Clinical opioid withdrawal scale: Difference between revisions
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==Criteria== |
==Criteria== |
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{| class="wikitable" |
{| class="wikitable" |
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− | ! |
+ | !Criterion |
− | ! |
+ | !0 |
− | ! |
+ | !1 |
− | ! |
+ | !2 |
− | ! |
+ | !3 |
− | ! |
+ | !4 |
− | ! |
+ | !5 |
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− | | |
+ | |'''Resting pulse rate'''<br />(measured after sitting or lying for 1 minute) |
− | | |
+ | |≤80 |
− | | |
+ | |81-100 |
− | | |
+ | |101-120 |
− | | |
+ | |>120 |
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− | | |
+ | |'''Sweating'''<br />(not accounted for by ambient temperature or recent activity) |
− | | |
+ | |No report of chills or lushing |
− | | |
+ | |Subjective report of chills or flushing |
− | | |
+ | |Flushed or observable moistness on face |
− | | |
+ | |Beads of sweat on brow or face |
− | | |
+ | |Sweat streming off face |
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− | | |
+ | |'''Restlessness'''<br />(observable during assessment) |
− | | |
+ | |Able to sit still |
− | | |
+ | |Reports difficulty sitting still, but is able to do so |
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− | | |
+ | |Frequent shifting or extraneous movements of legs/arms |
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+ | |Unable to sit still for more than a few seconds |
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+ | |'''Pupil size''' |
− | | |
+ | |Pupils pinned or normal size for room light |
− | | |
+ | |Pupils possibly larger than normal for room light |
− | | |
+ | |Pupils moderately dilated |
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− | | |
+ | |Pupils so dilated that only the rim of the iris is visible |
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+ | |'''Bone or joint aches'''<br />(only the portion attributed to opioid withdrawal) |
− | | |
+ | |Not present |
− | | |
+ | |Mild diffuse discomfort |
− | | |
+ | |Patient reports severe diffuse aching of joints/muscles |
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− | | |
+ | |Patient is rubbing joints or muscles and is unable to sit still because of discomfort |
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+ | |'''Runny nose or tearing'''<br />(not accounted for by cold or allergies) |
− | | |
+ | |Not present |
− | | |
+ | |Nasal stuffiness or unusually moist eyes |
− | | |
+ | |Nose running or tearing |
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⚫ | |||
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⚫ | |||
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− | | |
+ | |'''GI upset'''<br />(over last half hour) |
− | | |
+ | |No GI symptoms |
− | | |
+ | |Stomach cramps |
− | | |
+ | |Nausea or loose stool |
− | | |
+ | |Vomiting or diarrhea |
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− | | |
+ | |Multiple episodes of vomiting or diarrhea |
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− | | |
+ | |'''Tremor'''<br />(observable of outstretched hands) |
− | | |
+ | |No tremor |
− | | |
+ | |Tremor can be felt, but not observed |
− | | |
+ | |Slight tremor observable |
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− | | |
+ | |Gross tremor or muscle twitching |
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− | | |
+ | |'''Yawning'''<br />(observable during assessment) |
− | | |
+ | |No yawning |
− | | |
+ | |Yawning once or twice during assessment |
− | | |
+ | |Yawning three or more times during assessment |
− | | |
+ | | |
− | | |
+ | |Yawning several times per minute |
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− | | |
+ | |'''Anxiety or irritability''' |
− | | |
+ | |None |
− | | |
+ | |Patient reports increasing irritability or anxiousness |
− | | |
+ | |Patient obviously irritable/anxious |
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+ | |Patient so irritable or anxious that participation in the assessment is difficult |
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+ | |'''Gooseflesh skin''' |
− | | |
+ | |Skin is smooth |
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− | | |
+ | |Piloerection of skin can be felt or hairs standing up on arms |
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− | | |
+ | |Prominent piloerection |
+ | |- |
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+ | !Criterion |
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+ | !0 |
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+ | !1 |
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+ | !2 |
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+ | !3 |
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+ | !4 |
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+ | !5 |
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==Interpretation== |
==Interpretation== |
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+ | |||
− | * Mild: 5-12 |
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− | * |
+ | *Mild: 5-12 |
+ | *Moderate: 13-24 |
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− | * |
+ | *Moderately severe: 25-36 |
− | * |
+ | *Severe: more than 36 |
==Further Reading== |
==Further Reading== |
||
+ | |||
− | * |
+ | *The Clinical Opiate Withdrawal Scale (COWS). ''J Psychoactive Drugs''. 2003;35(2):253-259. doi: [https://doi.org/10.1080/02791072.2003.10400007 10.1080/02791072.2003.10400007] |
[[Category:Addiction medicine]] |
[[Category:Addiction medicine]] |
Latest revision as of 11:43, 20 February 2022
See also MDCalc COWS score
Criteria
Criterion | 0 | 1 | 2 | 3 | 4 | 5 |
---|---|---|---|---|---|---|
Resting pulse rate (measured after sitting or lying for 1 minute) |
≤80 | 81-100 | 101-120 | >120 | ||
Sweating (not accounted for by ambient temperature or recent activity) |
No report of chills or lushing | Subjective report of chills or flushing | Flushed or observable moistness on face | Beads of sweat on brow or face | Sweat streming off face | |
Restlessness (observable during assessment) |
Able to sit still | Reports difficulty sitting still, but is able to do so | Frequent shifting or extraneous movements of legs/arms | Unable to sit still for more than a few seconds | ||
Pupil size | Pupils pinned or normal size for room light | Pupils possibly larger than normal for room light | Pupils moderately dilated | Pupils so dilated that only the rim of the iris is visible | ||
Bone or joint aches (only the portion attributed to opioid withdrawal) |
Not present | Mild diffuse discomfort | Patient reports severe diffuse aching of joints/muscles | Patient is rubbing joints or muscles and is unable to sit still because of discomfort | ||
Runny nose or tearing (not accounted for by cold or allergies) |
Not present | Nasal stuffiness or unusually moist eyes | Nose running or tearing | Nose constantly running or tears streaming down cheeks | ||
GI upset (over last half hour) |
No GI symptoms | Stomach cramps | Nausea or loose stool | Vomiting or diarrhea | Multiple episodes of vomiting or diarrhea | |
Tremor (observable of outstretched hands) |
No tremor | Tremor can be felt, but not observed | Slight tremor observable | Gross tremor or muscle twitching | ||
Yawning (observable during assessment) |
No yawning | Yawning once or twice during assessment | Yawning three or more times during assessment | Yawning several times per minute | ||
Anxiety or irritability | None | Patient reports increasing irritability or anxiousness | Patient obviously irritable/anxious | Patient so irritable or anxious that participation in the assessment is difficult | ||
Gooseflesh skin | Skin is smooth | Piloerection of skin can be felt or hairs standing up on arms | Prominent piloerection | |||
Criterion | 0 | 1 | 2 | 3 | 4 | 5 |
Interpretation
- Mild: 5-12
- Moderate: 13-24
- Moderately severe: 25-36
- Severe: more than 36
Further Reading
- The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs. 2003;35(2):253-259. doi: 10.1080/02791072.2003.10400007