


Pain management is not a one-size-fits-all practice
Addiction concerns put healthcare professionals in precarious position

By
Carole Jakucs, MSN, RN, PHN

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For providers who oversee pain management in acute care settings and nurses who administer pain medications, alleviating pain for patients can be an ongoing challenge. In an era when one only has to turn on the news to hear about the opioid crisis, finding the sweet spot to achieve pain relief for patients while addressing concerns about preventing future addiction is no easy task.
Treating pain and society’s view of pain management
concern about addiction is a complicated problem
that requires complex solutions.”
There are growing concerns now about the use of opioids and what is being prescribed, said Christina Almgren, MSN, RN, CPNP, pediatric pain management nurse practitioner at Lucile Packard Children’s Hospital Stanford in Palo Alto, Calif.
“Limits are being looked at as to amounts of opioids that may be dispensed," she said. "Some insurance companies limit the amount they’ll cover in a certain period. There have been misguided beliefs that having access to pain medications for post-op pain creates addiction, but we know this is not the whole picture. One needs to consider the societal, genetic and psychological predictors when evaluating the use of pain medications. Even the addict can have a catastrophic injury or surgery and require pain medications.” Will inadequate pain control lead to addiction later?
When patients do become addicted to substances, thus far it does not appear to be related to the length of their hospital stay or the level of pain relief achieved as an inpatient, but rather the patient’s personal profile, the brain disease of addiction and the availability of drugs, Bernhofer said.
Ideas to improve pain treatment in acute care settings
•
Someone who is biologically wired for addiction may have poor pain control and go on to develop addiction problems, while another patient with no predisposition for addiction, given equally poor pain control, will have no issues.”
— Christina Almgren, RN
Address concerns about long-term opioid use
“All stakeholders need to come together,” said Tran, who sees a three-pronged approach that could be used to reduce the use of opioids in patients.
“First, connecting patients with multiple disciplines such as physical therapy, massage therapy, psychotherapy, acupuncture, water therapy, are some examples of alternative therapies that can provide pain relief,” he continued. “Second, we need to figure out at a policy level who is going to pay for these treatments. If we want to reduce dependency on pain medication, we need to look at paying for additional therapies that can help make that happen. Third, follow-up with a pain specialist is also part of the equation, to work with patients in determining what’s working and what’s not, while managing their medication and weaning them down when their pain subsides.”
Educating patients on medications is key
, Almgren said.
“Patients should be instructed on appropriate use of opioids as well as how to dispose of any extras,” she said. “Bottles of leftover pills in the home can be tempting to curious adolescents.”
Nonpharmacological techniques should also be utilized for both acute and chronic pain
, Almgren said. “Distraction methods such as virtual reality goggles worn during wound dressing changes can decrease the amount of medication a patient requires for the procedure. It’s important to connect patients with nonpharmacological options they find effective.” •
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EDITOR'S NOTE:
Carole Jakucs, MSN, RN, PHN, is a freelance writer.
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