Myths Related to the treatment of pain.
|
|
- Shavonne Kennedy
- 6 years ago
- Views:
Transcription
1 Good Evening. Myths Related to the treatment of pain. My goal this evening is to give you an opportunity to understand some of the strongly held beliefs concerning pain treatment which have been shared by medical professionals and patients alike, and how these have contributed to poor pain management. I have given you a sheet with some statements about pain and pain treatment and I hope you have taken the opportunity to think about your agreement or disagreement with those statements. As I develop my presentation, you can assess your own views with those of medical professionals and patients. My interest in this policy area, developed following my appointment to the State Board of Medicine in 1995, leading to my opportunity to work on the development of national guidelines by the Federation of State Medical Boards for the use of narcotic analgesics in the treatment of pain, and later as a patient with chronic pain for about a two-year period. Through both these experiences, I have developed new insights into this problem and discovered many of my own false beliefs about chronic pain management and the use of opioid analgesics. Acute and chronic pain are public health issues. The International Association of Pain defines pain, as a sensory or emotional process, associated with tissue damage. Acute pain, such as that which we experience with trauma, alerts us to the presence of harmful or potentially harmful stimuli. Our rapid withdrawal response when we touch a hot utensil is a prime example. Such a reaction requires no conscious thought process and is protective. Chronic pain is being understood more clearly today as far more than a protracted version of acute pain. The repeated nerve stimulation, caused by chronic tissue injury, particularly when associated with inflammation, can become embedded in the nerves and spinal cord, like a memory, creating changes in the nerve pathways and creating an exaggerated response to those same pain signals. Patients who have suffered from uncontrolled pain, for months or years, often develop pain in areas well beyond the tissue or organ originally generating the pain. Physicians unfamiliar with this concept of neural memory may interpret their patient s pain complaints as psychogenic because it fails to conform to their preconceived concept of the nervous systems response to pain. 1
2 Instead physicians need to realize that the failure to treat chronic pain can result in physical, psychological and behavioral changes. In such situations, one can see decreased appetite, malaise, sleep disturbances and irritability, as well as, anger and depression. Pain is the most common reason that patients visit a physician. New pain complaints account for 40 million patient-visits annually. Each year, nearly 64 million people suffer from trauma-related pain. Chronic pain causes $4 billion in lost workdays, and as much as $65 million is lost as a result of diminished work productivity. The scope of the pain problem is huge. It is obvious to you that pain is also a common complication of acute and chronic diseases, or medical procedures. It has been documented that as many as 29 million people experience uncontrolled postoperative pain each year. Also, approximately 35 million people experience chronic headache and 16 million people have chronic back pain. Approximately 50% of patients with cancer report pain of at least moderate severity, and 46% of patients with cancer, report pain that cannot be managed with pain medication. Experts have come to recognize two basic types of pain, that related to tissue injury, with activation of the nervous system, called somatic pain, and that related to injury to the peripheral nervous system or brain, that may occur and continue without ongoing tissue damage, called neuropathic pain. It is important to remember that pain is a subjective experience that has both sensory and emotional components. There are several types of pain receptors found in nearly all tissues that convert noxious stimuli into an electrical impulse within the nerve that is interpreted as pain. One of the most common causes of pain is inflammation of tissues. Narcotic analgesic agents, often called opioids as a class of drugs, can have peripheral sites of action in the presence of inflammation. For instance, opioid receptors can be found on cells that respond to the tissue site of inflammation. The barriers standing between patients and effective relief of pain are largely intrinsic to the medical profession, and have been highlighted by a number of studies conducted through the 2
3 early to mid 1990 s. Those studies demonstrated (1)a common lack of professional knowledge about pain relief strategies, (2)a failure to make pain relief a priority and (3)an exaggerated concern about addiction, adverse side effects and regulatory scrutiny by licensing boards and the Drug Enforcement Administration. Pain treatment, or more exactly its undertreatment, regularly finds its way into the popular press. In a January 1999 New York Times Editorial, a Manhattan attorney suffering from chronic recurrent pancreatitis wrote after 23 years and close to $100,000, traditional medicine has been unable to treat or find a cause for my illness. Each time Mr. Felber has an attack of abdominal pain, he ends up in the emergency room, in acute pain for hours, before finally, he is administered morphine or another opioid for him the only class of drugs that will bring pain relief. Several times a year, Mr. Felber experiences one of the primary barriers to effective management of chronic pain physician reluctance to provide narcotic analgesics to be dispensed by a community pharmacist, and administered by the patient at home. In the past, Mr. Felber has been given fewer doses than the doctor ordered and less potent medications that have been substituted without Mr. Felber s knowledge, or a consultation with his physician. Well known pain specialists such as Dr. Russell Portenoy are beginning to get out the message to health professionals that opioid analgesics long considered taboo for the treatment of chronic pain are winning approval for use with appropriate patients. He points out to medical professionals that these medications can be given for indefinite periods; their effectiveness may never decline; the side effects may be minimal or absent altogether; and, that the risk of true addiction associated with chronic opioid use is greatly overstated. Let me tell you about Marlene. Marlene s days never seem to end. After a night of fitful sleep, the 70 year-old woman rises haltingly and makes her way to her kitchen. If her back is not hurting too terribly, she feeds the cat. Most days, however, the reaching and bending, required for this task are too strenuous, and the cat has to wait for Marlene s home health aide or daughter. Marlene s chronic back pain has not lessened in 12 years of surgical procedures, physical therapy, anti-inflammatory drugs, 3
