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Addiction and Pain Management

Integrated Pain Management and Addiction Prevention







Pain Management practices would benefit by having an addiction professional as part of their interdisciplinary team just as addiction treatment centers would benefit from a pain management professional educating and monitoring their clients. I would be very interested in working with a pain management practice for the benefit of clients, staff, and the organization as a whole. 

Opiate addiction has sky rocketed among the elderly, adolescents, young adults and mid-life adults. Since the cost of heroin is cheaper than the cost of prescription pain killers, I have treated many clients for severe opioid use disorders.

The challenge of pain management and addiction is great. We need more training and research to assist those substance users in chronic pain. No faith-based approach I am aware of addresses this important issue. 

Successful pain management in the recovering addict provides primary care physicians with unique challenges. Pain control can be achieved in these individuals if physicians follow basic guidelines such as those put forward by the Joint Commission on Accreditation of Healthcare Organizations in their standards for pain management as well as by the World Health Organization in their stepladder approach to pain treatment.

Legal concerns with using pain medications in addicted patients can be dealt with by clear documentation of indication for the medication, dose, dosing interval, and amount provided. Terms physicians need to be familiar with include physical dependence, tolerance, substance abuse, and active versus recovering addiction. Treatment is unique for 3 different types of pain: acute, chronic, and end of life. Acute pain is treated in a similar fashion for all patients regardless of addiction history.

However, follow-up is important to prevent relapse. The goal of chronic pain treatment in addicted patients is the same as individuals without addictive disorders—to maximize functional level while providing pain relief. 

"To minimize abuse potential, it is important to have 1 physician provide all pain medication prescriptions as well as reduce the opioid dose to a minimum effective dose, be aware of tolerance potential, wean periodically to reassess pain control, and use non-psychotropic pain medications when possible.

Patients who are at the end of their life need to receive aggressive management of pain regardless of addiction history. This management includes developing a therapeutic relationship with patients and their families so that pain medications can be used without abuse concerns. By following these strategies, physicians can successfully provide adequate pain control for individuals with histories of addiction."


 

Treatment is unique for 3 different types of pain: acute, chronic, and end of life. Acute pain is treated in a similar fashion for all patients regardless of addiction history. However, follow-up is important to prevent relapse. The goal of chronic pain treatment in addicted patients is the same as individuals without addictive disorders—to maximize functional level while providing pain relief. 

However, to minimize abuse potential, it is important to have 1 physician provide all pain medication prescriptions as well as reduce the opiate dose to a minimum effective dose, be aware of tolerance potential, wean periodically to reassess pain control, and use non-psychotropic pain medications when possible. Patients who are at the end of their life need to receive aggressive management of pain regardless of addiction history.
 
This management includes developing a therapeutic relationship with patients and their families so that pain medications can be used without abuse concerns. By following these strategies, physicians can successfully provide adequate pain control for individuals with histories of addiction."




Pain Management practices would benefit by having an addiction professional as part of their interdisciplinary team. I would be very interested in working with a pain management practice for the benefit of clients, staff, and the organization as a whole.