Walking the Tightrope: Chronic Pain and Substance Abuse
Abstract
Pain management is a high priority in health care, and pain is a common reason for visits to primary care providers. The most challenging patients to manage are chronic pain patients with substance abuse issues. This article reviews 2 models that assist with making difficult decisions about when to prescribe opiates for chronic nonmalignant pain. A clear understanding of the terms addiction, tolerance, dependence, and pseudo-addiction is necessary. Appropriate precautions include assessing for risks of substance abuse; continual assessment of pain level, daily functioning, and aberrant behaviors; and complete documentation of communication of risks, benefits, and expectations with the patient.
In compliance with national ethical guidelines, the author reports no relationships with business or industry that would pose a conflict of interest.
1Donna G. Benedict, MSN, NP, was a nurse clinician at the Center for Pain Management at Allegiance Health for 10 years and has recently joined the Diabetes Center at Allegiance Health in Jackson, MI.
ABSTRACT