4 acupuncture and spiritual healers. In that time, Marlene s pain has alienated her husband, who now lives elsewhere, and two of her three grown children. Her physicians doubt that her pain will ever get better. Yet they have ignored the recommendation of a local pain specialist to prescribe opioid therapy to Marlene. When will the profession recognize the role of opioids in chronic back pain? That s a question that more and more medical professionals are asking, as the media focuses new attention on the fact that back pain remains poorly controlled. We should note that: Compensation for low-back pain and injuries now costs US business and industry 60 billion dollars a year. In the United Kingdom back pain resulted in 52 million lost work days; there, statistics show that if a person takes off work for back pain for more than six weeks, he only has a 50% chance of ever returning to work. Back pain is the most common cause of disability among people over the age of 45 years. As with every other medical issue, such cases, like these of Mr. Felber and Marlene, are finding their way increasingly into courts and to the Boards of Medicine, for review. Let me tell you about Mr. Bergman. Early in 1985, 85-year old William Bergman came to the emergency room of Eden Medical Center in Castro Valley CA in severe pain. The Vicodin (a mild narcotic analgesic agent) that had been prescribed for him was clearly no longer adequate. He was promptly given morphine by the ER physician, which provided him with welcome relief. Because of a long history of smoking, advanced lung disease, and a recent history of weight loss, Mr. Bergman was admitted to the hospital under the care of Dr. Chin. Ostensibly based on concerns that Mr. Bergman could not tolerate morphine because of his lung disease and respiratory depression, Dr. Chin ordered the patient be given mgm of Demerol, as needed for pain,[a dose which is known to be very minimal and often ineffective]. During the 5-day hospitalization, according to the charted nurse s notes, Mr. Bergman s pain ranged from 7-10 on a scale where 10 represents the most severe pain one can imagine. However, both Dr. Chin and the nurses who cared for Mr. Bergman denied that he experienced severe unrelieved pain. According to the nurses, whenever Mr. Bergman rated his pain in the 7-10 range, they administered Demerol according to Dr. Chin s standing order and Mr. Bergman was made more comfortable. The reason low pain levels never appear in the hospital record, 4
5 the nurses insisted, is that it was not their practice to chart pain levels when they were low. In his sworn deposition, Dr. Chin acknowledged that he pays no attention whatsoever to nursing notes that purport to chart pain levels based on a 10-point scale. His approach to pain assessment is to ask patients, in the course of making rounds, how they are feeling and to observe their demeanor. If the patient does not say he is in severe pain, and if the patient is not writhing in or otherwise physically exhibiting significant pain or discomfort, then he assumes either that the patient has no pain or that it is well controlled. Mr. Bergman s family insisted that when they visited him in the hospital, they often found him to be in severe pain and that it was often necessary to prevail upon the nurses to administer additional pain medication. Mr. Bergman, they affirmed, like many men of his generation, was not one who felt comfortable acknowledging weakness or complaining of physical pain. Mr. Bergman was convinced that he had lung cancer based on initial x-ray studies although no specific tissue diagnosis had been made. He refused further diagnostic studies and requested to be discharged home to die as his wife had done with lung cancer two years earlier. Dr. Chin indicated to Mr. Bergman, that without a tissue diagnosis he was not willing to treat him as a patient who was dying with lung cancer. Dr. Chin was prepared to discharge Mr. Bergman from the hospital with a prescription for oral Vicodin, the analgesic that had failed to relieve his pain prior to hospitalization, even though the nurses were charting his pain as 10/10 on the day of planned discharge. Dr. Chin agreed to give Mr. Bergman a shot of Demerol and sent him home on a narcotic patch, an analgesic approach that may require several days to achieve pain control. When Mr. Bergman was visited by the hospice nurse at home shortly after his discharge, she found him to be in significant pain. The nurse was unable to convince Dr. Chin to prescribe morphine for Mr. Bergman s pain, so she secured such a prescription from another physician in the community. Once he began to receive morphine, his pain was easily brought under control. Mr. Bergman died of advanced lung cancer 3 days after his discharge from the hospital. 5
6 While Mr. Bergman s case may be an extreme example, it is not rare, and, increasingly complaints are being filed with State Licensing Boards claiming medical negligence for failure to appropriately treat patients pain. Mr. Bergman s family did complain to the CA State Board of Medicine who heard conflicting testimony from several experts. For whatever reason, the Board chose not to take disciplinary action against Dr. Chin. One observer felt that the Board did not feel that one isolated instance of poor pain management constituted a basis for disciplinary action. It should be noted that other medical boards have take action in similar circumstances. Mr. Bergman s family subsequently filed a civil action against Dr. Chin and the hospital. The hospital settled with the family out of court but a judgement of 1.5 million dollars was assessed against Dr. Chin for gross negligence leading to elder abuse. While the treatment of cancer pain is a problem, there may be even greater problems with other forms of non-cancer chronic pain as demonstrated by Mr. Felber s and Marlene s case histories. In a survey of 2000 nursing home patients, ¾ had chronic pain