At the same time, there is a recently recognized potential for harm in suddenly discontinuing or rapidly tapering doses in patients who have been on long-term opioids or in forcing patients who have been stable on higher doses to reduce to a set threshold dose. 3,18-20 It is also critical that HCPs recognize and optimally manage OUD when present. Distressingly few people who need treatment for substance- use disorder (SUD) are able to access it, and far more people need treatment for OUD than receive it. In 2019, using adjusted estimates of past-year OUD prevalence, there was a gap in medication for OUD receipt for 8,986,485 individuals. 21 Solutions will include more accessibility of OUD treatment, including greater access to medications to treat OUD, and measures to prevent prescription and illicit drug misuse from developing in the first place. 22 For acute pain and for some chronic pain, unresponsive to non-opioid therapies, opioids may form part of a customized treatment plan. A subset of patients may benefit from treatment with opioids long term, for example, during severe exacerbations of pain during the course of chronic conditions. 23 More than ever, HCPs are called on to optimize a range of available therapies and reserve opioids for when the benefits are expected to outweigh the risks and nonopioid options are inadequate.
This educational activity is built on core messages of the U.S. Food and Drug Administration’s (FDA’s) Blueprint for the Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS). It provides guidance on safely prescribing opioid analgesics, including all extended-release and long- acting (ER/LA) and immediate-release/short-acting (IR/ SA) formulations. It is targeted to all HCPs who treat and monitor patients with pain, not prescribers alone. It stresses the importance of competence in considering and using a broad range of pharmacologic and nonpharmacologic therapeutic options for managing pain as well as in recognizing and managing OUD when indicated. The goal is to equip HCPs to recognize and manage any adverse events that may arise when a trial of potentially long-term opioids is part of a comprehensive treatment plan. Self-Assessment Question 1 Which percentage of patients prescribed opioids for chronic pain develop an opioid use disorder (OUD)?
a. 4% to 8% b. 8% to 12% c. 12% to 16% d. 16% to 20%
PAIN DEFINITIONS
● As existing independently of the ability to express its presence verbally, that is, verbal description is only one of several behaviors to express pain, and inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain. There are no precise clinical markers for pain, which is experienced by the individual as a constellation of biological, psychological, and social factors that include race and ethnicity (Figure 2). 3 This biopsychosocial model is now preferred to an earlier era’s biomedical model of pain care, which primarily aimed medical, procedural, and surgical treatments at a presumed biological pain generator in an attempt to fix or numb pain. 23 Given pain’s complexity, it is important to perform a thorough patient evaluation so that the presumed or differential diagnosis is accurate in order to select the best therapeutic option. 3
The International Association for the Study of Pain (IASP) revised its pain definition in 2020 to better convey pain’s nuances and complexities and to improve its assessment and management. The IASP defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” 24 The IASP further describes pain as follows: 24 ● As a personal experience that is influenced to varying degrees by biological, psychological, and social factors. ● As a separate phenomenon from nociception that cannot be inferred solely from activity in sensory neurons. ● As a concept learned through the life experiences of individuals. ● As an experience that should be respected. ● As serving an adaptive role that may, nonetheless, have adverse effects on function and social and psychological well-being.
Figure 2: The Biopsychosocial Model of Pain 1
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Book Code: MDCO1025
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