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Opioids Use in Pain Management

Opioids education:

Our plan in Trinity Pain Management, and medical weight loss for treatment of pain is primarily starting with non-opioids management like: Non narcotic medications, Topical treatment, Exercises, Cold & heat, PT, Chiropractor, Massage, Acupuncture, TENS units, Weight loss, Diet & nutrition, Interventional procedures.

If pain is sever or moderate and did not respond adequately to the above measures, we might prescribe opioids.

Opioids Prescription Guidelines:

Trinity Pain Management, and medical weight loss abides with CDC Guideline for Prescribing controlled substances for Chronic Pain and weight loss Aug 22,2016: We start opioids at low and up the dose slowly if needed. Tapering opioids down in near future is always in the treatment plan. We would generally AVOID increasing narcotic dosage to more than 90 MME (Milligram Morphine Equivalents) / day

© 2013 American Academy of Pain Medicine - Approved February 2013  Prescription of Opioids for Chronic, Intractable Pain Is Appropriate when The Treatment Plan Is Reasonably Designed To The Risks Of Addiction, Tolerance, Diversion, Respiratory Depression And Other Adverse Effects.


The following points are addressed carefully when we at Trinity Pain Management, and medical weight loss start a patient on controlled substances:

Opioids and controlled substances use in Elderly patients, effects on Males, and on Females

Short Acting Opioids. Long Acting Opioids. Opioids naive patient. Long term use of Opioids. 

Patient's Risk stratification for controlled substances use, and overdose.

Side Effects of controlled substances.

Addiction, Dependence/Withdrawal Syndrome, and Tolerance.

Co-morbidities and the use of Opioids.

Contraindications of opioid analgesics. 

Urine Drug Testing, and Pharmacy Drug Monitoring Program

Long term use of Opioids in chronic pain:

The long-term use of opioids over many years appears to be safe and effective for selected patients with intractable CNCP (Chronic Non Cancer Pain)for whom all other treatments have failed. Generally, pain relief and the tolerability of adverse effects were reasonably good, considering the intractable nature of the CNCP in these patients. Few patients returned to work or had complete relief, but most reported improvement in ADL.  Tolerance to the analgesic effect was not a major concern with long- and short-acting opioids over time. Tolerance to constipation may occur, but after a longer time than other opioid adverse effects. Pain Research and  Manag. 2010 Jul-Aug; 15(4): 213–217.   

Trinity Pain Management and medical weight loss Goal is to treat pain underlying cause to improve the patient's Quality of life, Functional Capacity, postural deficits, weakness, and overuse. If treatment attempts failed to treat the underlying cause of pain, we might use opioids as an adjunct to the treatment plan. Like chronic conditions of Hypertension, Arthritis, Diabetes, or Hypercholestrolemia requiring long term treatment, pain also can be chronic and may require long term treatment with opioids. This can last more than 7 days. In such conditions patient is closely  monitored for improvements and opioids side effects. Meanwhile, we try to minimize the dose of opioids to less than MME of 90 mg/24hr. Our plan is always to wean off opioids completely once patient achieves stable improvements without narcotics. 


Trinity Pain Management, and medical weight loss has been serving Port Richey, New Port Richey, Trinity, Tarpon Springs, Pasco, and Pinellas since 1999


Nader Said, MD Nader Said, MD, is a board-certified physician who specializes in pain management, anesthesiology, and bariatric medicine. Dr. Said, who has more than 20 years of professional experience, owns and operates Trinity Health Center in New Port Richey, Florida, where he has lived since 1999.

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