NR565 Week 3 Discussion Introduction and Medication Regimen

Introduction and Medication Regimen

Geraldine Marrec, my assigned client, is a 60-year-old woman who takes OxyContin 20 mg orally twice a day to control her chronic lower back pain that is a result of an old injury. OxyContin is an opioid medicine that is generally prescribed to control severe chronic pain in people who are already used to opioids (Cohen & Preuss, 2023). Even though chronic back pain is a common problem, the opioid administration of high-dose, prolonged-release opioids should be done after considering the guidelines from research.

Calculation of Daily Morphine Milligram Equivalents (MME)

To see if her regimen of opioids was safe, I calculated her daily MME as follows:

• Oxycodone ER 20 mg BID = 40 mg/day
• The MME conversion factor for oral oxycodone is 1.5.

40 mg (total daily oxycodone) x 1.5 = 60 MME/day

Evaluation of the MME Threshold

According to the study by Dowell et al. (2022), it is recommended that clinicians should be extra cautious if a patient’s opioid dose is 50MME/day or more. This is when the chances of an overdose or opioid use disorder are so much higher. When the children reach or exceed this dosage, it is important to rethink and consider alternative therapies. Geraldine is taking 60 MME a day, which is above the recommended caution level. It’s not really high, but it is something that needs to be paid attention to because there is a possibility of having serious issues in people who are above 65 when taking chronic opioids.

Additional Considerations

There are some important clinical issues to consider with Geraldine. Though certain individuals with consistent low back pain may need opioids as a treatment, the CDC emphasises the use of non-drug and non-medication treatments if possible. Possible treatment includes physical therapy, exercise, cognitive behavioral therapy (CBT), nonsteroidal anti-inflammatory drugs (NSAIDs), duloxetine, and other antidepressants. Since Geraldine has an extended-release medication (oxycodone) with an MME that is over 50 on a day-to-day basis, it would be better to try other supportive treatments. The use of a pain specialist is aimed at creating a personalized treatment plan, and screening for OUD can be performed with a valid tool such as the Opioid Risk Tool (ORT). If it is suitable, then you can try lessening the dose of her opioids or replacing them with safer drugs.

Appropriateness of the Current Regimen

Dowell et al (2022) say that opioids ultimately should not be the treatment of choice for chronic pain. When opioids are utilized, it is best to combine non-opioid and non-pharmacologic methods alongside opioid medications to make treatment safer and more effective. The CDC does not recommend opioids for long-term use, especially standard formulations of opioids, unless it is for patients who are already opioid-tolerant. For Geraldine, due to her age, chronic condition, and as well as the MME level, perhaps it would be better to convert her to an immediate-release oxycodone or other short-acting opioid if opioid therapy is necessary.

In addition, the administration of patients with the drug duloxetine, which is a non-opioid drug that helps to treat chronic musculoskeletal pain, could help them further. Moving activities and physical therapy activities can help in cases of chronic low back pain and must be applied. If her opioid therapy is to be decreased, it should be done in small steps, being very aware to prevent withdrawal and ensure that her pain can still be controlled.

Related discussion for your help: NR 565 Week 2