Study Points

Pain Management Pearls: Opioids and Culture

Course #97280 - $15 • 2 Hours/Credits

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  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
  1. Which of the following is one of the ten essential steps of opioid prescribing for chronic pain that can help mitigate any potential problems?

    OPIOID MANAGEMENT OF CHRONIC PAIN

    All patients with pain have a level of risk that can only be roughly estimated initially and modified over time as more information is obtained. There are ten essential steps of opioid prescribing for chronic pain to help mitigate any potential problems [7]:

    • Diagnosis with an appropriate differential

    • Psychologic assessment, including risk of substance use disorders

    • Informed consent

    • Treatment agreement

    • Pre- and post-treatment assessments of pain level and function

    • Appropriate trial of opioid therapy with or without adjunctive medication

    • Reassessment of patient levels of pain and functioning

    • Regular assessment with the 5 A's (i.e., analgesia, activity, adverse effects, aberrant behaviors, and affect)

    • Periodically review pain diagnosis and comorbid conditions, including substance use disorders

    • Documentation

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  2. The goal(s) of opioid treatment should be

    OPIOID MANAGEMENT OF CHRONIC PAIN

    Opioid therapy should be presented as a trial for a pre-defined period (e.g., ≤30 days). As noted, the goals of treatment should be reasonable improvements in pain, function, depression, anxiety, and avoidance of unnecessary or excessive medication use [8]. The treatment plan should describe therapy selection, measures of progress, and other diagnostic evaluations, consultations, referrals, and therapies.

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  3. Which of the following is NOT one of the 5 A's of monitoring chronic opioid response?

    OPIOID MANAGEMENT OF CHRONIC PAIN

    When implementing a chronic pain treatment plan that involves the use of opioids, the patient should be frequently reassessed for changes in pain origin, health, and function [8]. This can include input from family members and/or the state prescription drug monitoring program. Prescription drug monitoring programs are one of the most effective measures for reducing opioid analgesic diversion and abuse, but their efficacy is undermined by inconsistent use [9]. During the initiation phase and during any changes to the dosage or agent used, patient contact should be increased. Decisions regarding the continuation, modification, or termination of opioid therapy for pain should be based on evaluation of the patient's progress and the absence of substantial risks or adverse events [8]. At every visit, chronic opioid response may be monitored according to the 5 A's [11]:

    • Analgesia

    • Activities of daily living

    • Adverse effects

    • Aberrant drug-related behaviors

    • Affect (i.e., patient mood)

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  4. When prescribing opioids, clinicians should provide patients with instructions to

    OPIOID MANAGEMENT OF CHRONIC PAIN

    When prescribing opioids, clinicians should provide patients with the following information and instructions [10]:

    • Product-specific information

    • Taking the opioid as prescribed

    • Importance of dosing regimen adherence, managing missed doses, and prescriber contact if pain is not controlled

    • Warning and rationale to never break or chew/crush tablets or cut or tear patches prior to use

    • Warning and rationale to avoid other central nervous system depressants, such as sedative-hypnotics, anxiolytics, alcohol, or illicit drugs

    • Warning not to abruptly halt or reduce the opioid without physician oversight of safe tapering when discontinuing

    • The potential of serious side effects or death

    • Risk factors, signs, and symptoms of overdose and opioid-induced respiratory depression, gastrointestinal obstruction, and allergic reactions

    • The risks of falls, using heavy machinery, and driving

    • Warning and rationale to never share an opioid analgesic

    • Rationale for secure opioid storage

    • Warning to protect opioids from theft

    • Instructions for disposal of unneeded opioids, based on product-specific disposal information

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  5. What is the universal recommendation for the proper disposal of unused opioids?

