TIME TO REFER
- If a patient’s dosage has increased to ≥ 120 morphine milligram equivalents per day without substantial improvement in pain and function, seek a consult from a pain specialist.
- The CDC has published a brochure on Unintentional drug poisoning in the United States.
Consider referral to a Pain Medicine Specialist in the following situations:
- Patient with complex pain conditions or polytrauma
- Patient with significant medical comorbidities that may negatively impact opioid therapy
- Patient who is unable to tolerate increased pain or physical withdrawal symptoms arising from opioid tapering when opioid therapy is being discontinued
- Opioid induced hyperalgesia or opioid tolerance is suspected
- High dose of medication (greater than 200 mg/day morphine equivalents) provides no further improvement in function
- Patient requiring management beyond the expertise of the primary provider
- Exacerbation of an underlying psychotic disorder
- Uncontrolled, severe psychiatric disorder or those who are emotionally unstable
- Demonstration of high-risk behaviors suggestive of suicide ideation
- Psychosocial problems or comorbidities that may benefit from disease or case management
- Adverse behavioral or cognitive effects of opioid therapy
- Co-occurring trauma related conditions (mTBI, TBI, PTSD)