The opioid epidemic in the United States has raised critical concerns about the appropriate use of opioids for chronic pain management.
As advanced nursing practice pharmacology students, understanding the risks, benefits, and evidence-based strategies is essential.
How to safely approach chronic pain patients while minimizing the potential for opioid misuse and overdose?
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In the face of the ongoing opioid epidemic, nurse practitioners (NPs) play a crucial role in managing chronic pain while mitigating risks associated with opioid misuse and overdose. A comprehensive approach that balances effective pain relief with safety can be structured around several key principles: careful patient assessment, the use of non-opioid pain management strategies, and continuous patient education and monitoring.
Firstly, it is imperative that NPs conduct thorough and continuous assessments of pain and function, which include not only the physical aspect of pain but also its psychological and social dimensions. Utilizing tools such as the PAINAD scale for patients with communication barriers or the McGill Pain Questionnaire can provide a more holistic view of the patient’s pain experience (Pasero & McCaffery, 2011).
Secondly, prioritizing non-opioid treatments can significantly reduce the reliance on opioids. According to the CDC guidelines, non-pharmacological therapies and non-opioid pharmacologic therapies are preferred for chronic pain (Dowell, Haegerich, & Chou, 2016). Options like cognitive-behavioral therapy, physical therapy, and interventions such as TENS units or acupuncture should be considered. Moreover, when pharmacologic treatments are necessary, medications such as NSAIDs or anticonvulsants should be utilized as first-line treatments before opioids are considered.
When opioids are necessary, it is critical to use the lowest effective dose and to prescribe the shortest duration possible. The CDC also recommends establishing goals for pain and function, and discontinuing opioids if the benefits do not outweigh risks (Dowell et al., 2016). Moreover, the practice of “Start low and go slow” should be adhered to, gradually adjusting the dose based on patient response.
Furthermore, NPs must provide robust patient education about the risks of opioid use, including the potential for addiction and overdose. Patients should be instructed on how to safely store and dispose of medications to prevent misuse by others. Regular follow-ups and the use of state prescription drug monitoring programs can help NPs track prescriptions and identify patterns that might suggest misuse (Haffajee & Bohnert, 2018).
Lastly, a collaborative approach should be employed, involving a team of healthcare professionals including pharmacists, physical therapists, and mental health specialists. This multidisciplinary team can provide a comprehensive management plan that addresses all facets of the patient’s health and pain.
By integrating these strategies, nurse practitioners can effectively manage chronic pain and contribute to the broader efforts to curb the opioid crisis.
References
- Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA, 315(15), 1624-1645.
- Haffajee, R. L., & Bohnert, A. S. B. (2018). Characteristics of U.S. counties with high opioid overdose mortality and low capacity to deliver medications for opioid use disorder. JAMA Network Open, 1(2), e180283-e180283.
- Pasero, C., & McCaffery, M. (2011). Pain assessment and pharmacologic management. Elsevier Health Sciences.