01Approach to the Critical Patient/attcp40

Immediate priorities

›Red flag exclusion before chronic pain label applied

›New neurologic deficit

›Progressive weakness or sensory loss

›Gait instability or falls

›Cauda equina syndrome

›Urinary retention or incontinence

›Saddle anesthesia

›Bilateral lower limb weakness

›Spinal infection

›Fever with focal spinal tenderness

›IV drug use or immunosuppression history

›Malignancy concern

›Known cancer history with new pain pattern

›Unintentional weight loss

›Vascular emergency

›Tearing or pulsating pain with hemodynamic instability

›Pulsatile abdominal mass

Monitoring and targets

›Hemodynamic and pain monitoring

›Vital signs for pain-mediated tachycardia and hypertension

›Fever suggesting infectious etiology

›Hypotension suggesting sepsis or medication effect

›Neurologic reassessment

›Motor strength serial check if deficit present

›Mental status and affect monitoring

›Pain score trajectory

›NRS or VAS at baseline and after each intervention

02History/hx91

Exacerbation characterization

›Pain description compared to baseline

›Onset timing and acuity

›Sudden versus gradual worsening

›Duration since change from usual

›Location

›Same site as established chronic pain

›New or expanded distribution

›Quality

›Nociceptive character: aching, pressure, throbbing

›Neuropathic character: burning, shooting, electric

›Nociplastic character: widespread, diffuse, without clear structural correlate

›Severity on NRS

›Current score versus typical baseline score

›Worst score in past 24 hours

›Functional impact

›ADL limitation

›Mobility and ambulation change

›Work or role function disruption

Triggers and context

›Precipitating factors

›Physical triggers

›Overexertion or new activity

›Recent trauma or fall

›Procedure or injection

›Psychosocial triggers

›Significant life stressor

›Sleep disruption

›Mood episode

›Medication factors

›Non-adherence or missed doses

›Recent medication change or taper

›NSAID or analgesic overuse pattern

›Environmental and biological triggers

›Weather or barometric change

›Intercurrent illness or infection

Alarm features in history

›Red flag symptom screen

›Neurologic symptoms

›Limb weakness or heaviness

›Numbness or tingling in dermatomal distribution

›Bowel or bladder dysfunction

›Saddle area numbness

›Systemic symptoms

›Fever or rigors

›Night sweats

›Unexplained weight loss

›Cancer history

›Prior malignancy type and treatment

›Current oncology follow-up status

›Suicidal ideation

›Chronic pain associated with higher suicide rates

›Screen at every exacerbation visit

Current pain regimen and history

›Medication history

›All prescribed analgesics with doses and frequency

›Opioids: agent, dose in morphine equivalents, prescriber

›Gabapentinoids: gabapentin or pregabalin dose

›Antidepressants for pain: duloxetine, amitriptyline

›OTC analgesic use

›NSAID type and frequency

›Acetaminophen dose per day

›Recent adherence and effectiveness

›Perceived change in medication efficacy

›PDMP verification of controlled substance fills

›Prior interventional procedures

›Injections, nerve blocks, or spinal cord stimulator

Risk factors

›Biological risk factors

›Female sex

›Higher prevalence of fibromyalgia and nociplastic pain

›Age older than 50 years

›Osteoporosis and fracture risk

›Degenerative joint and spinal disease

›Obesity

›Mechanical loading effect

›Inflammatory adipokine contribution

›Sleep disorder

›Bidirectional relationship with pain amplification

›Genetics

›Heritability 21 to 67 percent for back pain

›Psychological and social risk factors

›Depression and anxiety

›PHQ-2 or PHQ-9 screening result

›GAD-7 screening result

›PTSD

›Trauma history

›Hypervigilance and catastrophizing

›Fear-avoidance behavior

›LR positive 2.11 for chronicity

›Low socioeconomic status

›OR 2.0 for chronic pain development

›Substance use disorder

›Opioid, alcohol, or benzodiazepine history

›Prior adverse childhood experiences

›Predispose to chronic pain development

03Physical Exam/exam69

Vitals and general

›Stability and pain behavior assessment

›Temperature

›Fever greater than 38.3 C suggesting infectious etiology

›Heart rate

›Tachycardia from pain or autonomic response

›Blood pressure

›Hypertension from pain

›Hypotension suggesting sepsis or opioid effect

›General appearance

›Affect and pain behaviors

›Functional assessment: gait, transfers, posture

Neurologic exam

›Focused neurologic assessment

›Motor strength graded 0 to 5 in affected limbs

›Comparison bilateral

›Proximal versus distal distribution

›Sensation

›Dermatomal mapping for radiculopathy

›Non-dermatomal widespread distribution suggesting central sensitization

›Deep tendon reflexes

›Hyporeflexia suggesting nerve root compromise

›Hyperreflexia suggesting upper motor neuron pathology

›Straight leg raise

›Sensitivity 92% for lumbar disc herniation

›Crossed SLR specificity 90%

›Saddle sensation and rectal tone if cauda equina suspected

›Bilateral leg weakness trigger

04Differential Diagnosis/ddx51

Life-threatening diagnoses

›Urgent pathology requiring immediate action

›Cauda equina syndrome

›ICD-10 G83.4

›Surgical emergency: urinary retention, saddle anesthesia, bilateral leg weakness

