When to Use Opioids and When to Consider Other Pain Management Options

Jeffrey Fudin, PharmD, DAIPM, FASHP, FFSMB, discusses best uses for opioids, and when to use other pain medications. This video was filmed at the ASHP (American Society of Health-System Pharmacists) 54th Midyear Clinical Meeting & Exhibition in Las Vegas, Nevada.

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Jeffrey Fudin, PharmD, DAIPM, FASHP, FFSMB: Opioids are effective in most acute pain. I think that they’re probably least effective for neuropathic-type pains. I don’t consider myself an opioid zealot; I think that people should try nonopioids first, there’s no question about that. But there are also some patients who respond well to opioids, and who do well on them for extended periods of time. I think that if a patient has some kind of inflammatory pain or inflammatory tissue or connective tissue, I think it’s clear that NSAIDs are probably the top choice as long as there’s no medical contraindications. If we can give occasional opioids, and use less NSAIDs in patients who are at potential risk—for instance, those patients who have diabetes, and their SAM creatine is kind of on the border—you don’t really want to expose them to NSAIDs. So if you can give them the occasional opioid, and keep them off of chronic NSAIDs, that might be good.