and nearly ½ of these had had no assessment of the pain within the previous 3 months. Most of these were receiving no therapy, medication or otherwise, for their pain. Of those receiving pain medication, 2/3 were receiving short acting drugs administered on an as needed basis, a therapeutic approach that is well recognized as ineffective treatment of chronic pain. Demerol, which may be very effective for the treatment of acute pain, is frequently prescribed for the treatment of chronic pain. This is inappropriate, because one of its metabolites builds up over time and is very toxic. In an opinion survey of physicians conducted in the year 2000, 1/3 physicians felt that narcotics should be limited to the treatment of severe intractable pain. One-third felt that the use of narcotics for non-cancer pain of any type was illadvised. Two-thirds of those surveyed felt there was a legal limit to the number of narcotic tablets that could be prescribed to a patient. One-fourth of the physicians noted that it was their practice to limit the number of pills they list on a prescription to avoid investigation by their licensing board or DEA. 6
7 Patient s attitudes also effect the ability to treat chronic pain. Many patients desire to be seen as non-complaining by their physician and therefore do not bring up or adequately describe their pain symptoms. Some patients have concerns about taking strong pain killers, even for a limited time. Some patients feel that if they focus on their pain concerns, that this will take their doctor s focus away from their primary disease process or problem. Many patients express concerns about becoming hooked or addicted to narcotic analgesics. Health care professionals and patients alike often lack an accurate understanding of drug tolerance, physical dependence and addiction. Confusion about these conditions results in unfounded fears in both patient and physician regarding the use of opioids. This, in turn, leads to suboptimal use of opioids, particularly in the treatment of chronic pain. Addiction is a chronic, neurobiological disease manifested by behaviors including impaired control over drug use, compulsive use, continued use despite harm and craving. There is no substantive data that the treatment of chronic pain with opioids leads to addiction. Physical dependence and tolerance are physiologic outcomes that should be expected in patients receiving long-term therapy with opioids and should not be confused with addiction. Physical dependence is a state of adaptation that can be manifested as a withdrawal syndrome. Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug s effects over time (i.e., a desired effect such as pain control or a side effect such as sedation). So enough bad news, what is happening to change this and what remains to be done? With a significant push from government standard setting groups and private accrediting agencies, the profession has begun a multidisciplinary effort to provide better care. My own assessment is that we are doing a better job of asking patients about pain during most acute care encounters [the concept of pain assessment as the fifth vital sign of the VA] and a better job of treating acute pain with appropriate use of patient controlled analgesia and follow-up assessments to gauge the effectiveness of pain control efforts. Medical Schools and residency training programs are including these issues in their 7
8 curricula and board examinations are including assessment of this cognitive area in their testing designs. Where we clearly still have much work to do is to get the word out to all practicing physicians, particularly those that potentially can improve the care of patients in nursing homes and those with chronic pain. In 1998, The Federation of State Medical Boards adopted guidelines for effective pain management that were developed on the basis of quality standards from governmental agencies and national pain professional organizations. These guidelines or a variation on them have been accepted by most of the 70 state medical boards. I would say that based on my experience with our own State Medical Board, that only the most egregious of actions are brought to the Board for disciplinary action and I have seen no complaints of undertreatment presented to the board. A nationally published consensus statement on the use of opioids for the treatment of chronic pain lists eight key points that are a reasonable roadmap of ongoing and for continued action. (1) In the US pain management is becoming a higher priority (2) Opioid pain management is in a critical phase of assessment (3) Non-cancer pain is often inadequately managed; opioids should be included in the list of potential treatment strategies (4) Commonly held assumptions about addiction, respiratory depression and side effects, tolerance and drug diversion need to be modified so that misconceptions do not impede effective opioid use (5) Evolving public policy on opioid use indicate a growing recognition that the use of opioids for the relief of chronic pain is a legitimate medical practice (6) There is a continuing need to promulgate accepted practice principles to physicians and regulators (7) Opioid prescribing requires good medical practice, no more and no less, to include proper patient evaluation, an 8
9 individualized treatment plan, consultation with pain specialists as needed, periodic review of treatment efficacy, and proper medical record documentation I have focused my presentation on myths related to the medicinal use of opioid agents because, as a therapeutic strategy, they can be very effective in the management of chronic pain and allow the patient to function normally. Effective pain management may require a multimodality approach that should not be solely limited to medications. I would be pleased to entertain comments or questions at this point. 9
Colorado State Board of Medical Examiners Policy
POLICY NUMBER: 10-14 Title: Guidelines for the Use of Controlled Substances for the Treatment of Pain Date Issued: May 16, 1996 Date(s) Revised: November 18, 2004 Reference: 12-36-117, C.R.S. Purpose:
More informationFoundations of Safe and Effective Pain Management
Foundations of Safe and Effective Pain Management Evidence-based Education for Nurses, 2018 Module 1: The Multi-dimensional Nature of Pain Module 2: Pain Assessment and Documentation Module 3: Management
More informationKANSAS Kansas State Board of Healing Arts. Source: Kansas State Board of Healing Arts. Approved: October 17, 1998
