● Emphasize to patients and their caregivers the importance of reading the medication guide provided by their pharmacist every time an opioid analgesic is dispensed to them. ● Consider using other tools to improve patient, household, and community safety, such as patient–prescriber agreements reinforcing patient–prescriber responsibilities. Give special safety instructions to patients with young children, especially toddlers, and those who live with a child or adult who is cognitively impaired. For example, prescribing a controlled substance to a patient with Alzheimer’s disease or other cognitive impairments must involve instructions to a responsible adult in the home. Family members should also have a plan for accidental overdoses, including poison control (1- 800-222-1222) for unintentional ingestion of a known or unknown substance. In addition, family members should call 911 to initiate emergency services if the individual is in respiratory distress and administer naloxone if available. Healthcare Consideration: Assessment of acute and chronic pain should be multidimensional. Consideration should be given to several domains, including the physiological features of pain and its contributing factors, with physicians and other clinicians assessing patients for function, quality of life, mental health, and emotional health. In addition to a complete medical and medication history typically obtained at an office visit, document pain intensity, location, duration, as well as factors that aggravate or alleviate pain (AAFP, 2021).
Counsel patients regarding common adverse effects of opioids used for acute pain. Upon initiation of opioid therapy, it is common for patients to experience sedation, nausea or vomiting, and pruritus. In most cases, these effects resolve within a few days. It is important to note that opioid-induced itching does not always indicate an allergic reaction, as opioids induce the release of histamine. Treatment with antihistamines usually resolves the itching but may increase sedation. Ensure patients are aware of the risk of oversedation, respiratory depression, and overdose, and recommend not taking more medication than prescribed without discussing it with their prescriber. The FDA approved the Opioid Analgesic Risk Evaluation and Mitigation Strategies (REMS), which apply to all opioid analgesics for outpatient use. The REMS program requires that training be made available to all healthcare providers involved in managing patients with pain, including nurses and pharmacists (FDA, 2021). Therefore, prescribers are strongly encouraged to do all of the following: ● Complete a REMS-compliant education program offered by an accredited continuing education (CE) provider or another education program that includes all the elements of the FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain. ● Use the Patient Counseling Guide (PCG) to discuss the safe use, serious risks, and proper storage and disposal of opioid analgesics with patients and their caregivers. Integrative nursing Kreitzer and Koithan (2019) define integrative nursing as a “way of being-knowing-doing that advances the health and well- being of persons, families, and communities through caring/ healing relationships. Integrative nurses use evidence to inform traditional and emerging interventions that support whole person/whole system healing” (p. 4). Integrative medicine and integrative nursing are the same. In the past, these therapies were called complementary because they were adjuncts to the prescribed treatment regimen. Some called these therapies nonsense. The opioid epidemic has pressured providers with the option to prescribe more controlled substances or offer alternatives. Literature shows that integrative therapies positively affect patients’ perception of pain. For example, DeBar et al. (2022) found that primary care–based cognitive-behavioral therapy (CBT) intervention using frontline clinicians produced modest but sustained reductions in measures of pain and pain-related disability compared with usual care. A similar positive finding was demonstrated for yoga and low back pain. A systematic review published in 2022 found that yoga revealed robust short- and long-term effects on pain, disability, physical function, and mental health compared with nonexercise controls (Anheyer et al., 2022). In their book Integrative Nursing , Kreitzer and Koithan (2019) offer a tiered approach to pain management. Nurses have offered these therapies to their patients for years. The different tiers and integrative therapy approaches are shown in Table 6.
Table 6. Tiered Integrative Approaches to Pain Management* Tiered Intervention Integrative Approaches Examples Tier 1 • Hot/cold therapy. • Relaxation response. • Guided imagery. Tier 2 • Aromatherapy. • Yoga. • Hydrotherapy. Tier 3
• Cognitive-behavioral (pain management) therapy. • Mindfulness-based stress reduction meditation. • Massage. • Acupressure. • Homeopathy. • Chiropractic care. • NSAIDs. • Transcutaneous electrical nerve stimulation.
Tier 4
Tier 5 • Pharmacological therapies. • Surgical procedures. • Nerve blocks. *Adapted from Integrative Nursing (Kreitzer & Koithan, 2019)
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Book Code: AUS3024
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