›Spinal epidural abscess

›ICD-10 G06.1

›Fever plus severe back pain plus progressive neurologic deficit triad

›IV drug use or immunosuppression association

›Vertebral osteomyelitis or discitis

›ICD-10 M46.20

›Indolent but can progress to abscess

›Metastatic spinal cord compression

›ICD-10 G95.20

›Known malignancy with new or worsening back pain

›Aortic aneurysm or dissection

›Tearing pain with hemodynamic instability

›Pulsatile abdominal mass

›Septic arthritis

›ICD-10 M00.9

›Monoarticular swelling with fever

Serious but non-emergent diagnoses

›Important secondary causes

›New vertebral compression fracture

›ICD-10 M48.50

›Osteoporosis, steroid use, trauma, or malignancy

›LR positive 31.1 when trauma with neurologic findings

›Inflammatory arthritis flare

05Laboratory Tests/lt36

Infection and inflammation markers

›Targeted infection screen

›Complete blood count

›Leukocytosis supporting infection or inflammatory etiology

›Anemia suggesting malignancy or chronic inflammation

›C-reactive protein and ESR

›Elevated in infection, inflammatory arthritis, and malignancy

›PMR: ESR typically greater than 40 mm/hr

›Blood cultures

›Fever plus focal spinal pain trigger

›IV drug use or immunosuppression trigger

›Prior to antibiotic initiation

Metabolic and organ function

›Baseline metabolic panel

›BMP or CMP

›Renal function before NSAID prescription

›Hepatic function before acetaminophen dose adjustment

›Electrolytes for methadone QTc risk: hypokalemia and hypomagnesemia

›HbA1c

›Diabetic neuropathy progression suspected

›Glycemic control assessment

›Thyroid stimulating hormone

›Hypothyroidism as neuropathy or myalgia cause

›Vitamin D and B12

›Osteomalacia and neuropathy contribution

›Creatine kinase

›Myopathy suspected: statin-related or inflammatory

06Diagnostic Tests/dt65

Scoring Systems

›Pain and functional assessment tools

›Numeric Rating Scale NRS 0 to 10

›Baseline versus current score comparison

›Response defined as 2-point or 30 percent reduction

›Brief Pain Inventory

›Pain severity and functional interference subscales

›Useful for multidimensional tracking

›PROMIS Pain Interference

›Validated patient-reported outcome measure

›Captures functional and emotional domains

›Red flag and risk stratification tools

›PHQ-9 depression screen

›Score 10 or greater indicates moderate depression

›Suicidal ideation item scored separately

›GAD-7 anxiety screen

›Score 10 or greater indicates moderate anxiety

›ORT opioid risk tool

›Stratifies low, moderate, and high risk for opioid misuse

›Use before initiating or escalating opioids

›STarT Back screening tool for low back pain

›Stratifies low, medium, and high psychosocial risk

›Guides targeted intervention intensity

MRI

›MRI indications for chronic pain exacerbation

›Mandatory indications

›New neurologic deficit on exam

›Cauda equina syndrome features

07Disposition/dispo43

Discharge criteria

›Criteria supporting safe discharge

›Red flags excluded on clinical assessment

›No new neurologic deficit

›No fever with spinal pain

›No malignancy or fracture concern

›Pain improved to tolerable or functional baseline

›NRS reduction of 2 or greater from presentation

›Able to ambulate safely

›Safe medication plan in place

›Clear analgesic instructions without escalation

›No suicidal ideation

›Outpatient follow-up arranged

›PCP or pain specialist within 1 to 2 weeks

›Physical therapy initiation within 2 to 4 weeks

Admission and observation indications

