Effective Management of Acute and Chronic Pain with Opioid Analgesics, 2nd Edition _ ________________
III. ASSESSING PATIENTS IN PAIN HCPs should be knowledgeable about how to assess each patient when initiating a pain management program. When appropriate, evidence-based, standardized scales and tools can be used to document pain characteristics and guide management decisions throughout treatment, noting the strengths and weaknesses regarding specificity and sensitivity of these scales. Important elements of an initial assessment should include the following: 1. Patient history 2. Screening tools to evaluate the known risk factors for development of chronic pain after an acute injury or disease 3. Screening tools to evaluate the known risk factors for opioid use disorder (OUD) or abuse 4. Queries of state prescription drug monitoring programs (PDMPs)
• How to safely and effectively manage patients on opioid analgesics in the acute and chronic pain settings, including initiating therapy, titrating, and discontinuing use of opioid analgesics • How to counsel patients and caregivers about the safe use of opioid analgesics, including proper storage and disposal • How to counsel patients and caregivers about the use of naloxone for opioid overdose • When referral to a pain specialist is appropriate • The fundamental elements of addiction medicine • How to identify and manage patients with opioid use disorder In addition, HCPs will gain an understanding of current information about safe opioid practices and about current Federal [9] and State regulations, national guidelines [10] and professional organization [11] and medical specialty guidelines on treating pain and prescribing opioids. HCPs will also become familiar with the use of naloxone and with the importance of its availability for use by patients and caregivers both in the community and in the home. SECTION 1: THE BASICS OF PAIN MANAGEMENT I. THE NEED FOR COMPREHENSIVE PAIN EDUCATION The FDA Blueprint was developed with two, competing, U.S. public health concerns in mind, (1) the large number of Americans with acute and chronic pain and (2) the epidemic of prescription opioid abuse. 1. Providing health care providers (HCPs) with a thorough understanding of the risks associated with opioids can give HCPs the opportunity to consider all pain management options, including nonpharmacologic and pharmacologic options, prescribing opioids only when non-opioid options are inadequate and when the benefits of using an opioid are expected to outweigh the risks. 2. When HCPs have information about the risks of opioid misuse and abuse, they will be better able to create opportunities for patient counseling and other strategies to reduce these risks. II. DEFINITIONS AND MECHANISMS OF PAIN Pain can be categorized according to its duration, underlying pathophysiology of the original insult, and whether a central sensitization component has developed. An understanding of these different categorizations can help direct therapeutic decisions. When defining, and classifying pain, the following should be taken into consideration: 1. Biological significance of pain (survival value) 2. Relationship between acute and chronic pain 3. Distinction between nociceptive and neuropathic pain
5. Pain assessment scales/tools 6. Functional assessment scales 7. Physical examination
8. Family planning, including information about use of contraceptives, pregnancy intent/status and plans to breastfeed
9. Psychological and social evaluation 10. Diagnostic studies when indicated
SECTION 2: CREATING THE PAIN TREATMENT PLAN A comprehensive pain treatment plan should be developed and customized to the needs of the individual patient. The treatment plan should include the types of therapies planned, the goals of treatment, and an explanation of the patient and prescriber roles and responsibilities. The goals of treatment should be based on (1) expected outcomes of pain reduction; (2) improvement in functional outcomes impaired by pain (e.g., activities of daily living); and (3) quality of life. If HCPs encounter potential barriers to managing patients with pharmacologic and/or nonpharmacologic treatment options, such as lack of insurance coverage or inadequate availability of certain HCPs who treat patients with pain, attempts should be made to address these barriers. The overall treatment approach and plan should be well documented in the patient record, including written agreements and informed consent/patient provider agreements (PPAs) that reinforce patient-provider responsibilities and avoid punitive tones.
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MDUT1125
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