The Demise of Interdisciplinary Chronic Pain Management and Its Relationship to the Scourge of Prescription Opioid Diversion and Abuse

2018 ◽  
Author(s):  
Michael E. Schatman
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Healthcare Providers ◽  
Well Being ◽  
Insurance Companies ◽  
Prescription Opioid ◽  
Pain Medicine ◽  
Opioid Crisis ◽  
Opioid Medications ◽  
Opioid Diversion

Even though the efficacy of interdisciplinary pain management programs is supported, their numbers have decreased and the vast majority of Americans with chronic pain do not have access to them. Insurance companies do not want to pay for these services, hospitals believe they are financial losers, and the opioid crisis has placed a pall over the practice of pain medicine. The demise of these programs has left pain medicine in a fragmented state. Few healthcare providers who treat chronic pain patients have the time to coordinate care by multiple professionals The opioid crisis seen in certain areas, such as Appalachia, may be related to the lack of these interdisciplinary programs. There should be concerted efforts to increase access to and funding of these programs. Although they are not a panacea for all types of chronic pain, they can improve patients’ well-being and function and reduce their need for opioid medications.

scholarly journals Virtual Reality for Pain Management to Tackle the Opioid Crisis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Sudarshan Ramanan ◽  
Ajay Yekkirala
Keyword(s):  
Chronic Pain ◽  
Virtual Reality ◽  
Pain Management ◽  
Side Effects ◽  
Clinical Intervention ◽  
Public Health Issue ◽  
Prescription Opioid ◽  
Main Stream ◽  
Opioid Crisis ◽  
Recent Developments

The opioid crisis is a serious public health issue of epidemic proportions, building over the past decades. Prescription opioid abuse is one of the key sources of this issue. While pain is usually managed using pharmacological approaches, such as opioids, they produce several unwanted side effects – including respiratory depression and addiction – non-pharmacological approaches can be significant with minimal or no side effects. Recent developments in technology, such as Virtual Reality (VR), show considerable promise for main-stream adoption as one of the non-pharmacological interventions. Preventing a patient’s transition from acute to chronic pain is one instance where VR can presumably be effective. However, challenges remain due to the inherent subjectivity and lack of clear baselines in clinical intervention studies. Here, we review recent studies on the application of VR as a treatment for acute and chronic pain management to primarily understand key technical challenges faced by VR. The secondary goal of this work is to identify possible options to tackle some of the key challenges. Design considerations emerge as one critical component in improving patient engagement.

scholarly journals Chronic pain diagnoses and opioid dispensings among individuals with serious mental illness

2019 ◽  
Author(s):  
Ashli Owen-Smith ◽  
Christine Stewart ◽  
Musu M. Sesay ◽  
Sheryl M. Strasser ◽  
Bobbi Jo Yarborough ◽  
...  
Keyword(s):  
Mental Health ◽  
Chronic Pain ◽  
Mental Illness ◽  
Healthcare Utilization ◽  
Serious Mental Illness ◽  
Research Network ◽  
Prescription Opioid ◽  
Medical Comorbidities ◽  
Pain Diagnosis ◽  
Opioid Medications

Abstract Background Individuals with major depressive disorder (MDD) and bipolar disorder (BD) have particularly high rates of chronic non-cancer pain (CNCP) and are also more likely to receive prescription opioids for their pain. However, there have been no known studies published to date that have examined opioid treatment patterns among individuals with schizophrenia. Methods Using electronic medical record data across 13 Mental Health Research Network sites, individuals with diagnoses of MDD (N=65,750), BD (N=38,117) or schizophrenia or schizoaffective disorder (N=12,916) were identified and matched on age, sex and Medicare status to controls with no documented mental illness. CNCP diagnoses and prescription opioid medication dispensings were extracted for the matched samples. Multivariate analyses were conducted to evaluate (1) the odds of receiving a pain-related diagnosis and (2) the odds of receiving opioids, by separate mental illness diagnosis category compared with matched controls, controlling for age, sex, Medicare status, race/ethnicity, income, medical comorbidities, healthcare utilization and chronic pain diagnoses. Results Multivariable models indicated that having a MDD (OR=1.90; 95% CI=1.85–1.95) or BD (OR=1.71; 95% CI=1.66–1.77) diagnosis was associated with increased odds of a CNCP diagnosis after controlling for age, sex, race, income, medical comorbidities and healthcare utilization. By contrast, having a schizophrenia diagnosis was associated with decreased odds of receiving a chronic pain diagnosis (OR=0.86; 95% CI=0.82– 0.90). Having a MDD (OR=2.59; 95% CI=2.44–2.75) or BD (OR=2.12; 95% CI=1.97–2.28) diagnosis was associated with increased odds of receiving chronic opioid medications, even after controlling for age, sex, race, income, medical comorbidities, healthcare utilization and chronic pain diagnosis; having a schizophrenia diagnosis was not associated with receiving chronic opioid medications. Conclusions Individuals with serious mental illness, who are most at risk for developing opioid-related problems, continue to be prescribed opioids more often than their peers without mental illness. Healthcare providers need to be especially conservative in prescribing opioids – or avoid opioid therapy altogether – for this population. Mental health clinicians may be particularly well-suited to lead pain assessment and management efforts for these patients.

