While reading through an ONS Connect published in 2010 from the ONS 35th Annual Congress, I ran across an article titled in part, "Breakthrough Pain Case Studies in Patients With Cancer." This article caught my interest, because it says at the beginning, "Some healthcare providers still believe that the use of opioids leads to addiction."
Kirsch discussed how nurses can help patients better understand their responsibility and identify potential problems. He explained that tolerance is not the same as addiction. He also talked about pseudo-addiction, which is really a result of undermedication. The nurse's role along the continuum of care includes identifing chronic and breakthrough pain, ensuring pain is treated promptly, screening for patients at risk for abuse or addiction before starting treatment, evaluating treatment effectiveness, and monitoring patients for aberrant drug behaviors while receiving treatment.
Cancer pain remains a major health problem in the United States. The magnitude of the problem, the subjective nature of the pain experience, and the complexity of the disease all make it difficult to control. Two-thirds of cancer patients with advanced disease have significant pain. There may be many causes of pain in a cancer patient, including the cancer itself as it grows, cancer treatments (which may include surgery, radiation, and/or chemotherapy), noncancerous causes, or a combination of these causes.
We lack sufficient understanding of how a pain pattern is related to other sensory pain characteristics, including location, intensity, and quality. You can read more on this in the article "Differences in Pain Location, Intensity, and Quality by Pain Pattern in Outpatients With Cancer."
The Journal of the American Medical Association reported that Dennis S. O'Leary, MD, president of the Joint Commission on Accreditation of Healthcare Organizations, told a pain summit meeting that "appropriate pain management is good medicine because it results in quicker clinical recovery, shorter hospital stays, fewer readmissions, and improved quality of life, leading to increased productivity." According to O'Leary, "the 'mystique of pain,' -- the long-held notion that because pain is subjective it eludes objective measurement -- has given way to evidence-based medicine as newer methods of assessing and controlling pain have emerged."
The JAMA article also states, "Excuses for inadequate pain control appear to have run their course and will no longer be accepted because poor pain control is unethical, clinically unsound, and economically wasteful."
For a more practical approach, nurses can review the pain management program at Sierra Tuscon. It incorporates a broad approach to treatment, since each person has different pain management needs. This approach addresses the various concurrent bio-psycho-social-spiritual factors that contribute to chronic pain. The patient receives both medical and psychological interventions and is guided into behavioral, lifestyle, and emotional changes that can help decrease pain over time.
How does your practice provide individualized pain control?