Effective Management of Acute and Chronic Pain with Opioid Analgesics, 2nd Edition _ ________________
A wide range of complementary and alternative therapies (CAT) are commonly used in end-of-life care. CAT interventions are aimed at reducing pain, inducing relaxation, and enhancing a sense of control over the pain or the underlying disease. Breathing exercises, relaxation, imagery, hypnosis, and other behavioral therapies are among the modalities used. Psychosocial interventions for end-of-life pain may include cancer pain education, hypnosis and imagery-based methods, and coping skills training. Educational programs are one of the most common interventions to address cancer pain barriers. CONCLUSION Managing pain is particularly challenging in an era when society is grappling with an epidemic of opioid misuse and overdose. This learning activity has reviewed an evidence-based path forward, based on a biopsychosocial model of pain and an emphasis on holistic assessment, individualized treatment planning, and multimodal therapeutic approaches. Physicians and caregivers need to base pain treatment plans on realistic functional goals and the level of pain management needed to reach those goals using a shared decision- making approach. As detailed in this activity, chronic pain syndromes respond differently to available pharmacologic and nonpharmacologic treatments, but in general, nondrug options (which can be as effective as drug options) should be tried first when possible. When drug options are considered, it is important to maximize nonopioid options before prescribing opioids. For selected patients requiring opioids, the risk of long-term opioid treatment should be minimized through patient education, screening of high-risk patients for OUD, continuous monitoring, use of alternative nonopioid options, and careful tapering when appropriate. Since much acute pain is self-limiting and remits with healing (typically within a month), helping patients frame expectations about acute pain and pain relief can provide reassurance and reduce fear, worry, and distress. Multimodal approaches should be used to manage acute pain, combining nondrug (e.g., interventional procedures, physical rehabilitation, and psychological support) as well as appropriate drug-based options. Opioid analgesics should be reserved for severe pain that does not respond to all other approaches and then should be used at the lowest doses, and shortest durations, appropriate for the pain intensity expected with the precipitating event. This activity has laid out the evidence supporting these conclusions and provides the basis for improved treatment and reduced risk, both for patients and society at large.
APPENDIX A
FDA’S OPIOID ANALGESIC REMS EDUCATION BLUEPRINT FOR HEALTH CARE PROVIDERS INVOLVED IN THE TREATMENT AND MONITORING OF PATIENTS WITH PAIN
(SEPT 2018) Background
In July 2012, FDA approved the Extended-Release and Long-Acting (ER/LA) Opioid Analgesic Risk Evaluation and Mitigation Strategy (ER/LA REMS) to ensure that the benefits of ER and LA opioid analgesics used in the outpatient setting outweigh the risks. That REMS was modified and the new Opioid Analgesic REMS includes, in addition to ER/LA opioid analgesics, all immediate-release (IR) opioids used in the outpatient setting that are not already covered by another REMS program. The Opioid Analgesic REMS is intended to support other national efforts underway to address the misuse and abuse of prescription opioid analgesics. As part of the Opioid Analgesic REMS, all opioid analgesic companies must provide the following: • Education for health care providers (HCPs) who participate in the treatment and monitoring of pain. For the purpose of the Opioid Analgesic REMS, HCPs will include not only prescribers, but also HCPs who participate in the treatment and monitoring of patients who receive opioid analgesics, including pharmacists and nurses. ‒ Education will be offered through accredited continuing education (CE) activities. These activities will be supported by unrestricted educational grants from opioid analgesic companies. • Information for HCPs to use when counseling patients about the risks of ER, LA, and IR opioid analgesic use. To facilitate the development of CE educational materials and activities as part of the Opioid Analgesic REMS, FDA has also revised the education blueprint ― originally designed to facilitate development of CE educational materials under the ER/LA REMS. FDA has completed the revisions to the FDA Education Blueprint for Health Care Providers Involved in the Treatment and Monitoring of Patients with Pain (FDA Blueprint), following publication of a draft version and consideration of received public comments. The FDA Blueprint contains a high-level outline of the core educational messages that will be included in the educational programs developed under the Opioid Analgesic REMS. The FDA Blueprint focuses on the fundamentals of acute and chronic pain management and provides a contextual framework for the safe prescribing of opioid analgesics.
WORKS CITED https://qr2.mobi/EffectiveManagement
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MDUT1125
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