Although international agreements have mandated that countries provide adequate pain medications to relieve the suffering of their people, pain remains one of the major unaddressed issues of modern society, particularly in poor countries. One of the great hopes of modern pain treatment, opioid analgesics, has led to an epidemic of overuse and diversion in some countries while at the same time being completely unavailable to those suffering from severe pain in other countries.
Pain management policies have been developed by a number of regulatory agencies, which provide voluntary and mandatory guidelines about pain management in healthcare organizations. A balanced multimodal approach to pain and its management is a key concept for healthcare organizations and clinicians.
Analgesics are important component of pain management: non-opioid, opioid, and adjuvant medications are available for the treatment and management of pain. Safe use of analgesics is promoted by utilizing a multimodal approach, using more than one type of analgesic to treat an individual’s pain. However, opioid analgesics carry a high potential for misuse, abuse, and diversion, even when prescribed for legitimate medical purposes, and clinicians must educate themselves about these issues and understand that opioid analgesics have the potential for misuse.
Consistent assessment and documentation of pain using an individualized approach is recommended by a number of organizations. Clinicians should be familiar with a variety of pain assessment tools and understand the necessity for regular assessment of pain based upon the needs of patient.
Many nonpharmacologic techniques are available for the treatment of pain. Physical and occupational therapy, chiropractic techniques, traditional Chinese medication, and complementary, alternative, and integrative practices are popular and well-tolerated. Although evidence-based studies are limited, there is increasing evidence that many of these techniques successfully decrease pain, and more research is underway.
The Institute of Medicine (2011) sums up the underlying principles related to effective management and treatment of pain, which provides a fitting conclusion to this course:
- Pain is a moral imperative.
- Chronic pain can be a disease in itself.
- Comprehensive treatment is critical.
- Interdisciplinary assessment and treatment may yield the best results.
- Prevention is important.
- Existing knowledge must be used more widely.
- Opioids present a conundrum.
- The clinician-patient relationship is of utmost importance.
- Public health and community-based approaches are invaluable.