KANSAS Kansas State Board of Healing Arts Source: Kansas State Board of Healing Arts Approved: October 17, 1998 GUIDELINES FOR THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF PAIN Section 1: Preamble
More informationWithin the Scope of Practice/Role of _X APRN RN LPN CNA ADVISORY OPINION PAIN MANAGEMENT GUIDELIINES
Wyoming State Board of Nursing 130 Hobbs Avenue, Suite B Cheyenne, WY 82002 Phone (307) 777-7601 Fax (307) 777-3519 E-Mail: wsbn-info-licensing@wyo.gov Home Page: https://nursing-online.state.wy.us/ OPINION:
More informationCOLLEGE OF PHYSICIANS AND SURGEONS OF NOVA SCOTIA SUMMARY OF DECISION OF INVESTIGATION COMMITTEE D. Dr. Deanna Swinamer
COLLEGE OF PHYSICIANS AND SURGEONS OF NOVA SCOTIA SUMMARY OF DECISION OF INVESTIGATION COMMITTEE D Dr. Deanna Swinamer Investigation Committee D of the College of Physicians and Surgeons of Nova Scotia
More informationOverview of Pain Types and Prevalence
Pain Resource Nurse Overview of Pain Types and Prevalence Pain Resource Nurse Program Module 1 The Resource Center of the Alliance of State Pain Initiatives University of Wisconsin Board of Regents, 2011
More informationMissouri Guidelines for the Use of Controlled Substances for the Treatment of Pain
Substances for the Treatment of Pain Effective January 2007, the Board of Healing Arts appointed a Task Force to review the current statutes, rules and guidelines regarding the treatment of pain. This
More informationNHS Training for AHP Support Workers. Workbook 5 Pain control awareness
NHS Training for AHP Support Workers Workbook 5 Pain control awareness Contents Workbook 5 Pain control awareness 1 5.1 Aim 3 5.3 What is pain and why does it occur? 4 5.4 Pain rating scales 11 5.5 Pain
More informationBuprenorphine Patient Education
Treating Chronic Pain The management of chronic pain often takes a multidisciplinary approach in order to be more effective. In other words, it takes more than one technique used in combination with others
More informationPain Module. End of Life Pain Assessment and Management
Pain Module End of Life Pain Assessment and Management Assessing pain at end of life Perform the routine pain assessment asking the typical questions e.g., location, severity, quality and so forth. Perform
More informationPAIN TERMINOLOGY TABLE
PAIN TERMINOLOGY TABLE TERM DEFINITION HOW TO USE CLINICALLY Acute Pain Pain that is usually temporary and results from something specific, such as a surgery, an injury, or an infection Addiction A chronic
More informationNational Council on Patient Information and Education
National Council on Patient Information and Education You are not alone The type of pain that caused your doctor to prescribe a pain medicine for you can make you feel that you are different from everyone
More informationPain Management During Endof-life
Pain Management During Endof-life The more that we understand about how pain works and how to relieve this suffering, the gentler and easier we can make end-of-life for patients who are suffering from
More informationRule Governing the Prescribing of Opioids for Pain
Rule Governing the Prescribing of Opioids for Pain 1.0 Authority This rule is adopted pursuant to Sections 14(e) and 11(e) of Act 75 (2013) and Sections 2(e) and 2a of Act 173 (2016). 2.0 Purpose This
More informationOCCUPATIONAL AND PROFESSIONAL LICENSING MEDICINE AND SURGERY PRACTITIONERS MANAGEMENT OF PAIN AND OTHER CONDITIONS WITH CONTROLLED SUBSTANCES
TITLE 16 CHAPTER 10 PART 14 OCCUPATIONAL AND PROFESSIONAL LICENSING MEDICINE AND SURGERY PRACTITIONERS MANAGEMENT OF PAIN AND OTHER CONDITIONS WITH CONTROLLED SUBSTANCES 16.10.14.1 ISSUING AGENCY: New
More informationOPIOID PAIN MEDICATION Agreement and Informed Consent
OPIOID PAIN MEDICATION Agreement and Informed Consent I. Introduction Research and clinical experience show that opioid (narcotic) pain medications are helpful for some patients with chronic pain. The
More informationOPIOIDS AND NON-CANCER PAIN
Ch05.qxd 1/6/04 4:33 PM Page 77 CHAPTER 5 OPIOIDS AND NON-CANCER PAIN Background 78 Side-effects of opioids 78 Tolerance, physical dependence and addiction 79 Opioid-induced pain 79 Practical issues 80
More informationConquering Chemical Dependency Step 1 Admitting My Powerlessness
Conquering Chemical Dependency Step 1 Admitting My Powerlessness We admit that by ourselves we are powerless over chemical substances, that our lives have become unmanageable Memory verse: Proverbs 14:12
More informationWellness along the Cancer Journey: Palliative Care Revised October 2015
Wellness along the Cancer Journey: Palliative Care Revised October 2015 Chapter 3: Addressing Cancer Pain as a part of Palliative Care Palliative Care Rev. 10.8.15 Page 360 Addressing Cancer Pain as Part
More informationPain and Addiction. Edward Jouney, DO Department of Psychiatry
Pain and Addiction Edward Jouney, DO Department of Psychiatry Case 43 year-old female with a history chronic lower back pain presents to your clinic ongoing care. She has experienced pain difficulties
More informationPain Control After Surgery. Patient Information
Pain Control After Surgery Patient Information What is Pain? Pain is an uncomfortable feeling that tells you something may be wrong in your body. Pain is your body s way of sending a warning to your brain.
More informationRULES OF THE ALABAMA STATE BOARD OF MEDICAL EXAMINERS
RULES OF THE ALABAMA STATE BOARD OF MEDICAL EXAMINERS 540-X-4-.07 Guidelines Requirements for the Use of Controlled Substances for the Treatment of Pain. (1) Preamble. (a) The Board recognizes that principles
More informationBuprenorphine Patch (Transtec Patch)
NHS Greater Glasgow And Clyde Pain Management Service Information for Adult Patients who are Prescribed Buprenorphine Patch (Transtec Patch) For the Treatment of Pain Contents Page What is a transtec patch?...
More informationThe Difficult Patient: Risk Mitigation Strategies
The Difficult Patient: Risk Mitigation Strategies C. Scott Anthony, D.O. Pain Management of Tulsa 1 Opioid Backlash National emergency Opioids not indicated for chronic pain Forces pushing for reduction
More informationAn unpleasant sensory and emotional experience associated with actual or potential tissue damage.
An unpleasant sensory and emotional experience associated with actual or potential tissue damage. Acute Pain results from disease, inflammation or injury to tissues; generally comes on suddenly and may
More informationNew Mexico. Prescribing and Dispensing Profile. Research current through November 2015.
