MI: Pain and Symptom ManagementPage 11 of 12

9. Concluding Remarks

Pain is a common reason for people to seek medical care. In Michigan, state policy recognizes that patients have the right to expect appropriate pain and symptom management as a basic and essential element of their medical treatment. This means that a person seeking medical care for pain in Michigan can expect to receive a thorough initial examination and ongoing assessment of the effectiveness of the pain management program.

All pain technically occurs in the brain (as perception) and differentiation between types of pain is theoretical. There is no one type of pain that is worse than the others. Although it may be difficult or even impossible to determine the exact cause of a person’s pain, certain pain conditions are common. Low back disorders, headaches, post-surgical pain, cancer, and arthritis are among the most common reasons someone seeks medical care for pain.

Assessment of pain is most effective when there is good communication between patients and their healthcare providers. A clinician’s ability to share information, provide compassionate and empowering care, and be sensitive to patient needs is essential for optimal pain management.

Nondrug techniques, including complementary and alternative medicine and self-management of pain, pose minimal safety issues and can provide positive outcomes. Healthcare providers trained in the medical model can improve outcomes by utilizing a team approach involving other healthcare providers and complementary practitioners in the care of patients with pain, particularly chronic pain.

The evidence base supporting the use of analgesics to manage acute pain is strong and clear—analgesics, particularly opioids, are effective in controlling acute pain. Use of analgesics, particularly opioids, is currently the foundation of treatment for most types of ongoing or chronic pain. Safe use of analgesics is promoted by using more than one type of analgesic to treat an individual’s pain. With opioid analgesics, in particular, pain management goals will require balancing side effects with pain control. While it is important to give enough medication to manage pain effectively, healthcare providers must remain aware of the potential for diversion of medication to recreational use or abuse.

In children, older adults, and those approaching the end of life, pain management is more complicated and requires a high degree of knowledge about side effects, drug–drug interactions, and dosing. Patients benefit from a team approach and from the use of complementary and alternative approaches to pain management.

Concern about the abuse and diversion of opioids has moved to the forefront in recent years. Although opioid analgesics unquestionably have a role in the treatment of acute and chronic pain, their increased availability has had many unintended consequences. Abuse has skyrocketed, as have deaths from prescription opioid overdoses. Healthcare providers, researchers, pharmaceutical companies, law enforcement personnel, and pain patients themselves are learning firsthand the importance of understanding the potential for abuse these drugs carry.

Healthcare providers in Michigan, as well as the Michigan Department of Licensing and Regulatory Affairs, and others involved with pain management are working to ensure that Michigan residents receive prompt and thorough pain assessment and treatment. Nevertheless, we still have a long way to go as we work to educate ourselves about the origins of pain, improve our understanding of pain medications and their effects, and learn to incorporate complementary and alternative options into our daily medical practice.

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