For clinicians
Neuropathic pain
LANSS scale for neuropathic pain
This 7-point questionnaire aims to determine if neuropathic mechanisms are predominant or not.
A score of 12 or higher suggests high likelihood of neuropathic pain.
SCS e-Health Tool
This tool aims to help clinicians select patients for consideration of Spinal Cord Stimulation.
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Risk assessment for drug dependence, addiction & withdrawal
Opioid risk tool
This 5-point questionnaire assesses prospective risk for opioid abuse or aberrant drug related behaviour.
A score of 0-3 is low risk, 4-7 moderate risk, and 8 or higher is considered high risk for opioid misuse.
Current opioid misuse measure
This 17-point questionnaire aims to identify opioid misuse during chronic opioid therapy.
A score of 9 or higher is suggestive of opioid misuse. xxxxxxxxxxxxxxxxxxx
Clinical opiate withdrawal scale
Thi 11-point questionnaire aims to identify assess a patient's level of opiate withdrawal.
A score of 5-12 is mild, 13-24 moderate, 25-36 moderately severe and >36 severe withdrawal.
Opioid tapering
Step 1: Establish oral morphine equivalent dose
Calculate the total daily dose for each opioid drug your patient is taking and multiply this by the relevant conversion factor to generate an oral morphine equivalent dose for that drug.
Sum the oral morphine equivalent doses for each drug together to generate their total oral morphine equivalent dose.
Step 2: Establish dose reduction timetable
For patients on a single formulation of a drug
Taper the drug dose by ~10% every fortnight starting with the morning dose.
For patients on multiple formulations of a drug
Keep the “regular” (modified-release) dose of the drug the same and taper the “when required” (immediate-release) doses of the drug.
Keep the same frequency of the “when required” (immediate-release) doses of the drug (i.e., 4 times per day), but decrease the dose each week (i.e., 15 mg to 10 mg to 5 mg etc) until it is stopped entirely.
Then taper the regular modified-release dose of the drug as described above.
Step 3: Establish a review schedule
Arrange 2-, 4- and 6-month appointments. Use the clinical opiate withdrawal scale as part of your assessment.
If your patient is progressing with the drug taper:
Do not reverse the taper; slow or pause rate as needed.
Continue taper to the lowest effective dose or drug is stopped entirely.
Once lowest effective dose is reached, extend interval between doses.
If your patient is not progressing with the drug taper
Reinforce the rationale for embarking on the taper
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