Prescribing and Dispensing Profile New Mexico Research current through November 2015. This project was supported by Grant No. G1599ONDCP03A, awarded by the Office of National Drug Control Policy. Points
More informationISSUING AGENCY: Regulation and Licensing Department - NM Board of Osteopathic Medical Examiners.
Code of New Mexico Rules Title 16. Occupational and Professional Licensing Chapter 17. Osteopathic Medicine and Surgery Practitioners Part 5. Prescribing and Distribution of Controlled Substances 16.17.5.
More informationJuly 6, Scott Gottlieb, MD Commissioner U.S. Food and Drug Administration New Hampshire Avenue Silver Spring, MD 20993
Scott Gottlieb, MD Commissioner U.S. Food and Drug Administration 10903 New Hampshire Avenue Silver Spring, MD 20993 RE: Draft Revisions to the Food and Drug Administration Blueprint for Prescriber Education
More informationPain Management at Stony Brook Medicine
Pain Management at Stony Brook Medicine Pain Management Policy All patients must have effective pain management Appropriate screening and pain assessment Documentation Care and treatment Pain education
More informationOpioids: What You Should Know About Opioid Prescribing. Denis G. Patterson, DO Nevada State Medical Association October 19, 2016
Opioids: What You Should Know About Opioid Prescribing Denis G. Patterson, DO Nevada State Medical Association October 19, 2016 Contact Information Denis G. Patterson, DO Nevada Advanced Pain Specialists
More informationMQAC Rules for the Management of Chronic Non-Cancer Pain For Allopathic Physicians Effective January 2, 2012
MQAC Rules for the Management of Chronic Non-Cancer Pain For Allopathic Physicians Effective January 2, 2012 WAC 246-919-850 Pain management Intent. These rules govern the use of opioids in the treatment
More informationAcute Pain NETP: SEPTEMBER 2013 COHORT
Acute Pain NETP: SEPTEMBER 2013 COHORT Pain & Suffering an unpleasant sensory & emotional experience associated with actual or potential tissue damage, or described in terms of such damage International
More informationChoose a category. You will be given the answer. You must give the correct question. Click to begin.
Instructions for using this template. Remember this is Jeopardy, so where I have written Answer this is the prompt the students will see, and where I have Question should be the student s response. To
More informationPain and its Treatments. Our Goals: Understand: What is pain and what causes it? 2. What are different types of pain? 3. How do opioid drugs work?
Pain and its Treatments Cheryl Stucky, Ph.D. Medical College of Wisconsin Our Goals: Understand: 1. What is pain and what causes it? 2. What are different types of pain? 3. How do opioid drugs work? What
More informationState of Connecticut Department of Education Division of Teaching and Learning Programs and Services Bureau of Special Education
State of Connecticut Department of Education Division of Teaching and Learning Programs and Services Bureau of Special Education Introduction Steps to Protect a Child s Right to Special Education: Procedural
More informationPatient Application for Treatment
Address: 179 Linwood Ave. Colchester, CT 06415 Phone: (860) 603-3541 Fax: (860) 603-3544 Visit Date: / / MR#: Patient Application for Treatment 1. Name: 2. Date of Birth: 3. Social Security #: 2. Address:
More informationOther significant mental health complaints
Other significant mental health complaints 2 Session outline Introduction to other significant mental health complaints Assessment of other significant mental health complaints Management of other significant
More informationUnderstanding the impact of pain and dementia
Understanding the impact of pain and dementia Knowing how to identify and manage the symptoms of pain in people living with dementia is an important part of a carer s role. This guide provides an overview
More informationPSYCHOLOGIST-PATIENT SERVICES
PSYCHOLOGIST-PATIENT SERVICES PSYCHOLOGICAL SERVICES Welcome to my practice. Because you will be putting a good deal of time and energy into therapy, you should choose a psychologist carefully. I strongly
More informationImpact of Opioid Shortages on Veterinary Medicine. Summary of a National Survey of Veterinarians September 2018
Impact of Opioid Shortages on Veterinary Medicine Summary of a National Survey of Veterinarians September 2018 Purpose Opioid shortages have a negative impact on veterinarians ability to provide appropriate
More informationHPNA Position Statement Pain Management
HPNA Position Statement Pain Management Background Pain is a common symptom in most serious or life-threatening illnesses. Pain is defined as an unpleasant subjective sensory and emotional experience associated
More informationImproving Health, Enriching Life. Pain Management. Altru HEALTH SYSTEM
Improving Health, Enriching Life altru.org Pain Management Altru HEALTH SYSTEM There are many different causes and kinds of pain. Pain can be caused by injury, illness, sickness, disease or surgery. Treating
More informationROLE PLAY #1: ASSESSMENT WITH THE 6 A s PATIENT ROLE
ROLE PLAY #1: ASSESSMENT WITH THE 6 A s PATIENT ROLE You are a 58 year old man/woman and have a history of severe chronic low back pain for 20 years. You injured your back 20 years ago at work and have
More informationLegal Issues in Opioid Prescribing
Legal Issues in Opioid Prescribing Joanne L. Martin, J.D. Legal Counsel Mayo Clinic Rochester, Mn 2015 MFMER slide-1 Conflict of Interest I have no relevant financial relationships to disclose I will not
More informationControlled Substance and Wellness Agreement
Controlled Substance and Wellness Agreement You and your provider have agreed on the use of controlled substance medications to treat your: We want to make sure you know how to manage your new prescription(s)
More informationBrief Pain Surveys. Developed by: Betty R. Ferrell, PhD, FAAN and Margo McCaffery RN, MSN, FAAN
Brief Pain Surveys Pain Assessment/Behavior Survey Pain/Gender Survey Brief Cancer Pain Information Survey Pain Addiction Survey Brief Pharmacology Survey Test Questions Developed by: Betty R. Ferrell,
More informationFocus on Pharmacy Management
NEW INSIGHTS FOR PAIN MANAGEMENT 1 I. Introduction CorVel s series illuminates the many facets of challenges faced in our industry. Each article shares best practices, tools and approaches payors may use
More informationOur Core Thoughts on Dealing with the Opioid Addiction Crisis. Meghan McNelly, PharmD, MHA, FACHE Suzette Song, MD Joseph Alhadeff, MD
Our Core Thoughts on Dealing with the Opioid Addiction Crisis Meghan McNelly, PharmD, MHA, FACHE Suzette Song, MD Joseph Alhadeff, MD Outline Brief History of the Opioid Problem How did we as a medical
More informationToday the overuse of opioids is a problem. Many of
A PPENDIX B A Word About Opioid Use Today the overuse of opioids is a problem. Many of these opioids are prescribed and thus are legal. Other people steal or buy opioids on the streets. These are illegal.
