Q Quality and Quantity of symptoms: Is it dull, sharp, constant, intermittent, throbbing, pulsating, aching, tearing, or stabbing? R Radiation or Region of symptoms: Does the pain travel, or is it only in one location? Has it always been in the same area, or did it start somewhere else? S Severity of symptoms or rating on a pain scale. Does it affect activities of daily living, such as walking, sitting, eating, or sleeping? T Time or how long have they had the symptoms? Is it worse after eating, changes in weather, or time of day? Other tools, such as the Brief Pain Inventory form, provide an assessment of pain and gauge treatment (AAFP, 2021).
● Pain insensitivity, which is also known as congenital analgesia and is one or more rare conditions in which a person cannot feel (and has never felt) physical pain. ● A sensory examination that could include response to light touch, light pressure, pinpricks, cold, or vibrations. (Clark & Galati, 2015) PQRST P What provokes symptoms? What improves or worsens the condition? What were you doing when it started? Do position changes or activities make it worse?
OPIOIDS FOR CHRONIC NONCANCER PAIN IN ADULTS
An estimated 100 million adults in the United States are affected by chronic pain and are commonly diagnosed with chronic low back pain, joint pain/arthritis, or headaches (Smith & Hillner, 2019). Chronic pain often has no cure; treatment will not provide complete resolution. Treatment interventions for chronic pain should focus on the long-term management of physical, psychological, and social symptoms to improve pain management and quality of life and decrease suffering. Thus, a multidisciplinary, multimodality approach is the most effective Assessment of adults for chronic opioid therapy A comprehensive assessment of the patient, caregiver(s), and family member(s) is necessary to determine an appropriate chronic pain management regimen. The goal is to determine the nature of the pain and how the pain affects the function and quality of life, assess prior treatment approaches, and detect other conditions that could influence the decision to utilize opioid analgesics (AAFP, 2021). The assessment should include: ● Nature and intensity of pain. ● Past and current treatment regimens and responses, including adverse effects or reactions. ● How pain impacts physical and psychological function. ● How pain influences sleep, mood, work, relationships, leisure, and substance use. ● Identification of concurrent conditions that may increase the risk for adverse events (e.g., obesity, renal disease, sleep apnea, COPD). ● Review of current medications; identify interacting drugs and other CNS depressants.
method to manage adults’ chronic noncancer pain (Smith & Hillner, 2019). Self-Assessment Quiz Question #4 Are integrative nursing therapies and complementary therapies the same?
a. Yes. b. No.
● Social support, housing, employment, or recent military deployment. ● Patient and family history of mental health disorders (e.g., bipolar, attention deficit disorder (ADD) / attention deficit hyperactivity disorder (ADHD), depression, posttraumatic stress disorder). ● Patient and family history of substance use, addiction, or dependence. ● Determination of any history of physical, emotional, or sexual abuse and risk factors for substance abuse disorder; validated screening tools for substance abuse disorder help determine a patient’s risk level. ● Review of PDMP results. ● Monitoring of PDMP regularly throughout chronic pain management follow-up to determine if the patient obtains other controlled substance prescriptions from other providers. If the prescriber institutes long-term opioid therapy, a written informed consent and treatment agreement are recommended. The informed consent may address several issues, such as: ● Limited evidence of the benefit of opioids or other medications in managing chronic pain (except for cancer). ● Potential risks and benefits of opioid therapy. ● Potential short- and long-term side effects of opioid therapy. ● The likelihood that tolerance to and physical dependence on the medication will develop. ● Risk of drug interactions and oversedation. ● Risk of impaired motor skills. ● Risk of substance abuse disorder, overdose, and death. ● The clinician’s prescribing policies (e.g., number and frequency of refills, early refills, exceptions). ● Reasons a drug may be changed or discontinued; treatment may be discontinued without agreement from the patient, such as violations of the treatment agreement. ● Education for patients stating that complete elimination of pain should not be expected. (HHS, 2019a)
Informed consent and treatment plans for chronic opioid treatment The patient-specific treatment plan should be developed and reviewed regularly to ensure that both the clinician and patient agree on the goals of the therapy, treatment regimen, and options. Consider different treatment modalities, such as an interventional approach, a formal pain rehabilitation program, physical medicine, psychological and behavioral strategies, or medications (nonopioids and opioids), depending upon the physical and psychosocial issues related to the pain. Opioid therapy is not the appropriate first-line treatment for most patients with chronic pain. It should be reserved for intractable chronic pain not adequately managed with more conservative or interventional methods. Other nonopioid medications, treatment modalities, and nonpharmacological therapy should be tried first. Practitioners should document the effectiveness or failure of these medications before initiating opioid therapy (CDC, 2022a; Dowell et al., 2016).
Suppose the prescriber determines that an opioid trial is an appropriate treatment option. In that case, the patient, caregiver(s), and family member(s) are informed of the risks and benefits of opioid analgesic therapy and the conditions under which the opioids are being prescribed. A trial implies that opioids are used for a short period (i.e., weeks or a couple of months), and continued use will be contingent upon demonstrated improvement in pain, physical function, and quality of life with no significant adverse reactions or aberrant behaviors (Kroenke et al., 2019).
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