Background
Patients, providers,
communities and health systems have struggled to achieve balance between access
to opioid treatment for chronic pain and its potential harmful consequences:
especially misuse, addiction and overdose. We developed an interdisciplinary
clinic embedded within primary care (the Opioid Reassessment Clinic—ORC) with
the goal of improving the quality of care of patients with co-occurring chronic
pain and issues related to opioid safety, efficacy and/or misuse.
Case descriptions
We present three cases
referred to the ORC that highlight complex clinical scenarios related to
assessment and treatment of patients with chronic pain and issues related to
opioid safety, efficacy and misuse.
Discussion and evaluation
In the context of the
three cases, with respect to assessment, we discuss: making the diagnosis of
opioid use disorder; allowing the patient space to endorse lack of efficacy;
identification of co-occurring hazardous alcohol use; and recognizing barriers
to multimodal pain care. With respect to treatment, we discuss: making a change
in treatment with which the patient may not agree; effectiveness of
buprenorphine/naloxone for the treatment of chronic pain; responding to low
efficacy; and making continued opioid therapy contingent on engagement with
substance abuse treatment.
Conclusions
The core components of
our approach—biopsychosocial assessment and multimodal treatment planning with
an emphasis on promoting functional goals and safety using clear communication
and a patient-centered stance—should guide providers in the management of
similar clinical scenarios. More evidence is needed to definitively guide
specific interventions and points of clinical equipoise.
Below: Opioid reassessment clinic flow
Full article at: http://goo.gl/4sDwzY
VA Connecticut
Healthcare System, 950 Campbell Avenue, Mail Stop 151B, West Haven, CT 06516
USA
Yale University
School of Medicine, 367 Cedar Street, New Haven, CT 06510 USA
University of
Alabama at Birmingham, BBRB 220a, 1720 2nd Avenue South, Birmingham, AL 35233
USA
William C. Becker, Phone: +1 203-932-5711, Email: ude.elay@rekceb.mailliw.
More at: https://twitter.com/hiv insight
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