Diet. Recommend a Mediterranean pattern of eating to lower inflammation and maintain a healthy weight. Although inflammation is part of the nociceptive process, research into the role of diet in modifying inflammation is in its early stages. The Mediterranean pattern of eating, characterized by a high intake of fruits, vegetables, whole grains and an emphasis on omega-3 fatty acids, has been established as a dietary pattern that lowers inflammation especially in the setting of cardiovascular disease.

Regular exercise. Start small, gradually increase to at least 150 minutes/week at moderate intensity. Adjust this goal to the individual’s status.

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Another option for opioid tolerant patients is buprenorphine, transdermal or buccal. Compared to full agonist therapy, buprenorphine has no ceiling on respiratory depression, generally provides good analgesia, gives consistent serum plasma levels, and does not lead to hyperalgesia or tolerance with the same frequency.

Benzodiazepines – Generally do not initiate opioid therapy in patients routinely using benzodiazepine therapy. Both increase sedation and suppress breathing.

Sublingual buprenorphine (Suboxone, Subutex and generic) may be prescribed off-label for pain with a regular DEA number. Sublingual buprenorphine has an evolving role, particularly in patients already treated with high dose opioid therapy who continue to complain of uncontrolled pain, and who may or may not have opioid use disorder.

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Transdermal buprenorphine takes approximately 12-24 hours to reach a steady state, during which a short-acting oral opioid may be needed for one-half to a full day, and then should be discontinued.

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But there are times when the addition of prescription sleeping pills may help you get some much-needed rest.

Patients should understand that reducing pain intensity will not be the sole focus of evaluation or management. This requires a shift in expectations for many patients accustomed to an acute pain management model.

Urine drug testing. Obtain a urine drug screen (UDS) for all patients on chronic opioid therapy at least once per year, and any time there is a concern for inappropriate use, use of other substances, or diversion.99

The feeling of pain and the emotional, physical, and social impact of pain are interrelated, but can be separated for treatment purposes. Therefore, problems with functioning related to pain can be addressed even if pain is not targeted directly and remains unchanged.

A clear plan raises your chances of success. One of the most effective methods is going cold turkey, which means quitting abruptly. While it can be challenging, studies suggest it works better than a gradual reduction. Choose a day, prepare yourself mentally, and make that commitment.