Pain Management in Patients with Opioid Dependence and Substance Abuse

PICO question/statement: In adult substance abuse patients, does behavioral counseling or long-term follow-up enhance pain management and treatment that allows the body to rid itself of drugs?

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Setting or Context

Pain and addiction, are two known medical factors that are interrelated. While pain is one of the renowned reasons why a majority of the patients seek medical attention, its prevalence may be much higher than among patients with substance abuse than on the normal and the general population. In this regard, the relationship between pain and addiction boils down to the fact that the treatment of one condition influences that of another. The context of the issue of pain relation with that of substance abuse is commonly observed in a clinical setting in which case addiction patients are considered to have special clinical conditions that are specific to this patient population (Mitra, et al., 2014). In this context, medical care practitioners first understand that there are those issues that are often related to the problem of substance abuse itself. For instance, before treatment is administered to these patients, doctors and caregivers identify and understand issues such as;

The abuse of substances such as opioids

They understand that these patients have an altered pain perception as well as adherence to a therapy that includes pain-relieving drugs.

A Description Providing High-Level Detail Regarding the Problem

Drug addiction, which is commonly referred to as substance abuse, is defined as the pathophysiologic adaptation of the brain to the repeated use of certain drug types, over time. Arguably, for patients dealing with substance abuse, the chronic and continued use of addictive drugs, occasionally affects the processing of pain stimuli, through the dysregulation of the hypothalamic pituitary adrenal axis, sympathetic stimulation, and most importantly, opioid tolerance. However, despite these facts, numerous misconceptions surround the medical treatment of those individual dealing with substance abuse. For instance, while moderate to chronic pain may be one of the challenges faced by these patients, a majority of the medical facilities lack formal guidelines about the treatment and pain management and pain management in the patients. In a similar regard, the type of treatment accorded to these patients is not evidence-based.

Quality of Care

From a quality of care perspective, the treatment of the substance abuse disorder goes hand in hand with the pain management process in these patients. While drug administration and follow-up are recommended for the treatment of these disorders, behavioral counseling is often included as a valid form of treatment. However, it is not well known whether treatment in the form of behavioral counseling, helps in the management of pain in the patients. Behavioral counseling is often aimed at reducing or entirely stopping substance use. In this case, counselors provide a variety of treatments for the patients, which include; assessment, planning, and treatment. Nonetheless, the most common counseling therapies involve the cognitive behavioral therapy that is aimed at teaching individuals in treatment, how to recognize and at the same time, stop negative behavior that leads to the addictive substance abuse (St. Marie, 2016). For example, the counselor may take the patient through a counseling process that makes the patient aware of the stressors, feelings, and situations that lead to substance use. This, in essence, aids in the quality of care and treatment, by encouraging the patient to avoid these situations and also act differently when they occur to them.

Patient Outcomes

There seems to be a broad agreement in the results of the studies done regarding the administration of treatment on substance abuse patients. These studies suggest that the patient outcome depends on the nature of the treatment that is accorded to the patient. For instance, these patients should be treated in the least restrictive setting which is most likely to be effective and above all else, safe for the patients (Zhiwei, Gerstein, & Friedmann, 2008). With reference to the severity of the issue, many at times, hospitalization is recommended for those patients with substance overdose and those who cannot be safely treated in an outpatient or emergency department setting. Therefore, in such a situation, both behavioral counseling and follow-up treatments are overlooked as the immediate treatment methods.

Significance of the Issue and Its Implications for Nursing

Addiction and substance abuse nurses care for patients on both an outpatient and an inpatient setting. However, recent literature suggests that very few nurses have received formal education, on how to identify those substance abuse patients need critical to extreme substance abuse treatment. Our current society, on the other hand, stigmatizes addiction and substance abuse (Morgan, 2014). This being said, nurses dealing with these patients, are susceptible to the same ways of thinking and may tend to judge or alienate substance abuse victims. Thus, it is evident that the patient outcome and the treatment effectiveness is directly impacted by both the attitude of the nurses, as well as the implications that this issue has in the nursing profession, as a whole (Oliver.et al., 2012).

References

Mitra, S., Sinatra, R. S., & McQuay, H. (2014). Acute Pain Management in Patients with Opioid Dependence and Substance Abuse. Acute Pain Management, 564-580. doi:10.1017/cbo9780511576706.036

Morgan, B. D. (2014). Nursing Attitudes Toward Patients with Substance Use Disorders in Pain. Pain Management Nursing, 15(1), 165-175. doi:10.1016/j.pmn.2012.08.004

Oliver, J., Coggins, C., Compton, P., Hagan, S., Matteliano, D., Stanton, M., Turner, H. N. (2012). American Society for Pain Management Nursing Position Statement: Pain Management in Patients with Substance Use Disorders. Pain Management Nursing, 13(3), 169-183. doi:10.1016/j.pmn.2012.07.001

St. Marie, B. (2016). The Experiences of Advanced Practice Nurses Caring for Patients with Substance Use Disorder and Chronic Pain. Pain Management Nursing, 17(5), 311-321. doi:10.1016/j.pmn.2016.06.001

Zhiwei Zhang, Gerstein, D. R., & Friedmann, P. D. (2008). Patient Satisfaction and Sustained Outcomes of Drug Abuse Treatment. Journal of Health Psychology, 13(3), 388-400. doi:10.1177/1359105307088142