Pain Management in an Opioid Epidemic: What’s Appropriate, What’s Safe

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Every patient has a right to adequate and safe pain control—but NPs and PAs must be aware of the potential for some patients to misuse opioids by taking them in a different way than intended, in a different quantity than prescribed, or without a prescription.13 Having prescriptive authority confers an obligation for NPs and PAs to recognize the prevalence of drug misuse and its impact on patients, families, and society.

Regrettably, there is lack of clarity in the literature about specific characteristics and demographic data that can help determine who is at risk for opioid misuse.14 For example, risk factors that have been associated with drug misuse include a personal or family history of substance abuse; younger age; and an ongoing psychiatric condition.

In contrast, Kennedy and colleagues determined that patients seeking prescription opioids for misuse or abuse tend to be older; be of Caucasian background; have a history of overdose; be receiving methadone maintenance therapy; and have been incarcerated.15 In addition, several characteristics—having moderate or extreme pain, disability, or a history of being refused pain medication—were also associated with a history of seeking prescription opioids to abuse.15

This diverse set of variables underscores the importance of obtaining and documenting a complete history from patients who are experiencing (and seeking relief of) pain; performing a thorough physical exam; and asking specific questions about the patient’s level of pain and the potential for misuse of pain medication.

Gathering this information may help identify patients at risk for opioid misuse or abuse. Furthermore, it ensures that a patient’s chronic pain is not being undertreated and that he/she is not being undeservedly labeled or judged as a drug seeker or abuser.

Continue to: Tools and strategies for appropriate use of opioids

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