Prescription Opioids: Risk Management and Strategies for Safe Use _ _________________________________ • Pain specialist • Nurse
purpose of the referral, with the following approach suggested [177]: • Present the substance abuse disorder referral as you would to any other specialist, using a matter-of-fact and unapologetic tone. • Emphasize the importance of assessing all factors, including substance abuse disorders, that may be contributing to chronic pain and that ongoing problems with substance abuse can interfere with optimal treatment of chronic pain. • Avoid focusing on patient explanations of their substance use. • Reassure patients that further evaluation and possible treatment of their substance abuse problem does not mean abandonment by their healthcare provider or neglect of their chronic pain condition. Emphasize that their care will be coordinated among all involved professionals. • Reassure the patient that federal regulations hold clinicians to a high standard of confidentiality concerning patient drug and alcohol treatment information. TREATMENT OF SUBSTANCE USE DISORDER Not infrequently, primary care providers do not have access to specialized addiction professionals or programs for patient referral. Although coexisting pain and addiction rank among the most challeng- ing conditions to manage in primary care, recovery is possible. Providers should practice patience, flex- ibility, and consistent motivational support with the patient. When addiction specialists are lacking, clinicians should [178]: • Identify contributory factors to the chronic pain and use of substances • Encourage and support the patient in develop- ing a self-care program • Implement or refer to initiate active treatment of the various underlying factors • Provide regular patient follow-up to monitor self-care and treatments and to revise the plan, as needed
• Pharmacist • Psychiatrist • Psychologist • Other behavioral health specialists, such as social workers or marriage and family therapists • Physical or occupational therapists To help build a therapeutic relationship with the patient, the following approach is suggested [177]: • Listen actively. • Ask open-ended, nonjudgmental questions. • Restate patient accounts to make sure they have been understood. • Use clarifying statements (e.g., “It sounds as if the pain is worse than usual this week”). • Demonstrate empathy. One approach is to acknowledge the effort required to simply get through each day with constant pain. • Use feeling statements (e.g., “This must be very difficult for you”). Referral to an addiction professional for further substance abuse disorder evaluation and possible treatment does not negate patient need for pain treatment, because addiction treatment programs rarely have the resources or expertise to treat pain. Patients who are seeking treatment for chronic pain with an unacknowledged substance abuse disorder may react negatively when told of their referral to an addiction professional. The clinician-patient relationship is especially critical for patients who have comorbid pain and substance abuse disorders. They may anticipate clinician criticism or judg- ment of their substance use, dismissal of their pain complaints, or misinterpret concern over a possible substance abuse disorder as lack of concern for their pain. They may blame themselves for the substance abuse problem and expect their healthcare provider to respond in kind. Clinicians should convey respect and concern and reassure patients they fully under- stand the pain and the substance abuse disorder are uninvited chronic illnesses requiring concurrent treatment. It is important to clearly explain the
46
MDMS1526
Powered by FlippingBook