“I Feel Uncomfortable ‘Calling a Patient Out’”: Educational Needs of Palliative Medicine Fellows in Managing Opioid Misuse

Childers, Julie; Arnold, Robert M.

doi:10.1016/j.jpainsymman.2011.03.009

Cited by 59 publications

(39 citation statements)

References 28 publications

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“…When pain requiring opioids are accompanied with a co-occurring addictive disorder, treatment becomes complicated and challenging both for the patient and the health care professionals. Patients with a substance misuse history are at increased risk of receiving inadequate pain management because many clinicians feel reluctant to prescribe opioids due to a fear of exacerbating the addiction by using opioid medications [2]. These patients are usually undertreated as a result of lack of knowledge and misconceptions [2,3].…”

Section: Discussionmentioning

confidence: 99%

“…When a painful illness is complicated by a co-occurring addictive disorder, management may be more complex and challenging for the health care providers. These patients are also at increased risk of receiving inadequate pain management due to a fear of exacerbating the addiction by using opioid medications and the lack of knowledge about treating patients with addiction [2,3]. We present our pain treatment strategy in a pancreatic cancer patient with a history of substance abuse.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pain Management in a Patient with Pancreatic Cancer and Substance Use Disorder

Şenel¹,

Oğuz²,

Koçak³

et al. 2017

J Addict Res Ther

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Objective: People with a history of substance misuse may develop cancer and associated pain syndromes requiring opioid therapy. These patients are at increased risk of receiving inadequate pain management due to fear of exacerbating the addiction by using opioid medications and the lack of knowledge about treating patients with addiction. We present our pain treatment strategy in a pancreatic cancer patient with a history of substance abuse.Case report: A 38 years male patient was admitted to emergency service with severe epigastric pain. He had a diagnosis of pancreatic cancer and underwent surgery 3 years ago. He had recurrence while receiving chemotherapy. He was using transdermal fentanyl 100 mcg/h and morphine subcutaneously given by his primary doctor. He was unable to obtain morphine because of prescription problems and experiencing severe pain and abstinence symptoms. On pain consultation, it was learned that he had a history of substance abuse and received treatment. A bilateral neurolytic splanchnic block was performed for pain relief and the patient was integrated to a supportive program with psychiatry clinic. After 3 months, pain control was adequate with transdermal fentanyl 50 mcg/h and adjuvant drugs. Conclusion:Splanchnic plexus neurolysis is a technique that can potentially improve pain control and quality of life in pancreatic cancer. For the effective management of pain in patients with a co-occurring addictive disorder, invasive treatment techniques might be preferable early in the course of pain treatment instead of opioid dose escalation. Good communication between teams is essential.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pain Management in a Patient with Pancreatic Cancer and Substance Use Disorder

Şenel¹,

Oğuz²,

Koçak³

et al. 2017

J Addict Res Ther

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“…Providers also often lack training in SUD treatment generally and in transition practices more specifically (Childers and Arnold, 2012). Formal training in transitional care that includes learning to communicate with providers at specialty SUD care sites, and how to elicit and implement patient and family preferences into treatment plans, may also be critical for improving the care transition process.…”

Section: Provider Factorsmentioning

confidence: 99%

A conceptual model to facilitate transitions from primary care to specialty substance use disorder care: a review of the literature

Cucciare

Coleman

Timko

2014

Prim Health Care Res Dev

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We conducted a narrative review that occurred in three stages: literature review of health care transition models, identification of conceptual domains common across care transition models, and identification of SUD-specific model elements. Findings The conceptual model presented describes patient, provider, and system-level facilitators and barriers to the transition process, and includes intervention strategies that can be utilized by primary care clinics to potentially improve the process of transitioning patients from primary care to SUD care. Recognizing that primary care clinics vary in available resources, we present three examples of care practices along an intensity continuum from low (counseling and referral) to moderate (telephone monitoring) to high (intensive case management) resource demands for adoption. We also provide a list of common outcomes clinics might consider when evaluating the impact of care transition practices in this patient population; these include process outcomes such as patients' increased knowledge of available treatment resources, and health outcomes such as patients' reduced substance use and better quality of life.

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“…Known risk factors should be identified and monitored in order to detect misuse; for example, by completing a Screener for Opioid Assessment for Patients with Pain-Short Form (SOAPP-SF), establishing an opioid agreement and obtaining a psychological evaluation 112 . However, it is difficult to differentiate between inadequate analgesia (pseudoaddiction), addiction, and use of opioids as an emotional coping strategy 113 . Misuse increases the complexity of pain management, and unchecked addiction can lead to impaired quality of life, decreased pain control, and caregiver stress 114 .…”

Section: Pain-related Problems After Cancermentioning

confidence: 99%

“…The risk of abuse may be greater for fast-acting fentanyls than other formulations, owing to their rapid onset of effect. Many hospice and palliative care physicians report having had very little training in this field, and survey results suggest that additional postgraduate training focusing on opioid misuse might prove beneficial 113 . Pain management programs which take cognitive and behavioral principles into account are the treatment of choice, delivered by a multidisciplinary team working in an interdisciplinary way 115 .…”

Section: Pain-related Problems After Cancermentioning

confidence: 99%

Pain in the cancer patient: different pain characteristics CHANGE pharmacological treatment requirements

Müller-Schwefe¹,

Ahlbeck

Aldington

et al. 2014

Current Medical Research and Opinion

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Twenty years ago, the main barriers to successful cancer pain management were poor assessment by physicians, and patients' reluctance to report pain and take opioids. Those barriers are almost exactly the same today. Cancer pain remains under-treated; in Europe, almost three-quarters of cancer patients experience pain, and almost a quarter of those with moderate to severe pain do not receive any analgesic medication. Yet it has been suggested that pain management could be improved simply by ensuring that every consultation includes the patient's rating of pain, that the physician pays attention to this rating, and a plan is agreed to increase analgesia when it is inadequate. After outlining current concepts of carcinogenesis in some detail, this paper describes different methods of classifying and diagnosing cancer pain and the extent of current under-treatment. Key points are made regarding cancer pain management. Firstly, the pain may be caused by multiple different mechanisms and therapy should reflect those underlying mechanisms -rather than being simply based on pain intensity as recommended by the WHO three-step ladder. Secondly, a multidisciplinary approach is required which combines both pharmacological and non-pharmacological treatment, such as psychotherapy, exercise therapy and electrostimulation. The choice of analgesic agent and its route of administration are considered, along with various interventional procedures and the requirements of palliative care. Special attention is paid to the treatment of breakthrough pain (particularly with fast-acting fentanyl formulations, which have pharmacokinetic profiles that closely match those of breakthrough pain episodes) and chemotherapyinduced neuropathic pain, which affects around one third of patients who receive chemotherapy. Finally, the point is made that medical education should place a greater emphasis on pain therapy, both at undergraduate and postgraduate level.

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“I Feel Uncomfortable ‘Calling a Patient Out’”: Educational Needs of Palliative Medicine Fellows in Managing Opioid Misuse

Abstract: HPM fellows regularly see patients who are at risk for opioid misuse and feel unprepared to treat pain in these patients. There is a need for more education of fellows in this area.

Cited by 59 publications

References 28 publications

Pain Management in a Patient with Pancreatic Cancer and Substance Use Disorder

Pain Management in a Patient with Pancreatic Cancer and Substance Use Disorder

A conceptual model to facilitate transitions from primary care to specialty substance use disorder care: a review of the literature

Pain in the cancer patient: different pain characteristics CHANGE pharmacological treatment requirements

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