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Pain Management in Patients with Addiction
Introduction
Addicted patients are among the most delicate types of patients as far as pain management is concerned. Addiction is characterized by the continued use of a substance despite the harm that such a substance poses to ones health. Research has shown that more than 15% of the worlds population are victims of drug or alcohol addiction. Due to the nature of the medicine used in dealing with pain, treating clinicians ought to be very careful not to promote the addiction in the process of curbing the pain. The process of treatment should be in accordance to the legislative rules pertaining the management of pain in the patients (Joan, 2008, p. 120). Since the two conditions, pain and addiction, present deleterious effects to ones health, health professionals should employ their skills, knowledge and expertise to ensure the well-being of the patient in question.
Society and pain management
Pain management in patients with addiction has raised a lot of concern from various parties in the society because of the nature of some analgesics that contain opium and heroin compounds. However, this began after the opium and heroin became readily available in many regions around the globe (Norman et al., 2010, p. 154). In the early 1900s, the availability of opium started to increase an aspect that led to broad societal ramifications. However, it was not until the emergence of purified morphine as well as heroin that the deleterious effects of opioids on not only individuals but also the society came into focus (Norman et al., 2010, p. 156). This led to the involvement of governments in the legislation of the use of such substances even in the medical settings.
The first nation to take legislative action towards the use of opiods was the US. In 1914, the US government formed the Harrison Narcotic Drug Act. The act restricted the distribution of opioids and cocaine to not only registered pharmacists but also physicians. It illegalized the prescription of opioids for the treatment of patients who are opioid addicts. In essence, the Act sought to stop opioid treatment for pain. Six years later, the authorities prosecuted and jailed the first American physicians who neglected the law by distributing opioids outside their professional conduct (Ries, et al., 2009, p. 1344). This had a major impact on the prescription of opioids to patients. This brought controversy to medical practitioners since it is not easy to distinguish between opioid addicts and non-addicts.
Other than the US government, the British government also took legislative measures to control the prescription of opiods to patients by formulating and implementing the Dangerous Drug Act in 1920. The Rollestone Committee (1924-1965) played the role of regulating the use of such drugs by giving directions to physicians. However, compared to the US, the UK did not have harsh restrictions since the committee allowed the physicians to give addicted patients diamorphine drugs as well as surgical syringes and needles. The factor that led to the leniency of the UK government in dealing with the prescription of such analgesics is that during that time, there were few cases of drug abuse in the UK (Clark and Treisman, 2011, p. 142). Research has shown that there were approximately 65 drug addicts in the UK during the period when the Rollestone Committee regulated the prescription of such drugs.
The fight against the use of opioids in pain treatment intensified in the 1960s. President Richard Nixon, began the war the against drugs which had a great impact on the American Healthcare system. One of the major effects of the war was the under treatment of addiction in patients. Additionally, the restriction on the use of opiods resulted in the under treatment of pain not only in the addicted patients but also the non-addicts. Following the increment of cases of under treatment of the two conditions, Americans began the opioid and pain advocacy. The opioid advocacy led to the establishment of the Narcotic Addict Treatment Act in 1974. The Act facilitated the re-establishment of the use of opioids (methadone) for the treatment of addicts. On the other hand, pain advocacy led to the re-establishment of opiods for the treatment of pain. This initially consisted of acute pain and cancer pain but was later extended to cover all forms of chronic pain. However, this created more problems to the society in that it led to the increase of opioid analgesics (Elbert, 2010, p. 132). In the late 1970s, there was an increase of opioid related deaths due to the increased availability of opiod analgesics in streets, homes and pharmacies.
The fight against drugs in the US and other nations such as Britain violated the patients right to pain control. Such a phenomenon was witnessed in Britain in 1998 when a general practitioner, Harol Shipman, caused the deaths of fifteen people. Investigations revealed that Shipman had administered diamorphine that was responsible for the deaths. The legal investigators claimed that the General Medical Council had neglected the plight of patients in its attempt to protect the actions of medical practitioners. Therefore, the use of opioids in pain treatment among addicts is a matter that requires great expertise, knowledge and skills.
Despite the legal acceptance of the opioid pain treatment, the religious views of most people object the practice. Most people believe that the use of opium or opium derivatives leads to the loss of moral judgment of an individual. Owing to this, the prescription of opioids for treatment contradicts religious principles of most patients since they believe that their use in treating addicts may escalate the addiction of the patient in question.
