Understanding Opioids: Part 2
Understanding Opioids: Part 2
Dr. Schreier: I am primarily involved in nursing education for both undergraduate and graduate students. The focus of the education that I provide is treatment of acute and persistent pain. It is clear that there is a need for a balanced approach in the treatment of pain and addiction. Chronic pain and addiction are 2 critically important illnesses. These illnesses also occur as comorbid conditions. Therefore, it is vitally important that healthcare professionals understand the treatment of these conditions. In this education, I find that I need to include information about the assessment of pain as well as the pharmacologic and nonpharmacologic management of pain. When nursing students enter the profession, they usually hold erroneous beliefs about substance misuse and addiction. As a result, a great deal of the content surrounds the definitions of terms as well as physiologic and neurologic pathways of acute pain and pathology of chronic or persistent pain. I also teach about the disease of addiction and the psychoneurologic changes that occur in affected people. In addition, the sociological aspects of addiction are considered. It is common for nurses to label patients who are frequently requesting pain medication as abusers without adequate assessment and without referral to appropriate addiction specialists. I see this as crucial to providing more education about both pain and addiction. In the current climate, chronic pain patients are being marginalized and experiencing significant difficulty with access to appropriate care.
Listed below is the essential content for both entry-level and advanced-level nursing practice:
As mentioned by Dr. McCance-Katz, it is extremely difficult to provide all of the needed education within very full nursing curricula. The American Society of Pain Management Nursing provides continuing education for nurses at all levels of practice.
Another important aspect of my work has been in providing advocacy for persons with chronic pain. With the growing concern regarding opioid abuse, state laws are making it increasingly difficult for individuals to have access to opioid medications. These medications are essential to the overall plan of care and functioning of these individuals. There is definitely appropriate concern and scientific discourse regarding the appropriateness of opioids for certain chronic pain conditions. However, there are individuals with chronic pain who use opioids appropriately as a part of the overall plan of care.
The Nurse
Dr. Schreier: I am primarily involved in nursing education for both undergraduate and graduate students. The focus of the education that I provide is treatment of acute and persistent pain. It is clear that there is a need for a balanced approach in the treatment of pain and addiction. Chronic pain and addiction are 2 critically important illnesses. These illnesses also occur as comorbid conditions. Therefore, it is vitally important that healthcare professionals understand the treatment of these conditions. In this education, I find that I need to include information about the assessment of pain as well as the pharmacologic and nonpharmacologic management of pain. When nursing students enter the profession, they usually hold erroneous beliefs about substance misuse and addiction. As a result, a great deal of the content surrounds the definitions of terms as well as physiologic and neurologic pathways of acute pain and pathology of chronic or persistent pain. I also teach about the disease of addiction and the psychoneurologic changes that occur in affected people. In addition, the sociological aspects of addiction are considered. It is common for nurses to label patients who are frequently requesting pain medication as abusers without adequate assessment and without referral to appropriate addiction specialists. I see this as crucial to providing more education about both pain and addiction. In the current climate, chronic pain patients are being marginalized and experiencing significant difficulty with access to appropriate care.
Listed below is the essential content for both entry-level and advanced-level nursing practice:
Physiology and pathophysiology of pain (nociceptive and neuropathic)
Negative physiologic consequences of the undertreatment of acute pain
Pharmacology of nonopioids, opioids, and adjuvant medications
Safety in administering of these medications in the hospital (specifically monitoring for respiratory depression) and outpatient setting -- advanced practice nurses in hospital settings are often essential members of the pain management service
Management and prevention of side effects, specifically constipation and nausea/vomiting
The use of nonpharmacologic treatment in addition to opioids is emphasized. Methods such as music, relaxation techniques, positioning of pains, and heat and cold can reduce the doses of opioids needed and increase the patient's ability to function and to recover from surgery or acute conditions.
The nurse plays a primary role in providing patients with education regarding the use of opioids. Patients are sometimes reluctant to use sufficient opioids because of fear of addiction.
Education about discharge from acute care facilities must be provided. The current issue that I see is that education about the securing of potentially addicting medications (opioids and some adjuvants) at home and getting rid of unused medications when no longer needed is not a routine for either nurses or other generalist prescribers.
Specific educational topics for generalist nurse practitioners (family nurse practitioners and adult nurse practitioners) include screening for addiction risks, continued monitoring of chronic pain patients, use of prescription drug monitoring programs, drug screen monitoring and how to interpret and respond to the results, and treatment and referral of patients with comorbid conditions of chronic pain and substance abuse.
As mentioned by Dr. McCance-Katz, it is extremely difficult to provide all of the needed education within very full nursing curricula. The American Society of Pain Management Nursing provides continuing education for nurses at all levels of practice.
Another important aspect of my work has been in providing advocacy for persons with chronic pain. With the growing concern regarding opioid abuse, state laws are making it increasingly difficult for individuals to have access to opioid medications. These medications are essential to the overall plan of care and functioning of these individuals. There is definitely appropriate concern and scientific discourse regarding the appropriateness of opioids for certain chronic pain conditions. However, there are individuals with chronic pain who use opioids appropriately as a part of the overall plan of care.
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