Compass OPSS Microlearning

This week's case is about a patient, Rick, a 36-year-old male with chronic back and neck pain. He works as a computer programmer, logging long hours in his office chair, which doubles as his gaming chair. He says that if he twists his neck or back the wrong direction, he experiences severe pains across his entire low back and up into his neck. He manages his pain with hydrocodone/apap, 4 tablets a day, along with daily cannabis use, which he says is helpful for pain, anxiety, and sleep. Lately his pain has been worse and he’s increased his dose to 6 tablets/day, so has now run out early and is requesting a refill.

This week's case is about a patient, Mary a 50 year old who presents with long standing knee pain for Xray proven moderate osteoarthritis. Mary is interested in trialing a steroid knee injection for her osteoarthritis and has trialed other interventions including OTC medications and lidocaine patches without significant relief. As her clinician you believe that prior to trialing knee injections, physical therapy, lifestyle changes and diclofenac cream may be important to trial, given her young age and potential harms.

This week's case is about a patient, Danielle, a 54-year-old female, with chronic lumbar radiculopathy taking long-term morphine. Her pain is manageable, but she occasionally requests early refills and denies non-medical drug use. Her urine drug screen is consistent with prescribed opioids only.

Mary is a 67-year-old woman with chronic pain, diabetic neuropathy, and depression, anxiety, and insomnia. She uses opioids, benzodiazepines, and other medications, and occasionally drinks alcohol to help with sleep.

Mary is a 67-year-old woman with chronic pain, diabetic neuropathy, and depression, anxiety, and insomnia. She uses opioids, benzodiazepines, and other medications, and occasionally drinks alcohol to help with sleep.

Mary is a 67-year-old woman with chronic pain, diabetic neuropathy, and depression, anxiety, and insomnia. She uses opioids, benzodiazepines, and other medications, and occasionally drinks alcohol to help with sleep.

This week’s case explores a 35-year-old female with a history of chronic insomnia, anxiety, ADHD, and bipolar disorder. Her current regimen includes PRN alprazolam and twice-daily dextroamphetamine/amphetamine 30mg.

This week’s case explores a 64 year old male with bilateral above-knee amputations and chronic pain transitioned to this practice in 2018 while on a high-dose regimen exceeding 400 MME. His treatment included OxyContin, oxycodone IR, and alprazolam.

This week’s case explores a 54 year old female with chronic pain transferring to a new practice in December of 2021 after her provider lost his license. She had been on methadone for well over a decade and had already been tapered down to 50mg per day (235 MME) in divided doses. She came in wanting to transition to buprenorphine.

This week's case is Kent, a 72-year-old male, on long-term opioid therapy for Persistent Spinal Pain Syndrome- Type 2 (formerly called failed back surgery syndrome). Over the last 18 months, you have been working collaboratively to slowly wean him down from a prior regimen of MS Contin 30 mg BID and hydrocodone plus acetaminophen, 5/325 mg, 8 tablets/day. (Total MME of this regimen: 100). He is now only taking the hydrocodone/acetaminophen, 1 tablet 3 times daily. He has tried to go lower, but every time he tries to decrease the dose or the frequency, he experiences diffuse body aches, runny nose, difficulty sleeping, and a very depressed mood. Nevertheless, he is highly motivated to completely stop opioid therapy, as he does not want to be tethered to a medication he no longer perceives as helpful.

This week’s case explores a 70-year-old patient with a remote history of heroin use disorder who had been stable for years on hydrocodone as part of a multimodal chronic pain treatment plan. After experiencing a sudden and severe worsening of pain, sleep disruption, and emotional distress, opioid-induced hyperalgesia became a suspected contributor. This case highlights the importance of trauma-informed care, careful reassessment of long-term opioid therapy, and the clinical decision-making involved in transitioning to buprenorphine while maintaining patient trust and safety.

This week's case is about Claire, a 62-year-old woman with osteoarthritis and chronic low back pain who takes hydromorphone ER 8 mg twice daily and gabapentin. This equates to approximately 80 MME/day. She occasionally uses a sleeping pill (temazepam) at night. She lives with her husband, who worries about accidental overdose. They have heard about naloxone but think it is only for people who misuse drugs.

