North Carolina medical journal
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Health care providers often face the challenge of deciding when and how to prescribe opioids for patients with chronic noncancer pain. In patients for whom opioid treatment is appropriate, the risks can be mitigated by an initial risk assessment, informed consent, regular monitoring, and treatment within a medical home.
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Patients with advanced degenerative joint disease of the hip or knee often experience chronic pain that can be effectively treated with joint replacement surgery. Joint replacement surgery remains beneficial even if patients have concurrent extrinsic pain or they are taking narcotics long term, although these groups are at higher risk for persistent pain and for dissatisfaction with their surgical results.
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The rate of unintentional deaths from opioid poisoning has reached epidemic proportions. One model of successful intervention is Project Lazarus, an integrated-care pilot program in Wilkes County, North Carolina. Community Care of North Carolina, supported by a grant of $1.3 million from the Kate B. Reynolds Charitable Trust and matching funds of $1.3 million from the North Carolina Office of Rural Health and Community Care, is now expanding the Project Lazarus approach statewide.
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This issue of the NCMJ addresses the problem of chronic pain in North Carolina; its diagnosis and management in primary and specialty care; and the need to balance efficacy and safety when prescribing opioid medications, as these drugs are associated with significant potential for misuse and abuse. The commentaries in this issue not only address the use of opioids for the management of chronic pain but also explore various alternatives, including medical marijuana, epidural and other injections, surgery, acupuncture, and other integrative therapies. Articles in this issue also describe the management of chronic pain in palliative care, the ways in which mental health affects pain, and the unintended consequences of chronic pain management. Finally, this issue describes several initiatives across the state that are addressing the epidemic of prescription drug abuse; these initiatives are effecting systematic changes in clinical practice to more effectively manage chronic pain, protect patients, and minimize the negative impact of prescription drug abuse on communities.