›Criteria for higher level of care

›New neurologic deficit requiring urgent imaging or intervention

›Cauda equina: emergent surgical consultation

›Progressive myelopathy: MRI and spine surgery involvement

›Suspected spinal infection

›Epidural abscess or osteomyelitis

›IV antibiotics and infectious disease consultation

›Intractable pain despite multimodal ED management

›IV ketamine infusion protocol consideration

›Pain medicine consultation

›Suicidal ideation with plan

›Psychiatric evaluation

08Treatment/t121

Immediate multimodal analgesia

›Non-opioid first-line agents

›NSAIDs

›Ibuprofen 400 to 600 mg PO every 6 to 8 hours

›With food to reduce GI risk

›Avoid in renal impairment, GI bleeding history, cardiovascular disease

›Ketorolac 15 to 30 mg IV or 10 mg PO for acute severe pain

›Maximum 5 days of use

›Renal function check before administration

›Acetaminophen

›1000 mg PO or IV every 6 hours

›Maximum 4000 mg per day in healthy adults

›Reduce to 2000 mg per day with hepatic impairment or alcohol use

›IV preferred when NPO or severe nausea

›Topical agents for localized pain

›Diclofenac 1% gel applied 3 to 4 times daily to affected area

›Reduced systemic NSAID exposure

›Preferred for knee and hand osteoarthritis

Subdissociative ketamine

›Ketamine for refractory acute exacerbation

›Dosing protocol

›0.25 to 0.5 mg/kg IV over 15 to 20 minutes

›80 to 83 percent achieved 20 mm VAS reduction vs 41 percent placebo

›Comparable efficacy at low and high subdissociative doses

›Intranasal or subcutaneous alternative when IV access unavailable

›0.5 to 1 mg/kg intranasal

›Monitoring requirements

›Continuous pulse oximetry during infusion

›Dissociative or emergence reaction monitoring

›Benzodiazepine available for severe emergence reaction

›Limitations

›No sustained relief beyond 24 to 48 hours

›Not indicated as maintenance therapy

Adjunctive IV and regional options

›Additional acute options

›IV lidocaine

›1.5 mg/kg IV over 10 minutes for renal colic, acute radicular pain, or post-herpetic neuralgia

›Avoid in structural heart disease or rhythm disturbances

›Cardiac monitoring required

›Regional anesthesia and nerve blocks

›Anatomically localizable pain

›Femoral nerve block for hip or femur pain

›Intercostal block for rib fracture or chest wall pain

›Ultrasound guidance preferred

›Reduces complication risk

Opioid use in acute exacerbation

›Opioid management principles

›Opioids not first-line for chronic non-cancer pain exacerbation

›ACEP policy: optimize non-opioid multimodal analgesia first

›CDC 2022 Clinical Practice Guideline supports non-opioid preference

›When opioids considered

›Refractory to full multimodal non-opioid trial

›Lowest effective dose for shortest duration

›Morphine 2 to 4 mg IV every 4 hours PRN for severe acute pain

›Titrate to effect with reassessment

›Avoid in known opioid-induced hyperalgesia

›Opioid escalation cautions

›Do not escalate home opioid dose in ED without pain specialist input

›Opioid-induced hyperalgesia: paradoxical increase in pain with dose escalation

Chronic outpatient pharmacologic management

›By pain type

›Nociceptive pain: OA and musculoskeletal

›Topical diclofenac or oral NSAIDs first-line

›Lowest effective dose and shortest duration

›Duloxetine 30 to 60 mg daily as adjunct

›Titrate to 60 mg daily for musculoskeletal pain

›Neuropathic pain

›Gabapentin 100 to 300 mg PO at night titrated to 300 to 1200 mg three times daily

