Acute Pain Management in Hospitalized Patients With Current Opioid Abuse

Marian S. Grant, CRNP; Grace A. Cordts, MD, MPH, MS; Danielle J. Doberman, MD, MPH

Disclosures

Topics in Advanced Practice Nursing eJournal. 2007;7(1) 

In This Article

Abstract and Introduction

Abstract

The number of patients who abuse opioids is increasing. Patients who abuse opioids have a higher incidence of pain and a greater rate of hospitalization. Providers tend to undertreat pain in this population due to biases, misconceptions, and systems issues. This article discusses the dynamics of pain management in patients who abuse opioids. Assessment and treatment approaches will be outlined that can make managing pain in this population more effective. An argument for viewing substance abuse as a chronic medical problem, rather than a moral issue, will be advanced.

Introduction

In 2004, 38.7 million Americans were hospitalized.[1] It is estimated that substance abuse affected up to a quarter of these patients, with rates as high as 40% to 60% for those admitted secondary to trauma. These figures include abuse of alcohol, prescription medications, and illicit drugs. There has been an almost 4-fold increase in the incidence of opioid analgesic abuse between 1990 and 2001 (628,000 vs 2.4 million) with use concentrated among adolescents and young adults.[2] Therefore, it is increasingly likely that healthcare providers will treat pain in patients with current opioid abuse. Clinicians are at risk of undertreating pain in this population, mostly due to misconceptions about the addictive dangers of opioids.

Patients involved with substance abuse are generally undertreated for pain.[3] The tendency is to "use opioids sparingly (for pain), resulting in both poor pain management and withdrawal phenomena."[4] This results in[5]:

  • Increased length of stay;

  • Frequent readmissions; and

  • Increased outpatient and emergency visits.

Advanced practice nurses (APNs) are particularly appropriate providers for patients who abuse opioids because APNs[5]:

  • Deliver expert patient care;

  • Provide role models for staff nurses;

  • Focus on nurse-patient relationships; and

  • Provide education and support for staff.

This article describes the prevalence of pain in the population of patients who abuse opioids, and examines why undertreatment occurs. Assessment and treatment approaches to make managing pain in this population more effective are outlined. An argument is advanced for viewing substance abuse as a chronic medical problem rather than a moral one.

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