Opioid Management for Chronic Pain

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Condition: Opioids are drugs that help relieve chronic and acute pain. An example of an opioid is morphine.

Background: Opioids are powerful and can help patients with severe pain. However, there is much confusing media coverage regarding opioid use and addiction. Because of this, people are sometimes hesitant to use them. As a result, pain can be undertreated or people may be stigmatized for using opioids. Physical medicine and rehabilitation (PM&R) physicians, also referred to as physiatrists, are uniquely well-equipped to evaluate and manage chronic pain.

Risk Factors:  People more at risk for abusing opioids include those who have had previous substance or alcohol abuse issues, depression, anxiety, and people who have used opioids at the same time as tranquilizers. Because opioids have the potential for abuse and serious side effects, it is important to be thoroughly evaluated to rule out causes of pain that may be better treated without the use of opioid medications. PM&R physicians are specially trained to perform these evaluations.

History and Symptoms:The term “pseudo-addiction” is used with people who are undertreated. Because they have severe pain and their prescription is not bringing relief, they may take more medication than prescribed, run out early, or experience withdrawal. Usually these symptoms are eliminated after proper medication adjustments are made. Addiction is different—it is a disease where people crave opioids and use them compulsively.

Physical Exam:  Every patient’s pain experience is unique. Therefore, the physical exam and decision to prescribe opioids can vary. A PM&R physician can perform a variety of specialized physical exam tests in-office to help identify the cause of a patient’s pain. Based on their findings, the physiatrist then suggests a treatment plan to address their specific kind of pain.

Diagnostic Process:  In the U.S., 10% of the population experiences chronic pain. Additionally, between 3% and 16% have substance abuse issues. Opioid medications have a number of adverse or dangerous effects, and they have the potential for abuse. Overdose of these medications can lead to death. However, when used appropriately they play an important role in pain management. Many PM&R physicians are expertly trained to assess a patient’s pain and risk factors in order to determine the best pain management options.

Rehab Management: An effective pain management program is based on quality patient-physician communication. If the patient feels the opioid is not helping, he or she must tell the physician so a better solution can be found, instead of taking more medication. PM&R physicians are experts in coordinating care with physical and occupational therapists who assist in improving function and quality of life for patients. They can establish a more definitive diagnosis, and prescribe medications that may be more specific to the pain generator. Furthermore, they may perform injections that avoid medications altogether.

Other Resources for Patients and Families: Families and patients should learn about substance abuse as well as how proper opioid use can improve quality of life. Learn more at the National Institute of Health’s Pain Consortium.


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