›NNT 2.9 to 7.7 across neuropathic pain conditions

›Renal dose adjustment required

›Pregabalin 75 mg PO twice daily titrated to 150 to 300 mg twice daily

›Faster titration than gabapentin

›Schedule V controlled substance

›Duloxetine 60 mg daily

›NNT 6.4 for diabetic neuropathy

›TCAs: amitriptyline 10 to 25 mg at bedtime

›NNT 3.6 across neuropathic conditions

›Avoid in elderly due to anticholinergic risk

›Topical lidocaine 5% patch for localized neuropathic pain

›12 hours on and 12 hours off

›High-concentration capsaicin 8% patch

›Applied by trained provider for postherpetic neuralgia and DPNP

›Nociplastic pain and fibromyalgia

›Pregabalin 75 to 225 mg twice daily

›FDA approved for fibromyalgia

›Duloxetine 60 mg daily

›FDA approved for fibromyalgia and musculoskeletal pain

›Milnacipran 50 to 100 mg twice daily

›FDA approved for fibromyalgia

›Avoid opioids

›Less effective than in nociceptive pain

›Carry serious risks including opioid-induced hyperalgesia

Medications to avoid

›Contraindicated or high-risk agents

›Meperidine

›Neurotoxic metabolite normeperidine accumulation

›Seizure risk with repeated dosing

›Skeletal muscle relaxants

›No benefit for chronic pain

›CNS depression and fall risk especially in elderly

›Benzodiazepines for pain

›No benefit for chronic non-cancer pain

›Significant harm: dependence, respiratory depression with opioids

›Triple combination with gabapentinoids and opioids: avoid per AGS Beers Criteria

›Methadone without specialist oversight

›QTc prolongation risk

›ECG monitoring required

›Complex pharmacokinetics require specialist management

Non-pharmacologic therapies

›Evidence-based non-drug treatments

›Exercise therapy

›Aerobic, aquatic, strengthening, yoga, and tai chi

›First-line per CDC and APA guidelines

›Class I recommendation from multiple guidelines

›Avoid prolonged bed rest

›Deconditioning worsens chronic pain

›Cognitive behavioral therapy CBT

›Small but consistent benefit for pain and disability

›APA Clinical Practice Guideline 2024 recommendation

›Address catastrophizing and fear-avoidance

›Mindfulness-based stress reduction MBSR

›Comparable efficacy to CBT for some pain types

›Physical therapy

›Spinal stabilization and core strengthening

›Initiate within 2 to 4 weeks of ED visit

›Multidisciplinary pain rehabilitation

›Refractory cases integrating medical, psychological, and physical approaches

›Most effective treatment for complex chronic pain

09Special Populations/sp71

Pregnancy

›Pregnancy-specific pain management

›Analgesic safety

›Acetaminophen: generally preferred analgesic in pregnancy

›Lowest effective dose for shortest duration

›Some observational association with adverse fetal neurodevelopment; discuss risks and benefits

›NSAIDs: avoid after 20 weeks gestation

›Risk of premature ductal closure and oligohydramnios

›Short-term use in first trimester may be acceptable with caution

›Opioids: caution; neonatal opioid withdrawal syndrome risk

›If required, use lowest effective dose

›Coordinate with obstetrics

›Agents to avoid

›Gabapentinoids: limited safety data; possible teratogenicity concerns

›TCAs and duloxetine: individualized risk-benefit discussion

›Imaging

›MRI without gadolinium preferred when imaging required

›CT with appropriate shielding if clinically necessary

›Fetal monitoring

›If viable gestation: fetal heart rate monitoring with significant illness or intervention

Geriatric

›Older adult considerations

›Pharmacologic cautions

›NSAIDs: increased GI bleeding, renal impairment, and cardiovascular risk

›Topical formulations preferred per AGS Beers Criteria 2023

›Avoid oral NSAIDs in CKD or heart failure

›TCAs: avoid due to anticholinergic effects

›Falls, urinary retention, cognitive impairment

›Opioids: increased sensitivity to CNS and respiratory depression

›Start low and go slow principle

›Avoid long-acting opioids as first-line

›Gabapentinoids: increased sedation and fall risk

›Dose reduction for renal impairment mandatory

›Triple combination avoidance: opioid plus gabapentinoid plus benzodiazepine

›AGS Beers Criteria strong recommendation against

›Atypical presentation

›Pain may present as functional decline or behavioral change

›Delirium as pain surrogate in cognitively impaired patients

›Fall and fracture risk

›Analgesic selection to minimize fall risk

›Vertebral compression fracture more common with minimal trauma

›Disposition considerations

›Lower threshold for admission due to frailty and limited home support

›Social work involvement for safe discharge planning

Pediatrics

›Pediatric chronic pain management

›Epidemiology

›Chronic pain affects 11 to 38 percent of children and adolescents

›Functional abdominal pain, headache, and musculoskeletal pain most common

›Assessment differences

›Age-appropriate pain scales: FACES Pain Scale, color analog scale, NRS age 8 and above

