Assessing Patients With Pain
Assessing Patients With Pain
Description:
A list of clinical features and their frequency in both patients with pain and patients who are addicted to opioids. Pain -- both acute and chronic -- is an issue that affects a large number of the patients seen within primary care settings. Given the prevalence and the cost of pain to individuals, physicians who prescribe buprenorphine may find that they are approached by patients seeking pain management.
However, while buprenorphine and other opioid agonists have been proven effective in treating chronic pain, there are a number of issues that complicate their implementation in pain management practice, including the following:
- Regulatory barriers
- Practitioners' misunderstandings about pain management
- Fear of adverse side effects
- Misconceptions about the potential risks of addiction (McCarberg and Barkin, 2001)
Patients who are being treated for pain may become physically dependent on the opioid analgesics that are prescribed to them. However, while these patients need treatment for pain, they do not necessarily need treatment for addiction. It is important to note that patients with pain problems and patients who are addicted to opioids often present differently, and it is essential to distinguish between the needs of these two patient types when starting a buprenorphine practice.
| Clinical Features | Patients With Pain |
Patients Who Are Addicted to Opioids |
|---|---|---|
| Compulsive drug use | Rare | Common |
| Crave drug (when not in pain) | Rare | Common |
| Obtain or purchase drugs from nonmedical sources | Rare | Common |
| Procure drugs through illegal activities | Absent | Common |
| Escalate opioid dose without medical instruction | Rare | Common |
| Supplement with other opioid drugs | Unusual | Frequent |
| Demand specific opioid agent | Rare | Common |
| Can stop use when effective alternate treatments are available | Usually | Usually not |
| Prefer specific routes of administration | No | Yes |
| Can regulate use according to supply | Yes | No |
(SAMHSA, 2004)
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