Pain Management Case

I inherited a patient with chronic lower back pain on tramadol 3 times a day as needed. I was able to reduce her dose to twice a day as needed and discussed continuing to taper. She has been doing PT as well.

I referred her to pain management who tried a few different injections. On the most recent note, pain specialist said they exhausted all interventions and now recommends increasing tramadol back to 3 times a day. The note mentioned that this treatment plan is "extremely safe". Of course, patient messaged me to request increasing tramadol prescription. Also, the pain specialist from my organization has a rule that they do not take over or prescribe opiates.

What do you guys think about the situation? Thanks.

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Follow-up question:

A lot of people are agreeing with this pain specialist to continue Tramadol for life. Please enlighten me with a recent study that reports the efficacy and safety of long-term use of opiates for chronic pain management.