Taking Control: Emerging Issues in Pain ... - Pharmacy Times

More documents

Recommendations

Info

Assessment of Addiction Risk • Screening measures for addiction risk: • STAR/SISAP • CAGE AIDD • Opioid Risk Tool (Emerging Solutions in Pain) • SOAPP (see painedu.org) • Psychiatric assessment of risk: • Chemical • Psychiatric • Social/Familial • Genetic • Spiritual Positioning Opioid Therapy Opioid Risk Tool Mark each box that applies. Female Male 1. Family history of substance abuse – Alcohol – Illegal drugs – Prescribing drugs 2. Personal history of substance abuse – Alcohol – Illegal drugs – Prescribing drugs 1 2 4 3 4 5 3 3 4 3 4 5 3. Age (mark box if 16-45 years) 1 1 4. History of preadolescent sexual abuse 3 0 5. Psychological disease – Attention deficit disorder, obsessive compulsive disorder, bipolar, schizophrenia – Depression Scoring: 0-3: low risk; 4-7: moderate risk; ≥8: high risk 2 1 2 1 Webster LR, Webster RM. Pain Med. 2005;6:432-442. ♦No past/current history of substance abuse ♦Noncontributory family history of substance abuse ♦No major or untreated psychological disorder Stratify Risk Low Risk Moderate Risk High Risk ♦Significant family history of substance abuse ♦Past/co-morbid psychological disorder ♦History of treated substance abuse ♦Active substance abuse ♦Active addiction ♦Major untreated psychological disorder ♦Significant risk to self and practitioner Current Opioid Misuse Measure (COMM) • 17-item patient self-assessment : for those currently on long-term opioid therapy • S/S intoxication, emotional volatility, poor response to medications, addiction, healthcare use patterns, problematic medication behavior • NOT used prior to therapy Gourlay DL, et al. Pain Med. 2005;6:107-112. Meltzer et al. Pain. 2011;152:397-402. Risk Factors for Aberrant Behaviors/Harm Restructuring Therapy to Reduce Risk Biological • Age ≤ 45 years • Gender • Family history of prescription drug or alcohol abuse • Cigarette smoking Psychiatric • Preadolescent sexual abuse (in women) • Major psychiatric disorder (eg, personality disorder, anxiety or depressive disorder, bipolar disorder) • Substance use disorder Social • Prior legal problems • History of motor vehicle accidents • Poor family support • Involvement in a problematic subculture • Consider discontinuation of opioid • Continue opioid but consider reactive strategies to improve control over drug use: • Written agreement (“contract”) • Frequent visits, small quantities • Long-acting drugs with no rescue doses • One pharmacy, pill counts, no replacements or early scripts • Urine drug screens • Required referrals Katz NP, et al. Clin J Pain. 2007;23:103-118; Manchikanti L, et al. J Opioid Manage. 2007;3:89-100. Webster LR, Webster RM. Pain Med. 2005;6:432-442.
Opioid Therapy: Exit Strategy Risks vs Benefits of Opioids • When is it appropriate to give up on opioid therapy • No convincing benefit despite attempts at optimal therapy • Occurrence of comorbidity (eg, substance abuse) that substantially increases burden or risk • Persistent adherence problems • High index of suspicion for diversion • Clinical Benefits • Demonstrated efficacy in numerous randomized clinical trials and chronic pain conditions • Low risk for end-organ damage • Risks • Side effects (eg, constipation, nausea, sedation) • Addiction • Abuse potential, physical dependence, tolerance Must evaluate risks vs benefits in each patient being considered for long-term treatment Portenoy RK. Opioid analgesics. In: Portenoy RK, Kanner RM, eds. Pain Management: Theory and Practice. Philadelphia, PA: FA Davis Co; 1996:248-276.. Long-Term Opioid Therapy: Key Points Questions • Always monitor multiple outcomes: • Analgesia • Adverse effects • Activities, other functional outcomes, quality of life • Aberrant drug-related behavior • “Document for an audit” Thank You!
Page 1 and 2: Taking Control: Emerging Issues in
Page 3 and 4: Barriers to Pain Management • Hea
Page 5 and 6: Conventional Practice: Opioid Treat
Page 7: Addiction or Chronic Pain Source of

Taking Control: Emerging Issues in Pain ... - Pharmacy Times

Create successful ePaper yourself

Delete template?

Save as template?