    OPIOID MANAGEMENT OF CHRONIC PAIN

    There are no universal recommendations for the proper disposal of unused opioids, and patients are rarely advised of what to do with unused or expired medications. According to the Office of National Drug Control Policy, most medications that are no longer necessary or have expired should be removed from their containers, mixed with undesirable substances (e.g., cat litter, used coffee grounds), and put into an impermeable, nondescript container (e.g., disposable container with a lid or a sealed bag) before throwing in the trash [12]. The FDA recommends that most opioid medications, including oxycodone/acetaminophen (Percocet), oxycodone (OxyContin tablets), and transdermal fentanyl (Duragesic Transdermal System), be flushed down the toilet instead of thrown in the trash [12]. Disposal by flushing down the toilet provides immediate and definitive elimination of safety hazards from intentional use or accidental exposure involving opioid products. All transdermal patch opioid products should be flushed down the toilet after folding in half by adhesive side against adhesive side [13]. Patients should be advised to flush prescription drugs down the toilet only if the label or accompanying patient information specifically instructs doing so. Flushing unused medications has been the subject of controversy, with some state governments and boards recommending against the practice due to pollution concerns and effects on waterways and wildlife [14].

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  6. An opioid should be safely discontinued with

    OPIOID MANAGEMENT OF CHRONIC PAIN

    The decision to continue or end opioid prescribing should be based on a joint discussion of the anticipated benefits and risks. An opioid should be discontinued with resolution of the pain condition, intolerable side effects, inadequate analgesia, lack of improvement in quality of life despite dose titration, deteriorating function, or significant aberrant medication use [8].

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  7. Which of the following statements regarding pain disparities in ethnic minority patients is TRUE?

    THE IMPACT OF CULTURE ON PAIN AND PAIN MANAGEMENT

    In a meta-analysis of ethnicity and pain management researchers found that professionals under-rated ethnic minority patients' levels of pain and were less likely to indicate their pain scores on their charts compared with their white counterparts [28]. In addition, African American and Hispanic patients were less likely to have been given analgesics than white patients.

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  8. Which of the following is considered a societal/institutional barrier to effective pain management in racial and ethnic minority groups?

    THE IMPACT OF CULTURE ON PAIN AND PAIN MANAGEMENT

    Societal and institutional barriers include racism, discrimination, poverty, lack of health insurance, and deleterious environmental factors in communities [35]. For example, groups that have historically (or currently) been victims of institutional racism and discrimination are more likely to delay seeking help for pain [28]. Some studies indicate that African American men may experience higher levels of pain intensity in part due to their experiences with different forms of racial discrimination [20]. Even today, racial and ethnic minority patients are more likely to be placed in a negative valenced relationship [34]. In the context of pain management, healthcare providers are more likely to discount the pain due to the negative valenced relationship triggered by racism and discrimination [34].

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  9. All of the following are healthcare professional barriers to effective pain management in racial and ethnic minority groups, EXCEPT:

    THE IMPACT OF CULTURE ON PAIN AND PAIN MANAGEMENT

    Healthcare professional barriers may include professionals' beliefs about appropriate pain management; lack of training and knowledge about the intersection of pain and culture, race, and ethnicity; lack of culturally sensitive assessment for pain; and expectations about racial and ethnic minority pain patients based on stereotypes [38]. Consequently, practitioners may underestimate and minimize racial minority patients' pain experiences. In a qualitative study, Native American individuals described their complaints of pain being dismissed, receiving inadequate care, and neglected aftercare [39].

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  10. Which of the following is considered a mind/body approach to pain management?

    THE IMPACT OF CULTURE ON PAIN AND PAIN MANAGEMENT

    Alternative remedies for pain can be classified into five different areas, and many can be used as adjuncts to conventional therapies [49,50]:

    • Alternative medications: Nonpharmacologic substances, such as those associated with homeopathic medicine, traditional Chinese medicine, and Ayurveda medicine

    • Mind-body interventions: Interventions that focus on using the mind to influence bodily symptoms, including biofeedback, meditation, music therapy, and guided imagery. Mind-body interventions help reduce pain and improve other comorbid conditions, such as depression.

    • Biologically based interventions: Consumption of biologic products (e.g., herbs, vitamins, foods)

    • Manipulation strategies: Adjustment of focused areas of the body (e.g., chiropractic measures, massage, acupuncture)

    • Energy therapies: Balancing energy fields (e.g., electromagnetic therapy, reiki, qigong)

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  • Back to Course Home
  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.