Exercise regularly—at least 150 minutes per week—to maintain a healthy weight and avoid liver fat accumulation.

A team-based approach, adequate consultative support, and training can begin to address some of these barriers. Patients may have individual barriers to accessing care or participating in self-management. Provide them with specific support as needed.

In some cases, underlying neurobiologic mechanisms may be overlapping, and more than one pain syndrome may be present.

“You’re still going through the motion of putting something in your mouth but without the harmful risks of smoking,” notes Dr. Solanki.

Requests for increases in medication. When patients request increases in opioid medication, perform a full reassessment of any new pain features and changes in psychosocial state. A request for additional opioids could indicate a new or worsened condition, increased tolerance, inappropriate opioid use, diversion, or opioid failure.

The experts recommend following basic pillars for healthy living to maintain a strong liver. Those include:

Substance use disorders. Obtain a substance use history in all patients with chronic pain, including the use of alcohol, illicit drugs, tobacco, and caffeine. When the etiology of pain is unclear, this history can help assess the risk for substance use disorder prior to considering treatment with opioids. Obtain a family history of substance use disorders as part of a comprehensive risk assessment. Consider use of a standardized screening tool, such as the drug abuse screening test (DAST-10) or the Michigan opioid risk assessment (MORA).

Consume a balanced diet with lots of fruits, vegetables, and whole grains to assist your body in healing. Drink a lot of water and sleep well to cope with withdrawal symptoms. Refrain from alcohol and caffeine at first, as they may induce the craving to smoke.

Understand regulations for prescribing controlled substances. Know state and federal regulations regarding controlled substance prescriptions. Key features include:

The most serious potential adverse effect is respiratory depression accompanied by symptoms of sedation and confusion. It may occur with high dose administration in opioid naïve patients. Opioids, at therapeutic doses, depress respiratory rate and tidal volume.

Fentanyl. Do not prescribe fentanyl for opioid naïve patients. Only consider prescribing fentanyl in a website few unusual situations. Possible examples include: transdermal when gut mu receptors should be avoided; in head and neck cancer when oral intake is challenging; end of life care; intravenous in a patient with intrathecal “pain pump”; buccal and sublingual for episodic and breakthrough end-stage cancer pain.

Physical therapy. If patients have functional deficits or secondary pain generators that directed therapy may improve, refer them to physical therapy.

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Treatment. In the treatment plan, address both the underlying cause and the associated acute pain. In developing a treatment plan for the acute pain, consider the degree of tissue trauma, the patient’s situation, and any unique patient factors.