Patients taking opioids chronically (including tramadol, which has dual mechanisms of action) will develop psyiological adaptation and live "dose to dose." Althought this can be necessary, they will suffer withdrawal symptoms if a dose is missed or late

anxiety, tachycardia, shakiness

(basically being an asshole)

All patients, including addicts, become "physiologically" adapted to opioids. Addiction is quite different and involves a strong desire or sense of compulsion to take the drug and difficulties in controlling drug - seeking behavior

This when the patient is quite anxious for the drug and may have used up the medication too quickly - which will appear as addiction, but is actually due to poorly treated pain

If the drug being taken too quickly is a hydrocodone/acetaminophen combo such as Vicodin, over-use will put the patient at risk of?

usually develops over time to opioids and necessitates a higher dose for the same analgesic response.

NO! No celing effect. It is not unheard of to see patients on very high opioid dose due to tolerance.

Break-through pain (BTP) is acute pain that "breaks through" the control provided by a long-acting opioid.

With a fast relief afent - such as an injection or fentanyl sublingual (such as Fentora).

In practice, BTP is often treated with generic hydrocodone/acetaminophen.

If many doses of BTP medication are needed, then the baselilne opioid dose should be increased. Baseline opioid should be dispensed with a BtP medication, and constipation prophylaxis

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Adjuvant pain medication can reduce the amount of regular pain medicine required. Adjuvants are normally of what class of medication?