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Here's how it works: "Spironolactone is an androgen hormone receptor blocker," Murphy-Rose explains. "Androgen hormones circulate in the blood and exert their effect after linking with a hormone receptor. Spironolactone blocks that receptor, preventing the hormone from being able to link and, therefore, blocking the 'activation.
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Disposal. Advise patients how to dispose of unused opioid medications safely and securely. Many options for disposal exist. Having unneeded opioids in the home is a vulnerability for patients and their families.
When treatment goals have been met or when progress plateaus, formal therapy may be discontinued, but advise patients to continue with a program of independent daily home exercise.
Pain is subjective! Pain scales are used to assess a patient's pain and response to pain management over time. They cannot be used to compare pain intensity between patients.
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Fentanyl testing. Fentanyl is a synthetic opioid and its metabolites are often missed in urine drug screens. GC/MS or LCMS are relatively good at detecting it and are reasonable confirmatory tests.
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.
Pain quality. A detailed account of pain quality may help identify potential types/sources of pain. Musculoskeletal or myofascial pain is often described as aching, throbbing or tight.
A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
Adhere to recommended guidelines and carefully document medical decision-making when prescribing opioids.
While multidisciplinary subspecialty pain services are increasingly available, primary care clinicians will continue to manage the majority of patients with chronic pain. This care can be challenging and resource-intensive, and many clinicians are reluctant or ill-equipped to provide it.