Physicians and other healthcare professionals may often be faced with the need to change opioids during the course of a patient's opioid analgesic care due to a number of clinical reasons. The act of converting opioid analgesics, for many physicians, nurses, and pharmacists, who do not receive adequate training, remains a challenging and often uncomfortable aspect of pain treatment. Part of the challenge clinicians face is secondary to the relatively weak literature evidence base that exists to support the equianalgesic ratios provided in textbooks, journals, and other medical resources. Another aspect involves the lack of a widely recognized treatment algorithm or guideline to assist clinicians with opioid conversion. The final decision on which opioid dose to prescribe must involve a thorough clinical assessment to minimize the risk of prescribing inappropriate opioid doses over or under the patient's actual need. The purpose of this paper is to provide the clinician with an approach for dealing with the conversion between opioid analgesics that is standardized, yet allows for individualized results to meet unique patient needs. We present a 5-step process as a guide for clinicians faced with the need to change a patient's opioid regimen. This approach may help to build a comfort level when dealing with the clinical challenges of converting from one opioid to another.

The safety, tolerability, and efficacy of the lidocaine patch 5% (Lidoderm), a targeted peripheral analgesic with an FDA-approved indication for the treatment of postherpetic neuralgia, has been well established. Recent case reports and studies have suggested potential efficacy in other neuropathic and nonneuropathic pain conditions. Several pharmacokinetic studies have demonstrated minimal systemic absorption with 12-, 18-, and 24-hour/day dosing. Mean maximum plasma concentrations have shown the lidocaine patch to possess a minimal risk for systemic toxicities or drug-drug interactions. The most common adverse events generally involve mild skin reactions. There have been no drug-drug interactions noted in clinical trials. Recent evidence suggests that extended application does not result in A-beta-mediated sensory loss at the application site, which is particularly important in patients who already have a degree of sensory loss due to their underlying condition. The lidocaine patch provides a treatment option that carries a relatively low systemic adverse event and drug-drug interaction risk burden, even with continuous application of up to four patches per day.

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Systemic racism is a public health emergency and disproportionately impacts communities of color, specifically Black Americans. Pharmacists took an oath to protect the welfare of humanity and protect our patients. As such, to practice truly patient-centered care, pharmacists must recognize racism as a root cause of social determinants of health and use their privilege to educate themselves and their colleagues around dismantling structural racism.