Healthcare in patients with addiction
The goal of all physicians is to improve the health of the patient by relieving the pain as well as restoring their functionality and quality of life. As aforementioned, this calls for the treatment of the pain as well as the addiction that the patient has developed in the course of his/ her life. In any person, pain increases not only anxiety but also distress. In patients with addiction, health professionals argue that pain has the potential of causing relapses. This is because victims of any form of substance abuse experience significantly high levels of anxiety, which is associated to the cause of the pain in their body (Joe, 2010, p. 6). Research has shown that such anxiety has a great impact on how the patient in question reacts to the pain. Therefore, effective and safe clinical management of pain in addicted patients requires several actions by the treating clinician.
Physicians and the other healthcare professionals should engage the patient in an open discussion about the form of addiction that the patient has i.e. patients substance use. Study has shown that most health professionals do not involve their patients with addiction on matters of their addiction as far as their treatment in concerned (John, 1997, p. 100). However, it is important for the professionals to consider getting information from the patients. Such information has proven to be useful as it boosts the patients active participation in the treatment process. However, certain patients fear that by disclosing information about their substance abuse, they might negatively influence the manner in which the physicians address their healthcare needs (Elbert, 2010, p. 99). It is therefore important for the healthcare professionals to assure the patients that their addiction disorder affect effective treatment of their pain. The medical practitioners should never ignore the information that they gather from the patients because it may be essential in designing an effective treatment plan for the patient.
The use of medicine containing the substance that an addict uses is advisable. For patients that are opioid addicts, it is usually essential to continue with the use of opioids for his/her pain treatment. In other instances, the physician may chose to use a non-opioid approach in treating the patient. In such cases, the physician should ensure that the opiods are tapered gradually. This plays a fundamental role in preventing withdrawal in the patient in question. Although opioids provide effective pain treatment for patients with addiction, a patient cannot continue using the medication after discharge. However, this can only happen if the patient is undergoing a licensed addiction treatment program. According to John, A certified buprenorphine provide can also authorize a patient to continue using opioid pain treatment after being discharged from the hospital (1997, p. 105).
Physicians should put into consideration the baseline opioid requirements of patients with opioid addiction in the prescribing their treatment. For effective pain treatment, the opioid treatment for pain should exceed the baselines of opioids for such patients (Joe, 2010, p. 9). Additionally, patients that use methadone treatment for their addiction should be given a different form of treatment for their pain. However, the treating clinician should ensure that the treatment provides for the baseline methadone dose for the patient. The increment of methadone, though an effective means of lowering pain, should not allowed for patients with addiction because of two main reasons. One of the reasons is that it has a long shelf life that makes it rather difficult to titrate for cases involving acute pain. The use of one drug to treat both pain and addiction may not be effective especially in treating the addiction disorder after the patients pain resolves.
Patients with non-opiod addiction such as alcohol addiction should also receive maximum care and attention from the health professionals. Pain treatment for such patients should involve the use of the most effective pain treatment. Their addiction should also be tackled during the treatment process. Withdrawal symptoms of the patients should also be treated during the treatment process. If the physicians fail to recognize the certain withdrawals especially alcohol withdrawal, pain control will be difficult to achieve. This is because physical signs associated with the withdrawal such as hypertension may be misinterpreted as acute pain.
Two main aspects constitute an effective treatment of addicts. Physicians should be timely in administering medication to the patients. They should also exercise adequate control of the pain for without the relief of the pain the patients would not be able to corporate in addiction treatment (Christopher et al., 2002, p. 128). On the other hand, under treatment of pain in patients with addiction may be harmful to their health. Patients not only become anxious, frustrated and angry but they may start craving for substances that could aid in relieving their pain. Methods that are employed in reducing the pain in addicts should not propagate any of the undesirable outcomes such as anxiety, stress or anger.
It is also important to document the patients treatment plan. This helps in reducing misunderstandings between the health care providers, which may cause inefficiency in the treatment process. It also helps in monitoring the patients progress enabling the physicians to address any concerns that may arise during the treatment process (Joan, 2009, p. 121). The treatment plan also ensures that the patient continues to receive his/her treatment even in cases when the primary healthcare professional is not available. It is important to mention that the treatment plan should be placed in a prominent place within the physicians vicinity.
In some cases, patients may experience a persistence of the pain despite the treatment physicians give to them. The pain may be due to some undetected physical problem. The problem could be as a result of the initially diagnosed source of the patients pain or could be a separate physical problem. The pain may also be attributed to cases of withdrawal caused by discontinuing the patients medication. This occurs mainly in patients that have developed dependence on analgesics in the course of their treatment. However, some patients have continued complaints of pain in their attempt to seek for more drugs to sustain their addiction. To address the problem of persistent pain in patients with addiction, the clinicians should continue opioid treatment as they monitor the patients reaction. Research has shown that if the quality of life of the patient in question does not improve, there is an undetected source of pain in the patient (Ries et al, 2009, p. 1340; Clark et al., 2011, 9.016). Therefore, physicians should also continue to screen for other sources of pain to the patient. Alternatively, the treating clinicians should continue tapering medication for the patient while introducing new treatment interventions to curb the pain of the patient. The introduction of an alternative form of treatment may do away within the negative effects that some opioid analgesics may present to a given patient (John, 1997, p. 106). The choice of treatment in cases of persistent pain should involve the two parties i.e. the patient and the healthcare practitioners.
