There are many resources available for patients struggling with chronic pain. However, the most commonly used one still remains to be opioids.
There are several guides for clinicians that address pain management through drugs for cancer patients and survivors who continue to experience ongoing pain after successful treatment.
However, healthcare providers need to be made aware of the opioid abuse prevalent in cancer patients of the United States. The general attitude in the past had been a dismissive one, assuming cancer patients had little risk of being addicted to drugs.
New evidence has brought to light that the chances of cancer patients developing an addiction for opioids are as high as those for patients suffering from regular chronic pain.
What Can Be Done?
It is important for everyone prescribing pain medication to go through the Risk Evaluation and Mitigation Strategy training which is available for free online to learn how to prescribe opioids to the appropriate patients. Every patient should be scrutinized and analyzed for signs of opioid use disorder, misuse and diversion.
It is time to bring back the universal precautions taken before prescribing opioids which were first introduced during the 1980s when AIDs was an epidemic in the American society. Everyone wore gloves and protective gear as it was assumed that all patients coming in could be carrying the HIV virus.
The same way any patient who is a candidate for opioids should be treated as potential drug abuser and mis-user regardless of their age, economic class and biological disorders.
How to Identify Patients at Risk
High-risk patients are the ones who have had a history of alcohol or substance abuse or are on medication such as buprenorphine or methadone. Other than that cancer patients who have struggled with chronic pain prior to their diagnosis and have been on opioid therapy are also a candidate for drug abuse. These patients experience ‘central sensitization’ which renders them less responsive to increasing doses of opioid and calls for and nonpharmacologic treatment for pain management.
The patient history is key to identifying those at risk of developing an opioid addiction.
A comprehensive history will tell the doctor about the type of pain the patient is suffering from and help them ascertain whether it is an inflammatory pain, neuropathic pain or a nociceptive pain.
The pain could be either acute or chronic, related to cancer or premorbid chronic pain.
Once the pain has been understood their history with substance abuse should be analyzed to verify if they carry the potential to misuse opioids. This even includes those patients who regularly consume alcohol and have been doing so for many years.
There are many screening tools available for clinicians that can aid the identification process. Their validation amongst patients of oncology or other serious illnesses is yet to be made.
However, the chances of it helping a patient avoid a dangerous addiction outweigh the limitations.
Do you have chronic pain? Book an appointment today with Dr. Tom Macek.
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