WV: Diversion of Drugs, 1 unitPage 4 of 10

2. The Treatment of Pain

Acute and Chronic Pain

Acute Pain is a normal physiologic sensation that signals injury or disease. It serves a vital function, warning of the need for medical treatment.

Chronic pain is pain that persists, often for weeks, months, or years. The presence of chronic pain is a disease state in itself. When the pain’s warning function is completed, continued pain is an abnormal state. Its distinct pathology causes changes in the nervous system that often worsen. Its effects on a patient’s psychology and cognitive ability are significant, and include anxiety, depression, and anger.

The National Institutes of Health, National Center for Complementary and Integrative Health (NCCIH), reports the following statistics about chronic pain in the United States:

  • About 25.3 million U.S. adults (11.2%) had pain every day for the previous 3 months.
  • Nearly 40 million adults (17.6%) had severe pain.
  • Individuals with severe pain had worse health, used more healthcare, and had more disability than those with less severe pain.
  • The annual economic cost of chronic pain in the United States, including both treatment and lost productivity, has been estimated at nearly $635 billion. (NIH, 2018a)

Trends in Pain Management and Prescribing

In past decades, concern about undertreatment of pain led to increases in prescribing of analgesics. In 1998 the Federation of State Medical Boards (FSMB) released guidelines that supported the use of opioids for chronic, noncancer pain. This contributed to the increase in opioid prescriptions that followed. The Joint Commission, an accrediting body, then issued the Pain Standard, which evaluated healthcare organizations (including hospitals, ambulatory care centers, behavioral health, and home care) on the basis of their consistent, documented assessment of patients’ pain (Zimmerman, 2017).

Balance is the goal in treating patients’ pain and preventing drug diversion. On January 1, 2018, the Joint Commission implemented a new and revised pain assessment and management standards. The new standards, which revise the original standards established in 2001, state that hospitals must:

  • Establish a clinical leadership team
  • Actively engage medical staff and hospital leadership in improving pain assessment and management, including strategies to decrease opioid use and minimize risks associated with opioid use
  • Provide at least one non-pharmacologic pain treatment modality
  • Facilitate access to prescription drug monitoring programs
  • Improve pain assessment by concentrating more on how pain is affecting patients’ physical function
  • Engage patients in treatment decisions about their pain management
  • Address patient education and engagement, including storage and disposal of opioids to prevent these medications from being stolen or misused by others
  • Facilitate referral of patients addicted to opioids to treatment programs. (The Joint Commission, 2018)

NCCIH is part of the National Institutes of Health Pain Consortium, which coordinates pain research across NIH. NCCIH-supported studies are helping to build an evidence base on the effectiveness and safety of complementary modalities for treating chronic pain. The scientific evidence suggests that some of the complementary health approaches that may help people manage chronic pain include mindfulness-based interventions, hypnosis, and cannabinoids (NIH, 2018).

. . . The amount of opioids being prescribed by our nation’s doctors, dentists and nurses is excessive. While opioids offer relief to many patients with pain and should remain an available and acceptable option for pain management when medically indicated, it is clear from prescribing data and related addiction treatment admission and overdose death data that the medical community has over-relied on opioids to treat pain. (ASAM, 2017)

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