Do not prescribe fentanyl for opioid naïve patients. Only consider prescribing fentanyl in a few unusual situations. Possible examples include: transdermal when gut mu receptors should be avoided; in head and neck cancer when oral intake is challenging; end of life care; intravenous in a patient with intrathecal “pain pump”; buccal and sublingual for episodic and breakthrough end-stage cancer pain.

Cherkaoui recommends reaching for anything that fits into the Mediterranean diet—“not only because it’s delicious, but because it’s consistently ranked as one of the healthiest diets in the world,” she says. And that applies to liver health.

Coffee is one of the most widely researched drinks for liver health, says Cherkaoui. “When consumed in moderation, it has been shown to help lower liver enzyme levels and protect liver cells thanks to its rich antioxidant profile,” she adds.

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