This month we welcome Robert Agnello, DO, FACOFP to the Clinical Podcast to talk about pain management and opioid use disorder. We cover integrating opioid analgesics into treatment plans along with patient education, handling patient opioid use outside of prescribed use and how to talk to patients about incorporating OMT into their treatment plan.

This transcript was created with the aid of automatic speech recognition technology.

Steve Legault: Welcome to the ACOFP DO.FM Clinical Podcast, I'm your host, Stephen Legault, the Director of Knowledge, Learning and Assessment at ACOFP.

Steve Legault: On today's episode. We're going to be talking about pain management with a specific focus on opioids. Opioid use disorder affects about 2.1 million people in the United States.

Steve Legault: We're glad to be joined for this episode by Robert Agnello, DO, FACOFP.

Steve Legault: He's an Assistant Professor of Family Medicine and Pain Medicine at Campbell University.

Steve Legault: He also serves as the Faculty Senate chair at QSOM for the University and is the NBOME Clinical Family Chair.

Steve Legault: Dr. Agnello serves on the Board of the American Academy of Osteopathy, and on a number of education focused committees here at ACOFP, including the Substance Use Disorder Task Force.

Steve Legault: welcome the Podcast Dr. Nolan. Anything I missed in your background that'd be helpful.

Robert Agnello: Oh, that sounds great, Steve, I think you covered it completely.

Steve Legault: Excellent. Well, thank you. And again, glad to have you here.

Steve Legault: you know you were one of the subject matter experts who created our de-stress pain management, rethinking opioid non opioid therapy, and we cover a lot in that course, and I encourage anyone listening to go and take a look at it and complete it. It will satisfy your DEA requirements, and it's also just a great in-depth resource for anyone looking to learn more about pain management.

Steve Legault: And it's also free. So any anybody who is in healthcare is welcome to do that regardless of ACOFP membership. So we encourage everyone to participate. But I wanted to ask your thoughts on a few specific aspects we cover in the course.

Steve Legault: When looking to safely integrate opioid analgesics into treatment plans, what considerations need to be made around patient education?

Robert Agnello: Oh, thank you so much, Steve, for that question. I think it's very important that all clinicians, physicians all provider types that are involved in chronic pain management. Consider the opportunities for opioid medications, you know, regarding analgesic management.

Robert Agnello: They are an option, you know. We are recovering from some very significant limiting recommendations that were out in the round 2016, and finally was recognized and loosened up upon in 2022 by the CDC.

Robert Agnello: There are patients that benefit from analgesic medications, including opioids. And there are tools that we have to help us select. You know the correct patients that could do well on opioid medications. First, we always want to make sure we have a wonderful history physical exam, and then come up with a complete his treatment plan.

Robert Agnello: And in that treatment plan we should be very integrative about our approach, very osteopathic about our approach, considering optimizing non-pharmacologic strategies, interventional procedures, and different adjunctive pain medications. There's a whole host to choose from.

Robert Agnello: But every now and then I like to give this example. You're going to get that patient. I won't say any specific age, but they have very extensive degenerative change, maybe in their spine, their hips, their knees, their quality of life is impacted, their functional status impacted and their pain levels are high and maybe they have a little bit of renal...