Managing Chronic Nonmalignant Pain in Patients with Addiction:

Barriers, Risks and Recommendations

Karen S. RawlinsWashington State University

Introduction

More than 76 million people in the U.S. are afflicted with chronic pain (DHHS, 2006).

Introduction

Providers have an ethical obligation to provide adequate analgesia for all their patients. (ASPMN, 2002; ASAM, 2001)

Opioid medications are effective for moderate to severe chronic nonmalignant pain. (Chou, 2009; Smith & Bruckenthal, 2010)

Chronic pain and the use of opioid

medications for patients with addiction.

Risks and barriers with opioid prescribing.

Universal Precautions model for all patients.

Screening tools and WAC 246

Statement of Purpose

Conceptual Framework

Virginia Henderson’s Need Theory

Four major concepts include the individual, environment, health, and nursing.

14 components

Chronic Pain“…persistent pain, which can be either continuous or recurrent and of sufficient duration and intensity to adversely affect a patient’s well-being, level of function, and quality of life.” (D’Arcy & McCarberg, 2007). It is generally considered pain which lasts longer than 6 months.

Opioid Therapy for Chronic Pain in Patients with AddictionIn the U.S. opioid medications are some of the most frequently prescribed drugs. The use of opioid medications in chronic nonmalignant pain is supported by national consensus guidelines across many professions. A history of addiction should not automatically mean no treatment with opioid medications.

Barriers to Opioid TherapyFrequently cited barriers include fear of regulatory punishment and inadequate education and training in pain management and chemical dependency.

Risks Associated with Opioid PrescribingThe risks associated with opioid prescribing include abuse, misuse and diversion of opioid medications, aberrant drug-related behaviors and

addiction.

Recommendations for Treatment

Management

Managing chronic pain requires diligence from providers to ensure adequate levels of analgesia and function are

achieved with their pain management patients, while also mitigating the risks of abuse, misuse, addiction and

diversion (Starrels, 2010).

Universal Precautions Model

Diagnosis w/appropriate differential

Screening for addiction and mental health disorders

Informed Consent Treatment Agreement Assessment of pain

and function

Reassessment of pain and function at regular intervals

Assess the “Five A’s” Periodically review

pain diagnosis and comorbid conditions

Documentation

Reference for PCP’s providing pain management in the State of WashingtonThe state of Washington has enacted new rules governing the prescribing of opioid pain medication for chronic, nonmalignant pain in an effort to curtail the growing problems of abuse, misuse, addiction and diversion.

Summary

Patients and providers alike benefit from a universal approach which emphasizes patient accountability, provider competence, and provides a well-structured and predictable

framework for patients receiving pain management treatment with opioids.

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