More informationPain 101: An Introduction to Chronic Pain & Pain Management
Pain 101: An Introduction to Chronic Pain & Pain Management CRC HEALTH GROUP What is Pain? The International Association for the Study of Pain defines pain as follows: Pain is an unpleasant sensory and
More informationEuropean Pain Federation (EFIC) Position Paper on: Appropriate Opioid Use in Chronic Pain Management
European Pain Federation (EFIC) Position Paper on: Appropriate Opioid Use in Chronic Pain Management 2017 Structured Cooperation between Health Care Systems tackling the societal impact of pain! Prof Tony
More informationTHE FDA DRUG APPROVAL PROCESS Under the Federal Food, Drug, and Cosmetic (FD&C) Act, FDA is responsible for ensuring that all new drugs are safe and
THE FDA DRUG APPROVAL PROCESS Under the Federal Food, Drug, and Cosmetic (FD&C) Act, FDA is responsible for ensuring that all new drugs are safe and effective. Before any drug is approved for marketing
More informationten questions you might have about tapering (and room for your own) an informational booklet for opioid pain treatment
ten questions you might have about tapering (and room for your own) an informational booklet for opioid pain treatment This booklet was created to help you learn about tapering. You probably have lots
More informationMEDICATION MANAGEMENT AGREEMENT Pain Management Program Participation Agreement and Consent
MEDICATION MANAGEMENT AGREEMENT Pain Management Program Participation Agreement and Consent Pain may be effectively managed through the use of controlled substance medications (referred to below as opioids
More informationLouisiana. Prescribing and Dispensing Profile. Research current through November 2015.
Prescribing and Dispensing Profile Louisiana Research current through November 2015. This project was supported by Grant No. G1599ONDCP03A, awarded by the Office of National Drug Control Policy. Points
More informationMay 2015 Clinical Nurse Educator Arohanui Hospice
May 2015 Clinical Nurse Educator Arohanui Hospice End of Life Care, what s on top? Feedback from last session (Physiology of Dying) Volunteer to present at August meeting Presentation: Breaking Bad News
More informationUnderstanding Pain. Teaching Plan: Guidelines for Teaching this Lesson
Understanding Pain Teaching Plan: Guidelines for Teaching this Lesson Lesson Overview This one-hour lesson plan is about pain and how your workers should respond to and care for residents with pain. You
More informationDear DEA. Howard A. Heit, MD, FACP, FASAM,* Edward Covington, MD, and Patricia M. Good
PAIN MEDICINE Volume 5 Number 3 2004,* Edward Covington, MD, and Patricia M. Good *Georgetown University, Washington, District of Columbia; Cleveland Clinic Foundation, Cleveland, Ohio; Office of Diversion
More informationI. Chronic Pain Information Page 2-3. II. The Role of the Primary Care Physician in Chronic Pain Management Page 3-4
SUTTER MEDICAL FOUNDATION (SMF) 2750 GATEWAY OAKS DRIVE, #150 SACRAMENTO, CA 95833 SPA PCP Treatment & Referral Guidelines PAIN MANAGEMENT Developed June 1, 2003 Revised (Format Revisions) November 13,
More informationKey Findings and Recommendations from the
June 2014 Improving Community Health Through Policy Research Key Findings and Recommendations from the 2013 IPLA INSPECT Knowledge and Use Survey 2014 Center for Health Policy (14-H54) IU Richard M Fairbanks
More informationRecognizing & Treating Pain
Recognizing & Treating Pain Making a Difference in the Lives of your Residents Presented by: Demi Haffenreffer, RN, MBA demi@consultdemi.net www.consultdemi.net Pain Assessment & Management in Long Term
More informationDemerol (meperidine oral tablet, oral solution), Meperitab (oral tablet)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subsection: Analgesics and Opioids Original Policy Date: May 8, 2015 Subject: Meperidine Page: 1 of 5 Last
More informationII. The Federal Government s Current Approach to Compensation. The issue of compensation for vaccine related injuries has been brought to
13 II. The Federal Government s Current Approach to Compensation The issue of compensation for vaccine related injuries has been brought to congressional and wider public attention most dramatically in
More informationComments on the proposal may be submitted to Colleen Klein, P.O. Box 2018, Austin, Texas A public hearing will be held at a later date.
