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Pain, pain, go away: Improving care and safety when managing pain

Recently published opioid therapy clinical practice guideline focuses aims to improve quality of care and patient safety when treating acute and chronic pain (U.S. Air Force Photo by Airman Valerie Monroy). Recently published opioid therapy clinical practice guideline focuses aims to improve quality of care and patient safety when treating acute and chronic pain (U.S. Air Force photo by Airman Valerie Monroy).

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You’re in pain, and it’s not going away. You go to your doctor wondering if there’s a way to relieve it, and you rest easy knowing you’re in good hands. With patient safety as a top priority, the Department of Defense and Department of Veterans Affairs have updated their clinical guidance on opioid therapy used to manage chronic pain.

“There has been a rapid advancement in the science and the knowledge of opioid therapy, and of the risks associated with it,” said Dr. Christopher Spevak, director of the National Capital Region Opioid Safety Program and a provider at Walter Reed National Military Medical Center in Bethesda, Maryland.

Updated every five years - available online and in a “pocket card” version - this clinical practice guideline is a tool that helps providers better manage the use of powerful drugs. It serves as a resource rather than a standard of care by helping doctors set reachable goals while coming up with treatment plans for their patients.

The updates in the 2017 guideline reflect a continued commitment to beneficiaries for safety and safe opioid prescribing, which will result in better quality of care, said Spevak. Since opioids like Vicodin, OxyContin, and morphine are powerful pain relievers, they can lead to dependence, misuse, or overdose if they’re not managed properly. Some of the most important updates to the recommendations include avoiding long-term opioid prescriptions for patients under the age of 30 and putting strategies in place to lessen risk.

The guideline also recommends helping patients manage their pain symptoms through non-drug and non-opioid treatments whenever possible. This can include a range of options, such as behavioral health, mental health, or physical approaches, and non-opioid based medications.

Army Lt. Col. Robert Brutcher, deputy director of the Department of Pharmacy at Walter Reed in Bethesda, supports the use of alternative approaches to care for chronic pain.

“The goal of updating recommendations is to help providers improve the quality of the care for patients who experience chronic pain,” said Brutcher, describing the new approach to pain management as holistic.

Physicians may discuss alternative pain therapies and remedies with their patients. By focusing less on strong pain medication, surgery or other treatment options, patients can work with doctors to learn how to self-manage their pain, which can lead to better quality of life, increased physical function, and improved pain coping skills.

That’s not to say prescriptions are discouraged in all cases. When patients start, or continue, opioid therapy, doctors are encouraged to evaluate the risks and benefits of this treatment plan every three months. The guideline encourages providers to start opioid therapy when needed for a short amount of time with the lowest dose allowed depending on a patient’s needs and health risks. Risk strategies for patients who are already on long-term treatment plans include overdose education and random urine drug testing.

“As research evolves and more evidence becomes available,” said Brutcher, “you have to adapt treatment strategies, and health care has to change with the information available. We’re trying to look out for what’s best for the patient.”

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