Part two: This week's case is about a patient, Tania, a 37- year-old female with chronic pain from lupus vasculitis and peripheral neuropathy. She has episodes of severe abdominal pain and describes intermittent electrical sensations in her legs and feet. Medications include hydroxychloroquine and azathioprine for lupus, duloxetine and bupropion for depression, and meloxicam, gabapentin, and lidocaine patches for pain. For severe pain she uses hydrocodone/acetaminophen 10 mg/325 mg, 1-2 tablets every 4-6 hours, and is prescribed 84 tablets every 28 days. She fills this medication on time every 4 weeks and has never requested early refills.

This week's case is about a patient, Tania, a 37- year-old female with chronic pain from lupus vasculitis and peripheral neuropathy. She has episodes of severe abdominal pain and describes intermittent electrical sensations in her legs and feet. Medications include hydroxychloroquine and azathioprine for lupus, duloxetine and bupropion for depression, and meloxicam, gabapentin, and lidocaine patches for pain. For severe pain she uses hydrocodone/acetaminophen 10 mg/325 mg, 1-2 tablets every 4-6 hours, and is prescribed 84 tablets every 28 days. She fills this medication on time every 4 weeks and has never requested early refills.

his week’s case is about Bob is a 50-year-old man with chronic low back pain who has been taking oxycodone ER 20 mg three times daily for three years. He recently asked for early refills, reports lost prescriptions twice, and his urine drug screen shows fentanyl and benzodiazepines. The state prescription drug monitoring program indicates prescriptions from multiple providers. This constellation of behaviors—unapproved dose increases, obtaining opioids from multiple prescribers, and concurrent non-medical drug use may signal increased risk for OUD. Bob insists he is taking opioids for pain but admits buying additional pills to “avoid getting sick.”

This week’s case is about David, who is a 65- year-old male with chronic pain from severe degenerative osteoarthritis of the cervical and lumbar spine. He takes extended-release oxycodone 20 mg twice a day, supplemented with immediate-release oxycodone 10 mg up to 4 times daily. The regimen has been unchanged for 8 years. Over that time, he has occasionally run out of his immediate release prescription early, which he has attributed to acute exacerbations of severe pain. He rates his pain as moderate on most days, and has variable function, is able to go on longer walks and go shopping on good days while relegated to staying at home during severe episodes. He returns for his scheduled 3-month follow-up appointment.

This week’s case is about Andrea, a 67-year-old woman with anxiety and insomnia who has been taking high-dose clonazepam for years, also takes citalopram and occasionally drinks alcohol, and is seeking support to safely reduce her medication, highlighting the importance of careful assessment, shared decision-making, and a structured taper.

This week's case is about a patient, John, currently prescribed OxyContin 40 mg every 12 hours and hydrocodone/acetaminophen 10-325 mg, two tablets three times daily, totaling approximately 180 MMEs per day. The patient is being considered for a transition to buprenorphine for chronic pain management using a standard rotation approach. We'll walk through the clinical reasoning, dosing strategy, and the transition protocol.

This week’s case is about Edward, who is a 45 y/o male patient experiencing chronic abdominal pain for over five years. The patient has had multiple CT scans, endoscopies, and other procedures without clear etiology of pain – his GI doctor has diagnosed him with irritable bowel syndrome and painful, daily chronic abdominal migraines. The patient has tried multiple medications – and is currently on a fentanyl patch and oxycodone for breakthrough pain. On exam, the patient has TTP out of proportion and complains of poor function and pain management. He also complains of significant anxiety and depression due to his pain. In today’s microlearning, we are going to discuss the concept of nociplastic pain, how to make the diagnosis, and how treatment of these pain types differs from other types of pain management.

This week’s case features Greg, a 42-year-old male patient, who while lifting a box at work developed sudden lumbar back pain, which is non-radiating but debilitating. The patient was seen in the ER, where he was diagnosed with a back strain, and provided with prescriptions for cyclobenzaprine and lidocaine patches. In addition, the patient has been using over-the-counter NSAIDS and Acetaminophen – with mild relief. He sees you in clinic, concerned about his continued pain and asking what else can be done. On exam, the patient has areas that are exquisitely TTP at his left SI joint and left perilumbar region around L4-5. This is the perfect patient to possibly receive in office trigger point injections, an effective and safe intervention – and the subject of today’s microlearning.