Anesthesia Pain Service Guidelines

This information explains the Memorial Sloan Kettering (MSK) Anesthesia Pain Service guidelines for pain medication.

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About MSK’s Anesthesia Pain Service

The doctors at MSK’s Anesthesia Pain Service will work with you to control your pain. We can help control your pain by:

  • Prescribing and adjusting opioid pain medications.
  • Performing a nerve block procedure (a procedure to stop your nerves from sending pain messages to your brain).
  • Implanting a pain device.

All of these things may also be combined with other non-opioid medications. Medications such as opioids are addictive and may be abused. They are a controlled substance and must be treated differently than other prescription medications.

If you’re taking opioids, we must monitor you and your medication use closely, both for your safety and for legal reasons. Because of this, you’ll need to give a urine (pee) sample at your first visit with your pain doctor. Your urine will be checked for medications or other drugs to make sure there are no safety concerns. We also review a state-wide registry before writing prescriptions for controlled substances. This will be done routinely during your care. For more information about opioids, read our resource Opioids: What You Need to Know.

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Guidelines for Pain Medications

  • Only your pain doctor should write your prescriptions for pain medication, even if you have other doctors who have prescribed your pain medication. Don’t ask other doctors to refill your pain medication.
  • Take your pain medication only as prescribed by your pain doctor. Don’t take more than your doctor or nurse told you to take. Taking more than you’re told may raise your chance of harmful side effects, such as trouble breathing or even death. If you have trouble breathing or become unconscious, someone must call 911 for an ambulance.
  • Do not drink alcohol while taking opioids, sleeping medication, or sedatives (medications to help you relax) such as lorazepam (Ativan®).
  • If you need any changes to your pain medication, call our office. The phone number is 212-639-6851. If another doctor adjusts your pain medication, call us to discuss the change by the next business day (Monday through Friday).
  • If your doctor changes your pain medication or dose, don’t drive or do other things that require you to be alert until you see how your new medications affect you. You may also be at a greater risk of falling while adjusting to your pain medication or dose.
  • Do not change the dose of your pain medications without talking with your pain doctor or nurse. Read the section “Getting Your Prescriptions Between Appointments” for more information.
  • If you miss a dose, don’t take extra medication. If you’re having pain, call your pain doctor. They will help you.
  • Do not suddenly stop taking your pain medication. Our goal is for you to use the least medication necessary to treat your pain. We also want you to take it for the shortest amount of time possible. If you suddenly stop taking opioids, you may have withdrawal symptoms, such as nausea and vomiting (throwing up), abdominal cramps, or sweats. If this happens and you have no pain medication, go to the closest emergency room or to the MSK Urgent Care Center (UCC).
    • The MSK UCC is on the 1st floor of Memorial Hospital. The closest entrance is at 425 East 67th Street, between First and York Avenues.
  • If you wish to lower the dose of your pain medication, your pain doctor can help you plan a schedule to taper off, or gradually lower, the amount of medication you take. You may experience withdrawal symptoms, but this isn’t common.
  • Let your healthcare providers know that you’re taking pain medication. Tell them if you’re taking any other medications or dietary supplements, such as herbs, vitamins, or home remedies.
  • If any of your other doctors prescribe sleeping medications or sedatives, tell them that you’re also taking prescription pain medications. Your pain doctors rarely prescribe sleeping medications.
  • Keep track of when you’ll need a new prescription for your pain medication. Pain medications can be prescribed only on business days, so you won’t be able to receive a new prescription on a weekend or holiday.
  • Keep all appointments with your pain doctor. If you’re getting opioids from us, we will need to see you in our clinic once a month. MSK has multiple Anesthesia Pain Service clinics. They are listed in the “Anesthesia Pain Service Locations” section at the end of this resource.
  • Keep your pain medication in a safe place away from others, especially children and pets. You may need to keep it in a locked box. Never share your medication with another person or take another person’s medication.
  • To find out where you can safely throw away any leftover opioids, visit the Drug Enforcement Administration website at
  • Take at least a 1-day supply of your pain medication with you when you leave your home.

About Naloxone (Narcan®)

If you’re prescribed opioids, we will also prescribe you a medication called Naloxone (Narcan®). Naloxone is a medication that can reverse an opioid overdose if you take more opioids than we prescribe you. We don’t expect that you’ll need to use Naloxone if you follow your healthcare provider’s instructions, but we want to make sure you’re safe in case of an emergency. Your healthcare provider will teach you and your caregiver how and when to use Naloxone.