Pain medicine

2014 ◽  
Author(s):  
Jeremy Prout ◽  
Tanya Jones ◽  
Daniel Martin
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Management Strategies ◽  
Multidisciplinary Management ◽  
Pain Medicine ◽  
Pain Pathways ◽  
Patient Groups ◽  
Chronic Pain Conditions ◽  
Sites Of Action ◽  
Specific Management

This chapter summarizes the assessment and management of acute and chronic pain for FRCA. Pain pathways and physiological consequences of pain are considered along with sites of action and the pharmacology of common analgesics. Assessment of pain for different patient groups and settings is explained. Pain management strategies, pharmacological, non-interventional and interventional techniques are described, including multidisciplinary management of chronic pain. Specific management of some common chronic pain conditions, such as trigeminal neuralgia, are discussed in more detail.

scholarly journals Acute and chronic musculoskeletal pain situations among the working population and their pain education needs: an exploratory study

2020 ◽  
Vol 37 (4) ◽  
pp. 445-452
Author(s):  
Shuk Kwan Tang ◽  
Mimi Mun Yee Tse ◽  
Sau Fong Leung ◽  
Theofanis Fotis
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Health Care Professionals ◽  
Work Performance ◽  
Online Survey ◽  
Management Education ◽  
Well Being ◽  
Working Population ◽  
Pain Education

Abstract Background Pain affects a person’s physical and psychological well-being, work performance and productivity. Working population bear their pain and continue to work which may contribute to the worsening of their pain condition. However, their pain situation was not well-examined. Objective The aim of the study was to explore the prevalence of acute and chronic pain in the working population in Hong Kong, understand their pain management strategies and determine their preferences with regard to the use of electronic pain management materials. Methods This was an exploratory online survey. The participants’ pain history, their preferences in methods of pain management, the source of the pain management education that they had received, sources and preferences in relation to the use of the Internet for pain education, and the participants’ demographic characteristics were collected. Results A total of 210 participants joined the study, 67% of whom were experiencing pain. Of the group in pain, 71.6% were in chronic pain that has persisted for 3 months or more. Pain intensities ranged from 2.82 to 3.82 on a 10-point numeric scale. Of the participants, 85.7% reported not receiving adequate pain management education, and 91.4% of those agreed pain services were inadequate. Websites and health care professionals were the sources from which they obtained their pain management education. Conclusions The high prevalence of pain in the working population requires special attention. Health care professionals should be proactive and an online pain management programme can be a solution to address the critical problem of pain in the working population.

scholarly journals Use of electroanalgesia and laser therapies as alternatives to opioids for acute and chronic pain management

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 2161 ◽  
Author(s):  
Paul F. White ◽  
Ofelia Loani Elvir Lazo ◽  
Lidia Galeas ◽  
Xuezhao Cao
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Pain Management ◽  
Abdominal Surgery ◽  
Myofascial Pain ◽  
Elective Surgery ◽  
Opioid Analgesic ◽  
Joint Disease ◽  
Prescription Opioid ◽  
Joint Replacement Surgery

