Racial and ethnic disparities in pain care Evidence documents disparities in health care in racial and ethnic minority populations, often related to such factors as lack of insurance or primary care access, discrimination, environmental barriers to self-management, lower likelihood of being screened for or receiving pain treatment and more. 3,23 The disparities extend to mental health care and addiction treatment where access to care is very limited for Black individuals, Indigenous individuals, and other individuals of color. There is evidence that racial and ethnic minority populations prefer seeking treatment in primary care over specialty mental health settings. 89 Active duty military, reserve service members, and veterans Pain management in veterans and active military members can be complex. Combat-related injuries include ballistic wounds, burns, over-pressurization, and blunt trauma. 3 In addition, complications can arise from PTSD and traumatic brain injury. 3 Delaying pain treatment can lead to acute pain becoming chronic. 90 Definitions related to opioid use and misuse The HHS Inter-Agency Task Force on best pain management practices endorsed a set of definitions to guide conversations and understanding of frequent
Veterans are also at risk for death by suicide, a risk compounded when pain conditions are present. HCPS can discuss suicide risk with service members and veterans and address pain treatment as part of suicide prevention as a recognized public health approach. 3 Medical complexities of pain care Genetic and phenotypic variations influence how quickly or well different people metabolize opioids and other drugs. 74 Medical conditions, including kidney and liver disease, also cause variations in opioid metabolism. 74 The FDA has approved some tests, for example, one aimed at determining whether a patient is a CYP2D6 ultra-rapid metabolizer. 76 However, little data actually exist to inform the practice of pain management, and these tests are not routinely performed. 91 HPCs should be aware that genetics is one of many factors that may affect drug metabolism and responses, so patient experience with certain pain treatments or medications should be used to develop individualized treatment plans.
terms related to opioid use and misuse. 3 These definitions are shown in Table 3.
Table 3: Definitions Related to Opioid Use and Misuse 3 Term Definition Physical dependence • Not the same as addiction.
• Occurs because of physiological adaptations to chronic exposure to opioids. • Withdrawal symptoms occur when medicine or opioid is suddenly reduced or stopped or when antagonist is administered. • Symptoms can be mild or severe and can usually be managed medically or avoided through slow opioid taper. • Same dose of opioid given repeatedly produces reduced biological response. • Higher dose of opioid is necessary to achieve initial level of response. • Taking medication in a manner or dose other than as prescribed. • Taking someone else’s prescription, even if for a medical complaint like pain. • Primary, chronic medical disease of brain reward, motivation, memory, and related circuitry. • Dysfunction in circuits leads to characteristic biological, psychological, social, and spiritual manifestations as individual pathologically pursues reward and/or relief by substance use and other behaviors. • Characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and dysfunctional emotional response. • Involves cycles of relapse and remission. • Without treatment or recovery activities, is progressive and results in disability or premature death. • Taking medication to feel euphoria (i.e., to get high). • Nonmedical use of prescription drugs refers to misuse.
Tolerance
Misuse
Addiction
Opioid-use disorder
• A problematic pattern of opioid use leading to clinically significant impairment or distress. • Defined by 11 criteria in the DSM-5* over a 12-month period. • Previously classified as “opioid abuse” or “opioid dependence” in DSM-4. • Severe opioid-use disorder also referred to as “opioid addiction.” *DSM-5 = Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition; 92 diagnostic criteria given later in this activity
Book Code: MDCO1025
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