Naloxone should be used only in case of an emergency where your breathing slows down or completely stops. If you’re not sure if you should use Naloxone, call 911 and follow the operator’s instructions. Always call 911 after using Naloxone as its effects only last 30 to 90 minutes and you may need more medical care.

Managing constipation

Constipation (having fewer bowel movements than what’s normal for you) can be a common side effect of pain medications. You may need to take additional medications, such as docusate sodium (Colace®), senna (Senekot®), and polyethylene glycol (Miralax®), to help prevent constipation. It’s important to tell your pain doctor or nurse if you have had problems with constipation in the past. Call your pain doctor or nurse if you:

  • Haven’t had a bowel movement for 2 days.
  • Have difficulty passing stool.
  • Have a hard stool.
  • Can’t empty your bowels completely.

For more information, read our resource Constipation.

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Getting Your Prescriptions Between Appointments

All prescriptions are sent to your pharmacy electronically (over the Internet). You must tell us which pharmacy to send the prescription to each time. We can’t call these prescriptions into your pharmacy.

To get a new prescription, call your pain doctor or nurse at least 4 to 5 business days before you’re out of medication. You can call the Anesthesia Pain Service at 212-639-6851, Monday through Friday from 9:00 am to 4:00 pm. Don’t wait to call until your medication is gone. We need time to process your request and we can only prescribe on a regular business day. If you call after 3:00 pm, we may not return your call until the next business day.

Several steps happen once you call your doctor to request a prescription:

  • We will ask you for the name and dose of your medication, the pharmacy from where you want pick up the prescription, and your phone number so we can contact you if we have questions.
  • We need to check a state-wide registry before writing the prescription. If we have questions about how you’re using the medication, we may need to call and talk with you before the prescription is written.
  • Your doctor must sign off on the new prescription. This may not happen until the end of the day.
  • Once your doctor signs off on the prescription, it’s sent to your pharmacy electronically.
  • Once your pharmacy gets the prescription, they must check with your insurance to be sure it’s covered. Sometimes your insurance company will have questions before it allows the pharmacy to process the prescription. Your medication may need prior authorization from the insurance company. It may take 24 to 72 hours (1 to 3 days) to get approval or denial. If it’s denied, your doctor must prescribe a different pain medication.
  • Finally, your pharmacy may need to order the medication because they may not have it in stock.
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Lost or Stolen Prescriptions or Medication

You need to keep track of your pain medication and prescriptions. If you lose your pills or if your medication is stolen, follow these steps:

  • Contact your local police station and file a police report. Then fax the police report to us at 212-717-3206 or bring it to us in person.
  • Call us afterward as you may need to come in for a clinic appointment.
  • Your prescription plan may not pay for your replacement medication. If it doesn’t, you’ll be responsible for the cost.
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Contacting the Anesthesia Pain Service

If you have questions, need to talk to someone about your pain control, or want to make an appointment, call 212-639-6851. You can reach us Monday through Friday from 9:00 am to 4:00 pm. We will ask you to leave your phone number so we can call you back. It’s best if you call earlier in the day, so we can review your records or talk with your pain doctor if needed. We will do our best to call you back the same day or the next business day.

If it’s after 4:00 pm, during the weekend, or on a holiday, and you’re having an emergency such as severe pain, call 212-639-2000 and ask for the anesthesia pain person on call. You can also go to your local emergency room or the MSK UCC.

If you need to send a fax to the Anesthesia Pain Service, the fax number is 212-717-3206.

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Anesthesia Pain Service Locations

The Anesthesia Pain Service has offices at multiple locations:

Memorial Hospital
1275 York Avenue, between East 67th and East 68th Streets
New York, NY 10065
MSK Westchester
500 Westchester Avenue 
West Harrison, NY 10604
MSK Commack
650 Commack Road
Commack, NY 11725
MSK Basking Ridge
136 Mountain View Boulevard 
Basking Ridge, NJ 07920 
MSK Monmouth
480 Red Hill Road 
Middletown, NJ 07748
MSK Bergen
225 Summit Avenue 
Montvale, NJ 07645
MSK Koch
530 East 74th Street Road 
New York, NY 10021
MSK Nassau
1101 Hempstead Turnpike 
Uniondale, NY 11553
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