PHILADELPHIA — Successfully treating patients with chronic pain and opioid use disorder must involve the patient being actively engaged in self-management of their condition, according to a presenter here at the annual meeting of the American Association of Nurse Practitioners.
“Just as we would with diabetes, asthma, hypertension and cardiac disease, we don’t just give patients the medication, we say ‘Let’s work on some of the factors that contribute to your condition.’ So, if someone has diabetes, we want them to be exercising, we want them to be eating right … We don’t just give them insulin,” Seddon Savage, MD, MS, FASAM, medical director, Chronic Pain Recovery Center, Silver Hill Hospital, New Canaan, Connecticut, told Healio Family Medicine in an interview. “If someone has chronic pain, just giving that person medication isn’t necessarily going to take care of that chronic pain. What health care professionals need patients to do is recognize what’s contributing to the pain.”
A critical component to patients managing chronic pain is recognizing and understanding the physical, psychological and social factors that contributed to the condition in the first place, according to Savage.
“Similarly, sometimes with opioid use disorders we use medications such as methadone as one tool in the treatment of the disease, so patients [also] need to be self-managing their moods and their activities to get into a solid recovery from opioid use disorder. When chronic pain and opioid use disorder converge, we need to engage patients in self-management of both conditions,” she said.
Savage noted that health care providers who are treating patients with chronic pain and opioid use disorder should weigh benefits such as pain relief, improved function and restored quality of life against the risks, such as side effects, toxicity and unintended consequences from use.
She acknowledged the negative consequences sometimes associated with opioid use disorder, but also said not everything surrounding such medications has to be negative, pointing to examples of treating patients with cancer and surgery-related pain.
“Opioids are beneficent, wonderful medications when they’re used well and used as prescribed,” Savage said. “Understandably, there’s been a huge demonization of opioids in the past 10 years, because they’re also very toxic and very devastating medications when they’re misused. But when opioids are used well, they also allow people to thrive in their lives … Opioids are a double-edged sword, they are a blessing and a curse.”
Several entities have responded to the escalating opioid crisis over by releasing guidelines or policies to assist in prescribing opioids. The CDC released 12 recommendations for primary care physicians last spring; among them, establishing goals for pain and function and avoiding prescribing concurrent opioid and benzodiazepine treatment. In addition, researchers identified several ‘building blocks’ for better opioid prescription management, including calculating progress toward achieving clinic objectives and pinpointing resources for complex patients.
Earlier this year, President Donald J. Trump signed an executive order establishing a commission that will assess the scope and efficacy of the federal response to drug addiction and the opioid epidemic and will make recommendations to the president accordingly. – by Janel Miller
Savage S, Hudspeth RS. Abstract 17.2.049. Presented at: American Association of Nurse Practitioners National Conference; Jun. 20-25, 2017; Philadelphia.
Disclosure: Healio Family Medicine was unable to confirm relevant financial disclosures prior to publication.