Pain.docx

Pain Shortcut Notes Dental Drug Check New S8 Script request Repeat S8 Script Tapering Valium Tapering Opioid Follow up Tapering S4/S8 Pain Review 6A Pain Killer Review Doctors Shopping Starting Opioid

Shortcut DENTIX DRUGCX NEWS8X RPTS8X VALTAPERX

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OPTAPERX FUPTAPERX PAINX 6AX DOCSHOPX OPIODSTARTX

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Drug Check - DRUGCX Verbal consent provided by patient to check up his drug intake history PSIS contacted, no record of patient in the Prescription Shopping list Victorian Drug and Poison Department contacted, no S8 permit issued for the patient Request for PBS claims information form filled up and signed by patient Dental pain - DENTIX Right upper gum swelling. Booked for dentist friday already Examination : Right upper gum : +ve focal swelling, -ve discharge Reason for contact: Dental Infection Actions: Advised to go to dentist soon New S8 Script request – NEWS8X Patient request script for ^ Not known to me, not known to practice Reason for use of medication: ^ Current pain scale : ^ Regular GP : ^ Proof of condition : ^ Reason for contact Script Management : PSIS called, not registered in the list S8 Permit called, doesn't have any S8 permit Other clinic/GP called, confirmed of the script Request for PBS Claims information form printed and signed by patient Advise to get transfer of medical record copy from other GP to get documentation of the condition Repeat S8 Script - RPTS8X Patient request for further script of his medication Medication taken : ^

Reason for medication intake : ^ Noted last script done on : ^ lapses on ^ Been on the medication since ^ No S8 permit in the system Reason for contact : Script Management : Advise to combine pain medication with NSAID and Panadol Education regarding tolerance and dependence about the medication provided

Tapering Valium – VALTAPERX Agreed to taper valium dosage Reasons for taper : ^ Current use : ^ Other substance use : ^ Alcohol : ^ Smoking : ^ Comorbidities : ^ Social issues : ^ Work : ^ Lives with : ^ Protective factors : ^ Does not have regular sex partners Does not claim to have suicidal thoughts. No perceptual disturbances No harmful thought nor act Examination : BP : ^ HR : ^ Wt : ^ Ht : ^ BMI : ^ Eyes : pupils isokor 4-4 mm equally reactive to lights Arms : -ve needle tracks Hands : -ve nicotine stain, -ve clubbing, -ve tremors Management : Time frame for taper : ^ Goal of taper : ^ Agreed frequency of dose reduction : ^ Agreed only to get prescription from me Agreed only to get medication from one Pharmacy : ^ on weekly basis Scheduled appointment for regular review Expected effect of taper discussed and explained. Consent for urine random drug screen provided by patient Possible consequences of not following tapering agreement discussed Danger of addiction and complications explained to patient Action : PSIS contacted, no record of patient in the Prescription Shopping list Victorian Drug and Poison Department contacted, no S8 permit issued for the patient

Request for PBS claims information form filled up and signed by patient Valium Tapering Sheet agreement printed and signed by patient and me. Letter for weekly dispensing medication to dedicated Pharmacy of Choice printed Review in ^ Note : 10% reduction of daily dose valium every 1-2 weeks Reason for taper : Misuse, exhibit abberant behaviour No desired pain relieve Intolerable side effect

Opioid Taper - OPTAPERX Agreed to taper opioid dosage Reasons for taper : ^ Current use : ^ Other substance use : ^ Alcohol : ^ Smoking : ^ Comorbidities : ^ Social issues : ^ Work : ^ Lives with : ^ Protective factors : ^ Does not have regular sex partners Does not claim to have suicidal thoughts. No perceptual disturbances No harmful thought nor act Examination : BP : ^ HR : ^ Wt : ^ Ht : ^ BMI : ^ Eyes : pupils isokor 4-4 mm equally reactive to lights Arms : -ve needle tracks Hands : -ve nicotine stain, -ve clubbing, -ve tremors Management : Time frame for taper : ^ Goal of taper : ^ Agreed frequency of dose reduction : ^ Agreed only to get prescription from me Agreed only to get medication from one Pharmacy : ^ on weekly basis Scheduled appointment for regular review Expected effect of taper discussed and explained. Consent for urine random drug screen provided by patient Possible consequences of not following tapering agreement discussed Danger of addiction and complications explained to patient Action : PSIS contacted, no record of patient in the Prescription Shopping list

Victorian Drug and Poison Department contacted, no S8 permit issued for the patient Request for PBS claims information form filled up and signed by patient Opioid Tapering Sheet agreement printed and signed by patient and me. Letter for weekly dispensing medication to dedicated Pharmacy of Choice printed Review in ^ Note : 10% reduction of daily dose opioid every 1-2 weeks Reason for taper : Misuse, exhibit abberant behaviour No desired pain relieve Intolerable side effect Follow up tapering S4/S8 - FUPTAPERX

Follow up review consultation during tapering of ^ Current use ^ Current symptoms : ^ Denies other substance use Alcohol : ^ Smoking : ^ No perceptual disturbances No suicidal thought, no harmful thought nor act Examination : Pupils : isokor, 4-4mm equally reactive to light BP : ^ HR : ^ , regular Arms : -ve needle tracks Fingers : -ve clubbing, -ve tremor, -ve nicotine stain Skin : -ve diaphoresis Action : Request for PBS claims information form filled up and signed by patient Urine drug screen ordered Clinical Opiate Withdrawal Scale (COWS) = ^

Pain Review - PAINX Pain feels like ^ Current meds : ^ Level of opioid : ^mg MED/day Type of pain : nociceptive, neuropathic with psychological contribution Activity : able to sit, standing, walking, perform ADL activities Analgesia : average pain scale ^/10, worst pain ^/10, pain killer relieves ^% of pain Adverse effect : no nausea, no dizziness, no constipation, no drowsiness Abberant behaviours : has been taking meds as scheduled, has not been drinking alcohol nor taking any other substance, no report of lost of prescription, has not escalate the doseage Mood: no report of anxiety nor depression symptoms

Beliefs and attudes about pain : ^ Behaviours : ^ Work : ^ Driving : ^ Sleep : ^ 6A Review Pain killer – 6AX Analgesia : Pain scale : ^/10 before meds, ^/10 after meds Adverse effects : none complained Aberrrant behaviours : none Activity : walking and light duties Affect : slighly anxious due to pain Noted last script done on ^ with ^ tablets, lapses on ^ Adherence to opioid contract with single prescriber and single designated pharmacy Progress with functional improvement : ^ Pain Diary noted

Signs of Doctors Shopping – DOCSHOPX New patient, recently moved to area Walk-in, no appointment Last minute presentation at the end of the day Very knowledgeable about their condition and drugs requested, often requests drug by name Previous doctor unavailable to corroborate story Multiple ‘allergis’ or drug reactions to non-addictive medications Carries letter from other doctors confirming treatment which appear to have dubious rationale Exaggerated appearance of pain Inconsistent behaviour with pain or other symptoms including variation between different movement Increasing behaviour when aware of being observed

Opioid Start – OPIOID1X

Opiod treatment agreement explained, signed and copied to patient Note : Trial for 4 weeks, after exploring other non-pharmacological and non-opioid strategies Not to commence with another drug Start low Monitor every 1-2 weeks, with family member present Advise on laxative when constipated Aberrant drug-related behaviour checked