Personal position
The goal of any healthcare professional is to enhance the well-being of the patient. Patients who happen to be addicts of any substance are also entitled to a healthy living thus should be awarded maximum healthcare. This calls for the treatment of all the health concerns that they may have which includes their addiction disorder and their pain. According to the teleological or the utilitarianism theory, the best thing to do is to treat the patients with the drugs that are available with the assurance that they will improve the quality of life of the patient in question as well as the society. Opioid treatment, as discussed above, leads to the treatment of not only the pain experienced by the patient but is instrumental in treating the addiction disorder in some patients. Consequently, the decision of the physician should always be based on the outcome of a given form of treatment.
In the case of pain treatment in patients with addiction, the deontological theory is debatable. It is morally right for healthcare practitioners to improve the quality of life of the patients but the process of attaining such may not be morally upright according to the perception of many people in the society, which should be put into consideration as well. The use of opioid analgesics may contribute to the increment of the addiction of the patient in cases where the healthcare professionals are unable to tame the addiction disorder. At the same time, effectiveness of the drugs in treating both the pain and the addiction is morally acceptable thus the society should embrace the process. However, the treating clinician should always have the best interest of the patient at heart even if he/she ends up violating the moral perception of the society.
All healthcare professionals should follow the relational theory. They should show care and concern to their patients. The care that they have towards the patients would drive or rather propel them to administer the rightful treatment to their patients and in the right manner. Their concern being improving the quality of life and enhance the physical well-being of the patients will enable them to involve the patients in every way possible towards the recovery of the patient. Matters of keeping a treatment plan for the patient will be important in enhancing a good relationship within the healthcare professionals avoiding any conflict that may cause poor treatment of the patient. All the healthcare practitioners should remain helpful to not only the patient but also to the society.
Irrespective of the type of treatment that physicians prescribe for the patients, the ultimate result should be the restoration of the well-being of the patient as far as the patient is concerned. Patients should also be given a chance to provide information that they may deem relevant in the treatment process. The medical practitioners should be aware of the rules and regulations that the government has set governing the treatment of pain in patients with addiction.
Conclusion
Healthcare professionals should employ their skills, knowledge and expertise to ensure the well-being of the patient in question. They should use all the materials within their disposal to enhance the recovery of patients with addiction form their pain as well as their addiction. Different patients may be addicts of different substances ranging from opioid addiction to alcohol addiction. As outlined in the discussion, the healthcare professionals should involve the patients in a discussion regarding their substance use history, which is helpful in determining the type of treatment to use on the patients. Additionally, physicians should follow the law in their prescription of drugs to avoid unnecessary conflict with the law. It is important to keep a treatment plan for a patient to enable proper monitoring of their condition. In cases of complaints of persistent pain, the treating clinicians should screen the patient to establish the cause of the pain. Following the screening results, the healthcare professionals should tailor the treatment to ensure that the pain is resolved. The well-being of the patient should be the primary interest of all the healthcare practitioners involved in treating patients with addiction.
Reference List
Christopher, D., Piater, M. D., Zylastra, R.G., & Miller, E. K. (2002). Successful Pain Management for Recovering Addicted Patient. Journal of Clinical Psychiatry, 4(4), 125-131.
Clark, M.R., & Treisman, G.J. (2011). Chronic Pain and Addiction. Baltimore, Md: Karger Publishers.
Elbert, M.H. (2010). Behavioral and Psychopharmacologic Pain Management. Connecticut: Cambridge University Press.
Joan, G. (2009). Fostering Nursing Students Use of Ethical Theory and Decision Making Models: Teaching Strategies. Learning in Health and Social Care, 8(2), 114-122.
Joe, M. (2010). Risk of Opioid Addiction for Chronic Pain Patients. Medical Post, 46(2), 5-10.
John, M. (1997). The Pharmacists Role in Palliative Care and Chronic Pain Management. Drug Topic, 141(1), 98-107.
Norman, G.A., Jackson S., & Rosenbaum, S.H. (2010). Clinical Ethics in Anaesthesiology. Cambridge: Cambridge University Press.
Ries, R.K., Miller, S.C., & Fiellin, D. A. (2009). Principles of Addiction Medicine. New York: Lippincott Williams and Wilkins.
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