Nadeje Aurubin Mills, PharmD

The opioid crisis has become an increasingly important subject in medical, public health, and political forums. Widespread media coverage highlights the scores of overdose victims, while a parallel alternate reality of compromised pain care exists for legitimate chronic pain patients, who suffer in silence without an advocate.

Among the silent sufferers are individuals with harrowing stories of a traumatic motor vehicle collisions and combat veterans injured by an IED or tanker. All left with unspeakable, debilitating pain and given the cold shoulder with respect to their pain experience.

Sub-optimally managed pain is the outcome of a reactionary position to the opioid epidemic. With a management approach that is hyper-focused on concerns of addiction, diversion, or liability, individual patients are irrefutably regarded as a drug abuser and deprived of personalized medical attention. 

This attitude often inappropriately offends and accuses non-abusers of opioid misuse and mishandling, labeling them “junkies.” For fear of liability from an overdosed patient, prescribers take on a prescribing pattern of reducing doses across the board, disregarding relevant medical complications, such as mental health disorders.

Pain management specialists can enhance care by adopting a mindful and patient-centered approach to pain care. That starts with building rapport with chronic pain patients, earning their trust, and practicing within an ethical framework.

In my personal experience, patients are more cooperative with a plan to taper opioids when their concerns have been validated and addressed, and when they are included in the decision-making process. This can include adjusting the rate of taper or explaining substance use disorder clearly and concisely when identified. 

With this foundation in place, a patient is more responsive to learning about opioid-related risks and the importance of a multi-modal plan that pinpoints the most efficacious form of treatment or therapy. An essential piece of pain management is risk mitigation—the process of predicting and preventing adverse drug outcomes, misuse, and addiction.

This process is also useful in identifying opioid use disorders and connecting patients with a medication-assisted treatment program. The risk assessment process stratifies the patient into a risk level based on personal, family, and social history.

Risk screening provides feedback on who can safely start opioid therapy and suggested dose restrictions. It's also recommended to establish functional goals, such as the ability to sleep through the night, get back to work, or start a light exercise program. Querying prescription drug-monitoring programs and offering naloxone are some additional risk-mitigating measures. 

Expert pain care coordination is achieved by a team engaging in open and frequent dialogue with other team players and, most importantly, with the patient. Prescribers can sharpen their ability to respond meaningfully to patients’ need for pain control while helping them to redefine their understanding of pain management and commit to a multimodal treatment program.

Pain providers determined to respond with a humanizing touch, despite the existing challenges, will be better equipped to support patients with chronic pain and can realize increased patient satisfaction.

Nadeje Aurubin Mills, PharmD, earned her PharmD at Mercer University College of Pharmacy and Health Sciences in Atlanta, GA and completed a pharmacy practice residency at Mayo Clinic in Jacksonville, FL. She’s currently a clinical pharmacy specialist at the Miami VA Medical Center where she specializes in pain management.

Articles

Sub-optimally managed pain is the outcome of a reactionary position to the opioid epidemic.