TITLE 22.EXAMINING BOARDS Part 9. TEXAS STATE BOARD OF MEDICAL EXAMINERS Chapter 170. AUTHORITY OF PHYSICIAN TO PRESCRIBE FOR THE TREATMENT OF PAIN [ I have annotated the Proposed Rule by enlarging the
More informationVirginia. Prescribing and Dispensing Profile. Research current through November 2015.
Prescribing and Dispensing Profile Virginia Research current through November 2015. This project was supported by Grant No. G1599ONDCP03A, awarded by the Office of National Drug Control Policy. Points
More informationIntroduction. What is RSD? Causes of RSD. What Makes Reflex Sympathetic Dystrophy So Complicated?
What Makes Reflex Sympathetic Dystrophy So Complicated? Article originally appeared in inmotion Magazine: Volume 14 Issue 5 September/October 2004 Introduction Because this condition is so complex, the
More informationPharmacy Law Disclosure Statement. Objectives 6/11/2016. I have no conflicts of interest to disclose related to this presentation.
Pharmacy Law 2016 Ronda H. Lacey, J.D., M.S. Pharm Disclosure Statement I have no conflicts of interest to disclose related to this presentation. Objectives At the conclusion of this continuing education
More informationChapter 19. Pain Management, Rest, and Restorative Sleep. Fundamentals of Nursing Care Concepts, Connections, & Skills, Second Edition
Chapter 19 Pain Management, Rest, and Restorative Sleep Presented by Farahnaz Danandeh, Nursing Educator @ GHOC Classifications of Pain Acute: Sudden pain; short duration of less than 6 months Chronic:
More informationWorkplace Health, Safety & Compensation Review Division
Workplace Health, Safety & Compensation Review Division WHSCRD Case No: WHSCC Claim No: Decision Number: 15240 Bruce Peckford Review Commissioner The Review Proceedings 1. The worker applied for a review
More informationPAIN MANAGEMENT. Understanding End-of-Life Pain Management. De Anna Looper, RN CHPN. Carrefour Associates. Management Company for Crossroads Hospice
Understanding End-of-Life Pain Management De Anna Looper, RN CHPN Carrefour Associates Management Company for Crossroads Hospice August 2009 The effect of uncontrolled pain at the end of life is substantial.
More informationCMA Response: Health Canada s Medical Marihuana Regulatory Proposal. Submitted to the Office of Controlled Substances Health Canada.
CMA Response: Health Canada s Medical Marihuana Regulatory Proposal Submitted to the Office of Controlled Substances Health Canada February 28, 2013 A healthy population and a vibrant medical profession
More informationThe Impaired Professional. Peter Cohen, D.O.
The Impaired Professional Peter Cohen, D.O. Definition The American Medical Association (AMA) defines impairment as the inability to practice medicine with reasonable skill and safety to patients by reason
More informationPalliative Care Asking the questions that matter to me
Palliative Care Asking the questions that matter to me THE PALLIATIVE HUB Adult This booklet has been developed by the Palliative Care Senior Nurses Network and adapted with permission from Palliative
More informationA PATIENT GUIDE FOR MANAGING PAIN
A PATIENT GUIDE FOR MANAGING PAIN PAIN MANAGEMENT Knowing the Facts Pain can be controlled. Pain is common after surgery and with many types of illnesses. Most patients with acute and chronic pain can
More informationSafe Prescribing of Drugs with Potential for Misuse/Diversion
College of Physicians and Surgeons of British Columbia Safe Prescribing of Drugs with Potential for Misuse/Diversion Preamble This document establishes both professional standards as well as guidelines
More informationPrinciples and language suggestions for talking with patients
SAFER MANAGEMENT OF OPIOIDS FOR CHRONIC PAIN: Principles and language suggestions for talking with patients Use these principles and language suggestions when discussing opioid risks and safety monitoring
More informationINFORMED CONSENT FOR OPIOID TREATMENT FOR NON-CANCER/CANCER PAIN Texas Pain and Regenerative Medicine
INFORMED CONSENT FOR OPIOID TREATMENT FOR NON-CANCER/CANCER PAIN Texas Pain and Regenerative Medicine The purpose of this agreement is to give you information about the medications you will be taking for
More informationThe Impact of Opioid Use and Abuse on Medical Community, Businesses, Social Organizations and Individiuals and Their Families
The Impact of Opioid Use and Abuse on Medical Community, Businesses, Social Organizations and Individiuals and Their Families THE MAGNITUDE OF THE OPIOID EPIDEMIC THE COSTS TO LOCAL, STATE AND NATIONAL
More informationIt s Mental Health Week!
