Pain Clinical Module 2: Risks and Benefits of Opioid Pain Treatment: Effective Prescribing and Monitoring
Goal:

The student will be able to decide how opioid therapy, especially chronic opioid therapy, might impact an individual patient, taking into consideration pain severity, functioning, and possible risks and side effects and take steps to minimize negative impact.

: 0.75 hrs

After completing this activity participants will be able to:

  • Recognize when opioid therapy is indicated based on pain severity, functioning, and risk of addiction or abuse plus response to first line therapies

  • Assess and minimize side effects of chronic opioid therapy and provide appropriate patient education.

  • Develop an opioid medication treatment plan that includes sufficient treatment structure and a plan for safe discontinuation if needed

  • Plan to monitor patients on chronic opioid therapy to assess continued need and appropriate use


Professional Practice GapsClinical guidelines for the use of chronic opioid therapy in chronic noncancer pain, developed by professional organizations of pain specialists based on an extensive review of the literature, include recommendations designed to reduce the risk of prescriptions drug overdose and diversion (Chou et al, 2009). The need for prescribers to do more to prevent diversion can be inferred from studies showing that a majority of patients do not take their pain medication as prescribed (Couto, et al. 2009) and that the source for the majority of non-medically used prescription drugs is a friend or relative (SAMHSA, 2010). Research shows that physicians do not follow key recommendations in evidence-based guidelines for avoiding diversion and overdose (CASA, 2005; Adams, et al. 2001). The need for education/training in the guidelines to avoid diversion and overdose is also evident in results of national physician surveys of physicians (CASA, 2005) and research linking "doctor shopping" to increased risk for overdose (Hall et al, 2008). Based on the overall results of their physician survey on the problem of drug diversion, CASA concluded that physicians should receive more continuing medical education related to prescribing and administering controlled substances and identifying, diagnosing, and treating substance abuse and addiction (CASA, 2005). References
Clinical guidelines for the use of chronic opioid therapy for chronic noncancer pain. J of Pain. 2009; 10(2): 113-130.
Opioids and the treatment of chronic pain in a primary care sample. Journal of Pain Symptom Management. 2001; 22(3): 791-796.
Patterns of abuse among inuntentional pharmaceutical overdose fatalities. JAMA. 2008; 300(22): 2613-2620.
Results from the 2009 National Survey on Drug Use and Health. Office of Applied Studies, NSDUH Series H-38A, HHS Publication No. SMA 10-4586 Findings, Rockville, MD. 2010. Available at: http://oas.samhsa.gov/NSDUH/2k9NSDUH/2k9ResultsP.pdf Accessed on: 2010-09-21.
Under the Counter: The Diversion and Abuse of Controlled Prescription Drugs in the U.S.. National Center on Addiction and Substance Abuse at Columbia University. 2005. Available at: http://www.casacolumbia.org/addiction-research/reports/under-the-counter-diversion-abuse-controlled-perscription-drugs Accessed on: 2014-06-03.