Minerals such as selenium and zinc can also help reduce oxidative stress and support liver enzymes, Cherkaoui says, while choline aids fat transport. Dr. Williams says choline is the “unsung hero” in the liver health story.

On the note of sugar: Fructose in particular is processed in the liver where it’s converted into fat, Routhenstein explains, which can cause fatty liver disease if consumed in excess.

Strength of recommendation: I = generally perform; II = may be reasonable to perform; III = generally do not perform.

Herbal supplements. Patients frequently request information about herbal supplements. The evidence for the use of some supplements is growing. Many are safe and may be considered when patients are interested. See Table 6.

The foundation of quitting smoking successfully lies in a strong will. Recognizing that smoking is harmful is important, but committing to quit is what truly matters. Once you make up your mind, stay determined and remind yourself why you started this journey.

Your provider may suggest trying a different medicine, changing your dose or weaning you off pills. Don't take a new sleeping pill the night before an important appointment or activity because you won't know how it affects you.

Transdermal buprenorphine (Butrans and generic) is FDA-approved for treating pain. It does not require an XDEA number or training to prescribe. The transdermal form is a good alternative for patients who have developed tolerance to other opioids, had a benefit from opioid treatment but wish to escalate treatment, and are taking ≤ 80 MME/day. Start with a 5 or 10 mcg patch (changed weekly), and discontinue other opioids.

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Pregabalin is a federal Schedule V controlled substance, and gabapentin has been scheduled in many states. Both of these medications produce an increased addiction risk.

Mindfulness based stress reduction (MBSR) may improve pain function in people with chronic pain. MBSR can provide patients with long-lasting skills effective for managing pain.34 Strong evidence shows that MBSR reduces functional disability and improves pain management for a variety of chronic pain conditions including low back pain,51 fibromyalgia, rheumatoid arthritis, and patients with opioid misuse.

Pain diary: regular documentation of the pain intensity to identify peaks and triggers; enables treatment optimization

In select cases, co-prescribing may be warranted, such as use of a benzodiazepine for an MRI. In those cases, discuss the risks with the patient. Furthermore, consider the kinetics of each drug relative to the timing of procedures. For example, counsel patients taking hydrocodone daily to skip a dose if they need to take a benzodiazepine for an MRI; benzodiazepines and short-acting opioids should not be taken within two hours of each other.

Some medicines must be stopped gradually. Also, be aware that you may have some short-term rebound insomnia for a few days after you stop taking sleeping pills.

Have a frank but supportive Buy Now discussion with the patient about the fears of a worse lifestyle and risk for overdose. Offer support and addiction treatment.