Full Sentence Outline

Pain Management and Addiction

Name

Institution

Pain Management for Patients with Addiction Problems

Thesis Statement

The ability of clinicians to keep patients in check has proven to be a challenge, especially with concerns regarding the legitimacy and physical functions affecting overall pain management in patients with an addiction problem.

Background

The treatment modalities for chronic pain using COT in active drug users or those who are in remission presents a significant challenge for clinicians who oversee the effectiveness of the intervention. Moreover, such notions are correlated to the concerns of patients experiencing a relapse to substance abuse during the duration of therapy since analgesics may obscure drug seeking behaviors that are characteristic of addictive diseases. This results in poor treatment outcomes where patients are likely to be discharged prematurely from pain care treatment. Additionally, there is the widespread misconception that chronic pain patients with an addiction problem often encounter health professionals who possess inadequate training in clinical guidelines that are related to comorbidities of chronic pain and related addiction issues. Moreover, there exists a dilemma for the treatment of abstinent and former heroin addicts as they are at a high risk of relapsing to addiction if they are exposed to opioid drugs. They also face the risk of relapsing if they are not accorded sufficient care. For people who are already on opioid medication such as methadone often experience challenges responding to pain relievers when they are hospitalized. In such as case, the fundamental principle of management denotes the prevention of withdrawals by initiating methadone for heroin users while providing additional analgesia as recommended while confirming whether the pain relief is satisfactory. Additionally, most physicians have developed a phobia of overprescription of narcotics as pain relievers. Perhaps this may be attributed to the fear of the legal repercussions that may ensue including the divergences in federal guidelines on matters about use of narcotics as a pain reliever. Thus, it is the responsibility of the individual practitioner to offer pain management using opioids for legitimate standard and by the regulation of medical practice.

Objective

The purpose of this research is to evaluate the challenges that are faced by clinicians in pain treatment for patients with addiction problems. On the other hand, the study focuses on offering a counter argument to the thesis by providing ideal solutions for pain management for patients with SUDs. Additionally, the research intends to highlight the complex interconnection that exists between pain management and addiction to opioids.

Supporting Points

1. Pain management and Addiction Endure a Complex Interaction

a. Opioid drugs are the nerve center of chronic pain management and the incorporation of the modalities such as COT augments the risk of relapse to addiction in patients with a history of SUDs due to the susceptibility to drug seeking behavioral patterns.

b. Patients struggling with SUDs are more likely to be discharged early from pain management care which would ultimately culminate in the prevalence of addiction problems due to drug dependency (Martell et al., 2007).

c. Stigma by clinicians has also emerged as a major contributor towards inhibiting the effective pain treatment of patients with SUDs as a result of ineffective communication and lack of utilization of collaborative efforts during treatment.

2. Controversy Surrounds the Level of Opioid Dosage

a. There exists limited evidence from randomised control trials or observational studies on the appropriate pain management techniques for patients with a history of addiction problems.

b. Patients who are currently on opioids face challenges usually experience difficulties in pain management when they are hospitalized. The victims’ predicament prompts clinicians to augment the dosage in a bid to achieve the desired outcomes, and such an approach bears ethical connotations (Michna et al., 2004).

c. Moreover, physicians are often cautious in regards to opioid treatment due to the legal issues that may occur in the event of oversubscription.

3. Pain Management in Health Care Setting

a. The management of acute pain for hospitalized patients require written procedures and policies to implement the treatment intervention for patients who struggle with SUDs.

b. Most health care settings lack support for individual practitioners who are expected to address the issues associated with complex problems of seemingly stigmatized patients. This may be characterized by the absence of a consultation-liaison service and an acute pain management team (Gourlay, Heit & Almahrezi, 2005).

c. Many addicts experience chronic pain, and the subsequent set up of addiction services and pain clinics necessitates the need to incorporate concerted effort in chronic pain management for drug abusers.

Counter Arguments

1. The categorization of the level of pain the patient is experiencing aids in determining the dosage of pain medication that is to be administered.

2. Administration of pain medication ought to be scheduled as the escalation of pain leads to the requirement of more medication to regulate the discomfort (Thorn, 2017).

3. Structured control of opioid medication access is essential in decreasing chances of opioid addiction including arranging for the distribution of drugs from someone other than the patient (Chou et al., 2009).

Response to Counter Arguments

1. According to the World Health Organisation (WHO), the application of the step ladder approach is instrumental since the classification of pain helps avert instances of oversubscribing (Fishbain et al., 2007).

2. Ensuring compliance of scheduled administration of opioids aids in decreasing the chances of drug dependence including increasing the assurances of a timely recovery (Ives et al., 2006).

3. The structured control of access to medication will aid in averting clinician-patient conflict which is mostly instigated by drug seeking behaviors (Ballantyne & Mao, 2003).

Implications

The management of chronic pain in patients with a history of SUDs can be quite challenging and although there are no right answers in a conventional model of administration and assessment may be achieved to enhance the quality of life and functionality. This may be accomplished through the use concerted efforts amongst health professionals in the prescription of opioids for patients who are susceptible to addiction. In a hospital setting, the organization may incorporate consultancy services where a team of experts is actively involved in identifying and diagnosing drug dependency in a patient.

Tentative Bibliography

Ballantyne, J. C., & Mao, J. (2003). Opioid therapy for chronic pain. New England Journal of Medicine, 349(20), 1943-1953.

Chou, R., Fanciullo, G. J., Fine, P. G., Adler, J. A., Ballantyne, J. C., Davies, P., ... & Gilson, A. M. (2009). Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. The Journal of Pain, 10(2), 113-130.

Fishbain, D. A., Cole, B., Lewis, J., Rosomoff, H. L., & Rosomoff, R. S. (2007). What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review. Pain medicine, 9(4), 444-459.

Gourlay, D. L., Heit, H. A., & Almahrezi, A. (2005). Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Medicine, 6(2), 107-112.

Ives, T. J., Chelminski, P. R., Hammett-Stabler, C. A., Malone, R. M., Perhac, J. S., Potisek, N. M., ... & Pignone, M. P. (2006). Predictors of opioid misuse in patients with chronic pain: a prospective cohort study. BMC health services research, 6(1), 46.

Martell, B. A., o'Connor, P. G., Kerns, R. D., Becker, W. C., Morales, K. H., Kosten, T. R., & Fiellin, D. A. (2007). Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Annals of internal medicine, 146(2), 116-127.

Michna, E., Ross, E. L., Hynes, W. L., Nedeljkovic, S. S., Soumekh, S., Janfaza, D., ... & Jamison, R. N. (2004). Predicting aberrant drug behavior in patients treated for chronic pain: importance of abuse history. Journal of pain and symptom management, 28(3), 250-258.

Thorn, B. E. (2017). Cognitive therapy for chronic pain: a step-by-step guide. Guilford Publications.