Managing Chronic Nonmalignant Pain in Patients with Addiction: Barriers, Risks, and Recommendations
Rawlins, Karen S.
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Primary care providers face significant risks and barriers when considering opioid pain medication therapy for their patients with chronic nonmalignant pain who also have addiction issues. While opioids are considered the most effective analgesic medications for chronic pain, increasing rates of abuse, misuse, diversion and addiction are being reported. Expert recommendations and guidelines advocate utilization of a universal precautions model for all patients in the treatment of chronic pain, use of screening tools for addiction, mental health and aberrant drug-related behaviors, appropriate risk stratification and monitoring and thorough documentation of analgesia, affect, aberrant behaviors, activity and adverse effects. By adhering to recognized standards of care, providers can overcome common barriers and provide safe, effective pain management care for their patients with chronic nonmalignant pain who may also have a history of addiction.