Assessing and Managing Pain of Patients with Substance Use History

Assessing and Managing Pain of Patients with Substance Use History

Identification of a clinical problem, need for investigation of the problem

Research on pain management has increased in the last two decades. In order to monitor the pain treatment and assessment JCAHO developed new standards for acute care pain in 2000, after which many hospitals have established certain programs for addressing pain management issues. Despite increased stress upon pain assessment and management and established programs, research studies continue finding insufficient pain management in patients. Pain management problem increases when patient has a history of substance abuse. Adequate pain management is hindered by the fear of addiction - both by the fear of patient and provider. On the other hand, lack of knowledge among pain management providers, particularly nurses regarding the pain management of substance users and stigma about the opiate use also becomes barriers in adequate pain management. Attitudes of nurses towards drug abusers and their lack of knowledge may result in taking inadequate measures for pain assessment and management. Owing to these facts, it is important that attitudes of nurses towards nurses must be assessed and then they must be provided by sufficient knowledge of pain management for this kind of population so that they can take effective measures.

Literature Review

Clinical dilemmas of addiction and pain management have been addressed by many authors. The overlap or coexistence of addiction and pain has always been a challenge for health professionals. Several numbers of screening tools and suggestions for screening of addiction among chronic pain addictions have also been provided by the researchers (Liberto and Fornili, 2013). On the other hand, guidelines and recommendations in order to deal with the pain among substance abusers are also suggested. Such suggestions include need of respect and accept the patient who report pain and are also substance users, using the written contracts with patient reading use and abuse of prescriptions and choosing one healthcare provider who will prescribe pain prescriptions(Blay, et al. 2012). For improving care of such patients, multidisciplinary team involvement, consultation with substance abuse and pain specialists and primary care service of drug-treatment centers should be given priority.

McCaffery and Ferrell (1997) have studied the differences between the assessment of pain by nurses and that of by patients and found that discrepancy between both of them is one of the other major factors behind inadequate pain management (cited in Blay, et al. 2012). Literature of past three decades is also reviewed by Howard and Chung (2000a; 2000b) regarding the attitudes of nurses towards patients who have chemical dependency. It is also found that despite certain improvements in their attitudes with the time, attitudes of nurses, as compare to the other health professionals, towards people with addictive disorders remain punitive, negative and authoritarian (Berg, et al. 2009).

Recommendations for long-term administration of drugs with potential for abuse, such as opioids, which are made to patients with a history of substance abuse, are based only on clinical ...