The use of opioid analgesics for postoperative pain management has contributed to the global opioid epidemic. It was recently reported that prescription opioid analgesic use often continued after major joint replacement surgery even though patients were no longer experiencing joint pain. The use of epidural local analgesia for perioperative pain management was not found to be protective against persistent opioid use in a large cohort of opioid-naïve patients undergoing abdominal surgery. In a retrospective study involving over 390,000 outpatients more than 66 years of age who underwent minor ambulatory surgery procedures, patients receiving a prescription opioid analgesic within 7 days of discharge were 44% more likely to continue using opioids 1 year after surgery. In a review of 11 million patients undergoing elective surgery from 2002 to 2011, both opioid overdoses and opioid dependence were found to be increasing over time. Opioid-dependent surgical patients were more likely to experience postoperative pulmonary complications, require longer hospital stays, and increase costs to the health-care system. The Centers for Disease Control and Prevention emphasized the importance of finding alternatives to opioid medication for treating pain. In the new clinical practice guidelines for back pain, the authors endorsed the use of non-pharmacologic therapies. However, one of the more widely used non-pharmacologic treatments for chronic pain (namely radiofrequency ablation therapy) was recently reported to have no clinical benefit. Therefore, this clinical commentary will review evidence in the peer-reviewed literature supporting the use of electroanalgesia and laser therapies for treating acute pain, cervical (neck) pain, low back pain, persistent post-surgical pain after spine surgery (“failed back syndrome”), major joint replacements, and abdominal surgery as well as other common chronic pain syndromes (for example, myofascial pain, peripheral neuropathic pain, fibromyalgia, degenerative joint disease/osteoarthritis, and migraine headaches).

Chronic pain – the idea of mechanism orientated treatment

Ból ◽  
2018 ◽  
Vol 19 (1) ◽  
pp. 42-49
Author(s):  
Magdalena Kocot-Kępska ◽  
Renata Zajączkowska ◽  
Jan Dobrogowski ◽  
Anna Przeklasa-Muszyńska
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Pain Treatment ◽  
Current Knowledge ◽  
Empiric Therapy ◽  
Pain Medicine ◽  
Significant Progress ◽  
Pain Syndromes ◽  
Pain Chronification ◽  
Rational Mechanism

Understanding the neurobiological mechanisms underlying chronic pain syndromes is a significant progress in modern pain medicine. Understanding the basic differences between acute and chronic pain processes, learning about the mechanisms of transition from acute to chronic pain, allows us to change the approach to pain management from commonly used empirical approach to more rational mechanism-oriented pain treatment. In many patients with chronic pain, empiric therapy, which does not consider the mechanisms of pain, is not fully effective. Often, when planning pharmacotherapy, current knowledge about the pain etiology and mechanisms of pain chronification is not considered. Management based on already known mechanisms of pain, using rational pharmacotherapy and non-pharmacological methods, may improve the quality and effectiveness of pain management.

Facilitating Treatment Adherence in Pain Medicine

2017 ◽  
Keyword(s):  
Pain Management ◽  
Healthy Lifestyle ◽  
Management Strategies ◽  
Healthcare Providers ◽  
Pain Medicine ◽  
Ethical Considerations ◽  
Patient Will ◽  
Patient Nonadherence ◽  
Healthy Lifestyle Interventions ◽  
Physician Adherence

One of the most distressing features of a healthcare providers practice is that of patient nonadherence. Adherence refers to an active, voluntary, collaborative involvement of the patient in a mutually acceptable course of behavior to produce a desired preventative or therapeutic result. Most of the research in the area of medical adherence has been focused on medication adherence or increasing the likelihood that a patient will take their medications as prescribed by their physician. Adherence also has a broader application with regards to patient behaviors that can either support or undermine a positive response to prescribed therapies.In the field of pain medicine there are a number of evidence-based interventions that can improve an individual’s pain, mood and functionality, but this depends highly on the patient adhering to the prescribed treatment regimens.This book will provide a practically oriented guide to understanding the conceptual models of adherence and non-adherence and methods to improve adherence, to both pharmacotherapy and psychosocial pain management strategies. Topics include the use of biometrics to measure and promote adherence, employing novel psychosocial techniques to improve adherence to pain management and healthy lifestyle interventions and the ethical considerations of patient and clinician nonadherence.

Opioid Misuse and Addiction Among Patients With Chronic Pain

2019 ◽  
pp. 339-354
Author(s):  
Marc O. Martel ◽  
Robert N. Jamison
Keyword(s):  
Chronic Pain ◽  
Opioid Therapy ◽  
Screening Tools ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Chronic Noncancer Pain ◽  
Medication Misuse ◽  
Opioid Medications ◽  
Noncancer Pain

Chapter 20 provides an introduction to understanding the prevalence and risk factors as well as screening tools for assessing opioid misuse and addiction in patients with chronic pain. In the era of the opioid epidemic in North America and beyond, the use of prescription opioid medications to help improve function in chronic noncancer pain is frequently debated. Out of fear of iatrogenic addiction, litigation, and/or potential medication misuse, some clinicians are refusing to prescribe opioids for chronic pain. Evidence indicates that rates of opioid misuse and addiction are fairly high among chronic pain patients prescribed long-term opioid therapy, but there is consensus that opioids can be safe and effective for carefully selected and monitored patients.

Sign in / Sign up

Export Citation Format

Share Document