Treatment Algorithm Criteria for Use of Controlled release Oxycodone For by tracy12

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									                                      Treatment Algorithm
                       Criteria for Use of Controlled-release Oxycodone

                         For further details, see Criteria for Use of Controlled-release Oxycodone CR;
                              available at: http://www.vapbm.org or http://vaww.pbm.med.va.gov


           Patient with moderate to severe chronic pain
             requiring continuous, around-the-clock
            analgesia for an extended period of time.




        Was there an adequate response to non-opioid                    Yes
            therapy, or does the patient have any                                               Continue non-opioid therapy.
             contraindications to opioid therapy?


                                        No

       Does patient require further diagnostic evaluation,                Yes           Consider consultation with a pain specialist,
      advanced treatment plan, specific treatment modality,                           particularly for patients with chronic nonmalignant
         intervention for aberrant social or drug-related                               pain. See When to refer to a pain specialist.1
      behavior, or assistance with work or disability issues?


                                      No
       Assess patient’s ability to take oral solid medication.



                                                                        Yes           Use methadone oral solution (see Methadone
     Is patient unable to swallow or does patient require
         tablets to be crushed before administration?                                   Dosing Recommendations),2 or fentanyl TTS.

                                    No

                   Start morphine CR / SR
                     and titrate to effect.


                                                                  Yes
          Are significant adverse effects absent or                       Continue morphine and
                        manageable?                                        document follow-up.

                                   No

                 Switch to methadone2 and                                                                  CR = Controlled release
                      titrate to effect.                                                                   SR = Sustained release
                                                                                                           TTS = Transdermal therapeutic system
                                                                                                           1
                                                                                                             Lesson 6 of Opioids in the Management
                                                                                                             of Acute and Chronic Pain; available at:
          Are significant adverse effects absent or              Yes                                         http://vaww.sites.lrn.va.gov/pain/opioids/.
                                                                           Continue methadone
                        manageable?                                                                        2
                                                                                                             Ideally, methadone should be initiated by
                                                                         and document follow-up.
                                                                                                             or in consultation with a practitioner who
                                   No                                                                        has knowledge of titrating this agent. In
                                                                                                             situations where there is no practitioner
         Switch to either oxycodone CR or fentanyl                                                           or consultant with experience in using
                  TTS and titrate to effect.                                                                 methadone for chronic pain, another
                                                                                                             long-duration opioid may be used until
                                                                                                             such consultation can be obtained. See
                                                                                                             Methadone Dosing Recommendations;
          Are significant adverse effects absent or               Yes                                        available at: http://www.vapbm.org or
                                                                          Continue current opioid
                        manageable?                                      and document follow-up.             http://vaww.pbm.med.va.gov.

                                   No                                                                      Prepared by F. Goodman, PharmD, BCPS;
                                                                                                           W. N. Jones, BSc, MSc; P. Glassman,
       Switch to the alternative opioid (fentanyl TTS or                                                   MBBS, MSc
            oxycodone CR) and titrate to effect.


          Are significant adverse effects absent or              Yes
                                                                          Continue current opioid
                        manageable?                                      and document follow-up.

                                   No

                   Consult pain specialist.

Algorithm Oxycodone CR CFU Final (Rev 20Aug03).doc                              Updated versions may be found at www.vapbm.org

								
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