It s Mental Health Week! This year, the Canadian Mental Health Association (CMHA) presents Mental Health Week from May 5 th to May 11 th. CMHA is launching a Be Mind Full initiative asking Canadians if
More informationWILLIAMS, WYCKOFF & OSTRANDER, PLLC Attorneys at Law
WILLIAMS, WYCKOFF & OSTRANDER, PLLC Attorneys at Law Wayne L. Williams Douglas P. Wyckoff Dane D. Ostrander 2958 Limited Lane N.W. P O Box 316 Olympia, WA 98507 Telephone (360) 528-4800 Telefax (360) 943-2430
More informationNew York Law Journal. Friday, May 9, Trial Advocacy, Cross-Examination of Medical Doctors: Recurrent Themes
New York Law Journal Friday, May 9, 2003 HEADLINE: BYLINE: Trial Advocacy, Cross-Examination of Medical Doctors: Recurrent Themes Ben B. Rubinowitz and Evan Torgan BODY: It goes without saying that the
More informationCourt Preparation and Participation
Court Preparation and Participation Trainer Guide July 2013 Table of Contents Review ~ Court Preparation... 1 Topic ~ Responsibilities to Review and Prepare for Court Materials... 2 Topic ~ How to be a
More informationHealthPartners Inspire Special Needs Basic Care Clinical Care Planning and Resource Guide CHRONIC PAIN
The following evidence based guideline was used in developing this clinical care guide: National Institute of Health (NIH National Institute of Neurological Disorders and Stroke), Mount Sinai Beth Israel
More information10 symptoms of caregiver stress
10 symptoms of caregiver stress If you experience any of these signs of stress on a regular basis, make time to talk to your doctor. 1. Denial about the disease and its effect on the person who s been
More information4/3/2014. Dame Cicely Sanders : Born in England Nursing Degree Social Work Degree Doctor Opened 1 st Stand Alone Hospice 1967
Catherine Hausenfluke Independent Consultant 512-966-4955 Know More about Dying and Grief Come to Terms with Your Own Morality Understand Grief and What are the Rules Understand the Dying Process Relating
More informationPain Assessment & Management. For General Nursing Orientation
Pain Assessment & Management For General Nursing Orientation April 2012 Overview Definition of pain Barriers to effective pain management Types of pain Objective pain assessment Approaches to management
More informationADULT INTAKE QUESTIONNAIRE. Ok to leave message? Yes No. Present psychological difficulties please check any that apply to you at this time.
ADULT INTAKE QUESTIONNAIRE Name: Today s Date: Age: Date of Birth: Address: Home phone: Work phone: Cell phone: Ok to leave message? Yes No Ok to leave message? Yes No Ok to leave message? Yes No Email:
More informationResponding to The Joint Commission Alert on Safe Use of Opioids in Hospitals
Responding to The Joint Commission Alert on Safe Use of Opioids in Hospitals Suzanne A Nesbit, PharmD, CPE Clinical Pharmacy Specialist, Pain Management The Johns Hopkins Hospital Objectives and Disclosures
More informationWhat are symptoms of oxycodone withdrawal? Once an oxycodone user lowers the dosage by more than 1/2 at a time or stops taking oxycodone altogether,
What are symptoms of oxycodone withdrawal? Once an oxycodone user lowers the dosage by more than 1/2 at a time or stops taking oxycodone altogether, the body starts manifesting withdrawal symptoms. Vitamin
More informationDiagnostic Lumbar Medial Branch Block: Summary and Discharge Instructions
Scheduled Date:! 2012 / /!! Arrival time:!!!! am / pm What is going to be done today and why? Today, you will have a procedure called a diagnostic lumbar medial branch block. The term diagnostic is used
More informationPublic Policy Agenda 2016
Public Policy Agenda 2016 1 in 26 Americans will have epilepsy over the course of their lifetime. Nearly three million children and adults in the United States have epilepsy. Epilepsy is defined as an
More informationTest Bank for Ebersole and Hess Toward Healthy Aging Human Needs and Nursing Response 8th Edition by Touhy and Jett
Test Bank for Ebersole and Hess Toward Healthy Aging Human Needs and Nursing Response 8th Edition by Touhy and Jett MULTIPLE CHOICE Chapter 17: Pain and Comfort 1. When performing a pain assessment on
More informationNCPA Controlled Substances Access Survey Results January Key Highlights
NCPA Controlled Substances Access Survey Results January 214 NCPA surveyed our members in December 213 regarding pharmacy access to controlled substances and received over 1, responses. These survey results
More informationTreatment Issues: The Opiate Crisis Among Us
Treatment Issues: The Opiate Crisis Among Us Presenter: Jessica Cirillo, BS, MA, ACRPS Clinical Supervisor & Relapse Prevention Specialist with Mirmont Treatment Center Facts About Addiction Addiction
More informationSENSORY FUNCTIONING CHAPTER 44
SENSORY FUNCTIONING CHAPTER 44 THE SENSORY EXPERIENCE The sensory experience consists of 2 components: Reception: Conscious process of receiving thru the senses about the external or internal environment
More information1. Acute Pain Conditions 2. Narcotics 3. Chronic Pain
Dr. Bertus 1/22/14 1. Acute Pain Conditions 2. Narcotics 3. Chronic Pain An unpleasant sensory and emotional experience......caused by actual or potential tissue injury,...or described in terms of such
More informationSyllabus. Questions may appear on any of the topics below: I. Multidimensional Nature of Pain
Questions may appear on any of the topics below: I. Multidimensional Nature of Pain Syllabus A. Epidemiology 1. Pain as a public health problem with social, ethical, legal and economic consequences 2.
More informationToday s Presenters. Pills, Providers, and Problems: How to Investigate Drug Diversion in Long-Term Care
Pills, Providers, and Problems: How to Investigate Drug Diversion in Long-Term Care 203 - Monday, April 16, 2018 Today s Presenters Ben Purser Former F.B.I. Special Agent Donna Thiel ProviderTrust Chief
More informationWHY GOOD PAIN MANAGEMENT IS GOOD DRUG ABUSE PREVENTION
WHY GOOD PAIN MANAGEMENT IS GOOD DRUG ABUSE PREVENTION Bob Twillman, Ph.D., FAPM Executive Director Academy of Integrative Pain Management Walking the Tightrope of Pain Management Adverse Events Misuse
More informationPrimary Care Coordination
Primary Care Coordination ANDREW SUCHOCKI, MD, MPH MEDICAL DIRECTOR CLACKAMAS HEALTH CENTERS The Opiate Crisis: Scapegoats and Solidarity Primary Care and the Emergency Dept. 1 Basic Assumptions Chronic
More information