›Functional disability more prominent endpoint in pediatric chronic pain

›Behavioral and school impact assessment

›Pharmacologic approach

›Acetaminophen 15 mg/kg PO or IV every 4 to 6 hours

›Maximum 75 mg/kg per day and not exceeding 4000 mg per day

›Ibuprofen 10 mg/kg PO every 6 to 8 hours

›Maximum 40 mg/kg per day

›Avoid under 6 months

›Gabapentin for neuropathic pain

›5 to 10 mg/kg per day in divided doses titrated to effect

›Sedation monitoring important

›Amitriptyline for neuropathic or headache related chronic pain

›0.1 to 1 mg/kg per day at bedtime

›ECG before initiation

›Non-pharmacologic emphasis

›Psychological therapies are primary treatment in pediatric chronic pain

›CBT has strongest evidence: APA and IASP recommendations

›Acceptance and commitment therapy ACT emerging evidence

›Exercise and physical therapy

›Graded activity and desensitization approach

›Family involvement

›Avoid inadvertent reinforcement of illness behaviors

›Parent coaching component in treatment programs

10Background/b66

Epidemiology

›Prevalence and burden

›Chronic pain prevalence

›Affects approximately 20 to 30 percent of adults globally

›Chronic pain syndrome: persistent pain greater than or equal to 3 months

›Leading cause of disability and healthcare utilization worldwide

›Exacerbation frequency

›Most chronic pain patients experience periodic flares

›ED visits for pain exacerbation represent a major proportion of non-traumatic pain visits

›Demographic distribution

›Higher prevalence in women, older adults, and lower socioeconomic groups

›OR 2.0 for low socioeconomic status

›OR 1.21 for poor social support

›Mortality and morbidity

›Chronic pain associated with elevated suicide risk

›Major contributor to opioid use disorder epidemic

›Annual US economic burden estimated in hundreds of billions

Pathophysiology

›Mechanisms of chronic pain

›Peripheral sensitization

›Ongoing nociceptor activation from tissue damage or inflammation

›Lowered activation threshold of peripheral afferents

›Chemical mediators: prostaglandins, bradykinin, substance P

›Central sensitization

›Amplified synaptic transmission in dorsal horn

›Reduced inhibitory modulation from descending pain pathways

›NMDA receptor upregulation contributing to wind-up

›Clinically manifests as allodynia and hyperalgesia

›Nociplastic pain mechanism

›Altered nociception without clear tissue damage or nerve injury

›Dysregulation of pain modulation systems

›Associated with fibromyalgia, chronic widespread pain, IBS

›Psychosocial amplification

›Fear-avoidance model: catastrophizing increases disability

›Depression and anxiety lower pain threshold

›Adverse childhood experiences alter HPA axis and pain processing

›Opioid-induced hyperalgesia

›Paradoxical pain sensitization from chronic opioid exposure

›NMDA receptor and dynorphin pathway involvement

›Worsening pain despite or due to opioid escalation

Therapeutic Considerations

›Management philosophy

›Biopsychosocial model as framework

›Biological: pharmacologic and interventional treatments

›Psychological: CBT, mindfulness, acceptance-based therapies

›Social: occupational support, social connection, housing stability

›Goal of treatment is improved function, not pain elimination

›Pain flares are expected in chronic pain

›Functional restoration is primary endpoint

›Non-pharmacologic treatments as foundation

›Exercise, CBT, and physical therapy are first-line per CDC, APA, and VA/DoD guidelines

