Patient Data
History
Pain Characteristics
Clinical Questionnaires
Patient interview — does the pain have the following characteristics?
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- The questionnaires included are clinical screening questions for exclusive use by healthcare professionals and do not integrally reproduce the original instruments.
- Where available, bibliographic sources are cited. The intellectual property of the original instruments remains with their respective authors and rights holders.
- The adaptation of these questions into an interactive digital clinical screening format constitutes fair and non-infringing use under applicable copyright law.
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Physical Examination by Region
Current Treatment and Clinical Tools
| Drug | Dosage | Frequency | Route | Since | Efficacy |
|---|
eGFR Stages — KDIGO 2024
| Stage G | eGFR | Description | Follow-up / notes |
|---|---|---|---|
| G1 | ≥90 | Normal or increased | If known renal damage: every 12 months |
| G2 | 60–89 | Mildly reduced | Every 12 months |
| G3a | 45–59 | Mild-moderate reduction | Every 6 months — adjust some medications |
| G3b | 30–44 | Moderate-severe reduction | Every 3 months — avoid NSAIDs; reduce gabapentinoids |
| G4 | 15–29 | Severe reduction | Every 1–3 months — urgent nephrology referral; RRT preparation |
| G5 | <15 | End-stage renal disease | Dialysis/transplant — maximum pharmacological caution |
Albuminuria stages A1/A2/A3 combine with G to define KDIGO risk (green=low; yellow=moderate; orange=high; red=very high).
📋 Equianalgesic dose table (reference: oral morphine 30 mg/day = 1 OME)
| Opioid | Route | Equianalgesic Dose | OME Factor | t½ / Notes | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Weak opioids (step 2) | ||||||||||||
| Tramadol | PO/IV | 300 mg | × 0.10 | 4–6 h — max 400 mg/day — serotonergic — avoid in CKD G4-G5 | ||||||||
| Codeine | OS | 200–300 mg | × 0.10 | 4–6 h — prodrug (CYP2D6) — significant genetic variability | ||||||||
| Tapentadol | OS | 100 mg | × 0.30 | 4–6 h (IR) / 12 h (PR) — MOR+NRI — useful in neuropathic pain | ||||||||
| Morphine — OME reference drug | ||||||||||||
| Morphine | PO (ref.) | 30 mg | × 1.00 | 4 h (IR) / 8–12 h (SR) — active metabolites M6G (accumulation in CKD) | ||||||||
| Morphine | SC/IV | 10 mg | × 3.00 | 3–4 h — ratio PO:SC=3:1 — PO:IV=3:1 | ||||||||
| Strong opioids — others | ||||||||||||
| Oxycodone | OS | 20 mg | × 1.50 | 4–6 h (IR) / 12 h (CR) — bioavailability ~60–87% | ||||||||
| Oxycodone | SC/IV | 10–15 mg | × 2.00 | 3–4 h — ratio PO:IV ≈ 2:1 | ||||||||
| Hydromorphone | OS | 6 mg | × 5.00 | 4–5 h (IR) / 12–24 h (SR) — hydrophilic; useful for SC route | ||||||||
| Hydromorphone | SC/IV | 1.5 mg | × 20.0 | 3–4 h — caution: dosing errors due to high potency | ||||||||
| Fentanyl TDT | Patch | 12.5–25 mcg/h | mcg/h × 2.4 | 25 mcg/h ≈ 60 mg oral morphine/day — 72h — useful if oral not tolerated | ||||||||
| Buprenorphine TDT | Patch | 17.5–35 mcg/h | mcg/h × 1.7 | 35 mcg/h ≈ 60 mg oral morphine/day — 84–96h — safe in CKD, hepatic elimination | ||||||||
| Buprenorphine SL | SL | 0.2 mg | × 30.0 | 6–8 h — 0.2 mg SL ≈ 6 mg oral morphine | ||||||||
| Methadone — dose-dependent conversion ⚠️ SPECIALISTS ONLY | ||||||||||||
| Methadone PO |
Long and variable t½ 24–36h — accumulation risk — monitor QTc — divide dose and reassess after 5–7 days |
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Diagnosis and Treatment Plan
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REFERTANDO.IT
un portale a cura del Dr. Dario Anselmi
Legal Disclaimer: This report is a clinical documentation aid and does not replace the clinical judgment of the physician. Clinical questionnaires, calculators (CKD-EPI, OME) and pharmacological tables are for guidance only. The author disclaims all liability for errors, omissions or damages. Reserved for licensed healthcare professionals. This software is not a medical device under EU Regulation 2017/745 (MDR) and does not bear CE marking. Opioid prescription is regulated by applicable national laws.
Privacy: The data contained in this document are special categories of personal data (Art. 9 GDPR) subject to GDPR (EU) 679/2016 and HIPAA regulations where applicable. The physician is responsible for the custody and processing of the patient's personal and health data.
Clinical Questionnaires: The questionnaires in this tool are clinical screening questions inspired by the literature and do not constitute validated scales. Use of the original instruments (DN4, LANSS, BPI, ODI) requires permission from their respective authors. Rights belong to the respective holders.