Chronic Pain Flashcards
Identify barriers to effective chronic pain management
Pain as a sign of ‘weakness’ Accepted as part of aging Fear of serious illness Concerns for medication effects Concern for addiction Failure to report pain to provider Anticipating pain will go away Reluctance to upset status-quo
Provider Barriers
Inadequate training Consider pain inevitable & accepted Biases of race, gender, culture, age, disability Behavioral cues (or lack thereof) Negative feelings toward patients Legal fears
Health Care System Barriers
Failure to adopt a specific assessment tool
Time
Fragmented care, poor coordination/communication
Reimbursement policies
Limited access to specialty consultation
Health insurance
Failure to acknowledge pain as a cause of disability
Cultural Barriers
Increased risk for underuse of analgesics in ethnic & racial minorities
Linguistic & cultural differences
Pharmacies in minority neighborhoods less likely to have opioids in stock
In ER analgesic use influenced by race & ethnicity, despite controlling for gender, language, insurance status, severity of experience
African American patients less likely to receive analgesic medications
Impact of language & culture on descriptions of pain
Legal/Regulatory Barriers
Controlled Substance Act DEA Risk Evaluation and Mitigation Strategies (REMS) State medical boards CME
Overcoming Barriers (will be on test)
Know your biases EBM Comprehensive patient evaluation Team-based care Education of both patient & provider Shared goals
Identify your own biases and their potential impact on clinical judgment
Use scientific evidence and knowledge of pathophysiology and pharmacology to drive care decisions
Pain Dilemma
Balance two public health concerns:
Prevention & treatment of drug abuse & related problems
Improved care of patients with unrelieved pain
IOM: “Underlying Principles”
A moral imperative. Effective pain management is a moral imperative, a professional responsibility, and the duty of people in the healing professions.
Chronic pain can be a disease in itself. Chronic pain has a distinct pathology, causing changes throughout the nervous system that often worsen over time. It has significant psychological and cognitive correlates and can constitute a serious, separate disease entity.
The committee recognizes the serious problem of diversion and abuse of opioid drugs, as well as questions about their long term usefulness.
However, the committee believes that when opioids are used as prescribed and appropriately monitored, they can be safe and effective, especially for acute, postoperative, and procedural pain, as well as for patients near the end of life who desire more pain relief.
biggest source of misused drugs?
55% of people who are misusing drugs get them from a friend
Competencies for Safe Prescribing
Evaluate opioid abuse risk using a validated screening tool
Effectively establish a chronic pain contract
Properly interpret UDT
Treat and monitor patients at highest risk for abuse
Integrated recovery program Addiction specialist Conditional prescribing & participation in recovery program, PT/OT etc. Tox screens, pill counts Quantities & frequency of prescribing Scheduled long acting rather than prn Informed consent/opioid use agreements Records release & effective communication with patient, family, other providers