›Class I recommendation for non-pharmacologic approaches

›Opioid prescribing principles

›CDC 2022 Clinical Practice Guideline framework

›Non-opioid therapy preferred for chronic non-cancer pain

›When opioids used: immediate-release preferred initially

›Lowest effective dose

›Reassess risks and benefits with each prescription

›PDMP use at every opioid-related encounter

›Detect concurrent prescriptions and fill patterns

›Naloxone co-prescription

›Indicated for patients on opioids above 50 MME per day

›Also for concurrent benzodiazepine use or substance use history

›Tapering and de-escalation

›Gradual taper preferred over abrupt discontinuation

›10 percent per month taper as commonly recommended rate

›Individualize based on dose duration and patient response

›Opioid-induced hyperalgesia managed by taper rather than escalation

›Counterintuitive but evidence-supported approach

11Patient Discharge Instructions/pdi36

copy discharge instructions

›Chronic pain flare home care instructions

›Your current flare is a worsening of your known chronic pain

›This is expected in chronic pain conditions

›The goal is improved function, not complete pain elimination

›Take medications exactly as prescribed

›Do not increase opioid doses without contacting your prescribing doctor first

›Use acetaminophen and NSAIDs as directed; do not exceed recommended doses

›Stay as active as possible

›Avoid prolonged bed rest as it worsens chronic pain

›Gentle walking or prescribed exercises as tolerated

›Sleep and stress management

›Maintain regular sleep schedule

›Practice relaxation techniques: deep breathing, mindfulness

›Diet and lifestyle

›Anti-inflammatory diet: fruits, vegetables, whole grains, omega-3 rich foods

›Avoid excessive alcohol; it interacts with pain medications and worsens sleep

›Return immediately to the emergency department for

›New weakness, numbness, or difficulty walking

›Especially if involving both legs

›Loss of bowel or bladder control

›Inability to urinate or urinary leakage

›Fever or chills with worsening pain

›Severe uncontrolled pain despite prescribed medications

›Tearing or pulsating pain spreading to your chest, abdomen, or legs

›Thoughts of self-harm or suicide

›Call 988 Suicide and Crisis Lifeline or go to emergency

›Follow-up appointments

12References/r25

Guidelines and key sources

›Primary guidelines

›CDC Clinical Practice Guideline for Prescribing Opioids for Pain, United States 2022

›Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. MMWR 2022

›Non-opioid therapy preferred for chronic non-cancer pain

›VA/DoD Clinical Practice Guideline for Low Back Pain, 2022

›Anderson DPT et al. Department of Veterans Affairs 2022

›Exercise and non-pharmacologic first-line recommendation

›VA/DoD Clinical Practice Guideline for Use of Opioids in Chronic Pain, 2022

›Brown DPT et al. Department of Veterans Affairs 2022

›APA Clinical Practice Guideline for Nonpharmacological Treatment of Chronic Musculoskeletal Pain, 2024

›Prasad R et al. American Psychological Association 2024

›ACEP Policy Statement: Optimizing the Treatment of Acute Pain in the Emergency Department, 2018

›American College of Emergency Physicians

›ACR Appropriateness Criteria Cervical Pain or Cervical Radiculopathy, 2025 Update

›Eldaya RW et al. Journal of the American College of Radiology 2025

Key evidence

›Landmark studies and systematic reviews

›Cohen SP, Vase L, Hooten WM. Chronic Pain: An Update on Burden, Best Practices, and New Advances. Lancet 2021. PMID 34062143

›Lumanauw DD et al. Subdissociative-Dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain. Academic Emergency Medicine 2019. PMID 30901130

›Beaudrie-Nunn AN et al. Efficacy of Analgesic and Sub-Dissociative Dose Ketamine for Acute Pain in the ED. American Journal of Emergency Medicine 2023. PMID 37290249

›Fitzcharles MA, Cohen SP, Clauw DJ et al. Nociplastic Pain: Towards an Understanding of Prevalent Pain Conditions. Lancet 2021. PMID 34062144

›Dunn M et al. Biopsychosocial Factors Associated With Development of Chronic Musculoskeletal Pain. PLoS One 2023. PMID 38557647

›Chiarotto A, Koes BW. Nonspecific Low Back Pain. NEJM 2022

›Sokol R, Grossman E, Bourgery R. Nonopioid Pharmacologic Management of Chronic Noncancer Pain. American Family Physician 2025. PMID 40834375

›Steinman MA. Alternative Treatments to Selected Medications in the 2023 AGS Beers Criteria. Journal of the American Geriatrics Society 2025

›Krantz MJ, Palmer RB, Haigney MCP. Cardiovascular Complications of Opioid Use. JACC 2021. PMID 33446314

Evidence & Review