Daily chronic pain, opioid use disorder add to the challenges of relieving pain among patients

The combination of more Americans reporting daily chronic pain and the rapidly increasing prevalence of opioid misuse and opioid use disorder (OUD) adds to the challenges of relieving patients' pain effectively and safely.

Most acutely and critically ill patients experience pain during their illness or injury, and pain management is essential to providing optimal care, delivering appropriate relief and preventing chronic pain with its long-term impact on quality of life.

These challenges, as well as significant gaps related to effective pain management in acutely and critically ill patients, are the focus of a series of seven articles in the winter 2019 issue of AACN Advanced Critical Care.

One of the symposium articles, "Assessing Patients' Risk for Opioid Use Disorder," reviews risk factors for OUD and opioid misuse, validated risk assessment tools and strategies for monitoring patients for OUD and opioid misuse.

Author Barbara St. Marie, PhD, AGPCNP, is assistant professor, College of Nursing at the University of Iowa, Iowa City.

"Opioids will always play a large role in management of acute pain. The challenge is to address urgent needs to relieve patients' pain while preventing misuse and reducing incidents of opioid use disorder," she said. "Patients who are prescribed opioids are increasingly concerned with the risks of using them, and healthcare providers need to be ready to answer their questions."

The article provides an overview of the four most widely used opioid risk assessment tools, which can be used as part of conversations about pain, treatment options and associated risks.

In addition to ongoing assessment and review, methods of helping clinicians monitor for opioid misuse include prescription drug monitoring programs and urine drug toxicology screening. These methods can yield additional information to facilitate the care of patients with pain in the context of OUD.

St. Marie also encourages healthcare providers to overcome any reluctance to refer patients to substance abuse treatment.

"Less than 10% of admissions to substance abuse treatment result from referrals by a healthcare provider. We must increase this percentage if patients are to receive the care they need," she said.

She offered a few strategies to ensure safe care for patients who are discharged from the hospital in pain and considered at high risk for OUD or opioid misuse:

• Designate a responsible person who has been vetted as a reliable caregiver to be in charge of opioid medications, with comprehensive instructions for safe use.
• Order a computerized lockbox for the medication and arrange for them to be dispensed on a predetermined schedule.
• Transfer the patient to a transitional care unit where opioid medications can be administered for short-term pain management while the patient is recovering from illness or injury.
• Determine whether pain can be managed effectively with nonopioid medications and nonpharmacological interventions.

Céline Gélinas, PhD, RN, served as editor for the symposium. She is associate professor, Ingram School of Nursing, McGill University, and a researcher at the Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, in Montréal, Québec, Canada.

"Appropriate pain relief is an important element to optimize recovery and to prevent development of chronic pain, but it remains a daily challenge," she said. "This symposium offers important updates on key topics, as well as relevant assessment tools, strategies and interventions for nurses and care teams to use and to help them provide the best and safest care to patients and families."