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Introduction More than 76 million people in the U.S. are afflicted with chronic pain (DHHS, 2006).
Introduction Providers have an ethical obligation to provide adequate analgesia for all their patients. (ASPMN, 2002; ASAM, 2001) Opioid medications are effective for moderate to severe chronic nonmalignant pain. (Chou, 2009; Smith & Bruckenthal, 2010)
Statement of Purpose Chronic pain and the use of opioid medications for patients with addiction. Risks and barriers with opioid prescribing. Universal Precautions model for all patients. Screening tools and WAC 246
Conceptual Framework Virginia Henderson’s Need Theory Four major concepts include the individual, environment, health, and nursing. 14 components
Chronic Pain“…persistent pain, which can beeither continuous or recurrent andof sufficient duration and intensityto adversely affect a patient’s well-being, level of function, and qualityof life.” (D’Arcy & McCarberg,2007). It is generally consideredpain which lasts longer than 6months.
Opioid Therapy forChronic Pain inPatients withAddictionIn the U.S. opioid medications aresome of the most frequentlyprescribed drugs. The use of opioidmedications in chronicnonmalignant pain is supported bynational consensus guidelinesacross many professions. A historyof addiction should notautomatically mean no treatmentwith opioid medications.
Barriers to OpioidTherapyFrequently cited barriers includefear of regulatory punishment andinadequate education and trainingin pain management and chemicaldependency.
Risks Associated with Opioid PrescribingThe risks associated with opioid prescribing include abuse, misuse and diversion of opioid medications, aberrant drug-related behaviors and addiction.
Recommendations for Treatment Management Managing chronic pain requires diligence from providers to ensure adequate levels of analgesia and function are achieved with their pain management patients, while also mitigating the risks of abuse, misuse, addiction and diversion (Starrels, 2010).
Universal Precautions Model Diagnosis Reassessment of pain w/appropriate and function at regular differential intervals Screening for addiction Assess the “Five A’s” and mental health disorders Periodically review Informed Consent pain diagnosis and Treatment Agreement comorbid conditions Assessment of pain and Documentation function
Reference for PCP’sproviding painmanagement in theState of WashingtonThe state of Washington hasenacted new rules governing theprescribing of opioid painmedication for chronic,nonmalignant pain in an effort tocurtail the growing problems ofabuse, misuse, addiction anddiversion.
Summary Patients and providers alike benefit from a universal approachwhich emphasizes patient accountability, provider competence,and provides a well-structured and predictable framework for patients receiving pain management treatment with opioids.
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