GP Vivas · pain-management
Chronic non-cancer pain and opioid stewardship — structured viva
Structured oral on opioid stewardship: defending non-opioid first-line care with SPACE, quantified risks above 50 MME and with benzodiazepines, safe tapering versus abrupt cessation harms, and buprenorphine transitions.
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Study tools
Target exams
RACGP CCEFRACGP oralsMRCGP SCA
Prompt
The examiner opens: 'The patient says nothing else works and demands an increase. Talk me through your next five minutes.' The viva branches through assessment, risks, tapering, OUD and naloxone.
Stem
You are the GP. A patient on long-term opioids demands escalation. [1]
References4ShowHide
- [1]Krebs EE, Gravely A, Nugent S, et al. Effect of Opioid vs Nonopioid Medications on Pain-Related Function (SPACE) JAMA, 2018.PMID 29509867
- [2]Sun EC, Dixit A, Humphreys K, et al. Association between concurrent use of prescription opioids and benzodiazepines and overdose BMJ, 2017.PMID 28292769
- [3]Fenton JJ, Magnan E, Tseregounis IE, et al. Long-term Risk of Overdose or Mental Health Crisis After Opioid Dose Tapering JAMA Netw Open, 2022.PMID 35696163
- [4]Webster LR, Webster RM Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool Pain Med, 2005.PMID 16336480