toothaches and headaches. Even patients with legitimate pain are
fearful of decreased medication doses and may rate their pain at a
higher number than they were actually experiencing. Patients will
often tell providers that tylenol or NSAIDs do not work for them.
They will also refuse physical therapy stating it has been tried in
the past without success. The only thing that will help their pain is
an opioid. They just want a pill and refuse to get further involved
in their care. Others have discovered that certain medications like
Phenergan and Gabapentin can be used to augment the sensation
they get with their opioids.
The ability to decipher actual pain from fabricated pain will not be
found on a pain scale or as a vital sign. “It takes a village” to control
opioid abuse and misuse. On the heels of this epidemic of pain, we
must find a better way to work with patients who truly do suffer.
To help ourselves and our patients, we must communicate with
each other if we find a patient who is “doctor-shopping.” We must
use the tools available including EMRs, and state-controlled inspection networks. Pain agreements, pill counts and regular drug
screens add objectivity to a subjective illness. Holding patients
accountable when patterns of misuse of medication are evident
is essential. We have to teach patients that they will probably not
get their pain level to a zero nor should they expect to achieve
this number. Their treatment should be individualized based on
what they would like to accomplish in life, and we expect them to
use multiple modalities to obtain those goals. The most important component in a pain care plan is patients’ willingness to take
ownership of their health. Gone are the days when a patient is prescribed an opioid and sent on their way. Now patients must engage
and show they are willing to work to help themselves. Patients are
expected to be active participants instead of watching the world go
by. Hopefully, inside that Pandora’s Box, at the very bottom is still a
little thing called hope.
References:
Baker, D.W. (2016). Joint commission statement on pain management. The Joint Commission, April 18, 2016. jointcommission.org
Centers for Disease Control. (2016). Injury prevention & control:
Opioid overdose. CDC, March 16, 2016. cdc.gov
Morone, N. E., and Weiner, D.K. (2013). Pain as the 5th vital sign:
Exposing the vital need for pain education. Clinical Therapeutics,
35(11): 1728-1732, http://doi.org/10.