Pain Management in Patients with Substance Use Disorders

Medical professionals may find it difficult to control discomfort in individuals with substance use problems. How can pain be adequately treated without running the danger of addiction or relapse?

A growing public health concern is the prevalence of substance use disorders, which affect millions of individuals worldwide. Many of these people also experience chronic pain, which makes recovery and therapy even more challenging. Managing pain while avoiding addiction or relapse is a delicate balance that healthcare providers must strike.

Let’s explore the challenges of pain management in patients with substance use disorders and discuss strategies that healthcare professionals can use to effectively treat pain while minimizing the risk of addiction or relapse.

Assessment of Pain in Patients with Substance Use Disorders

1. Understand the Patient’s History

Prior to evaluating a patient’s discomfort, it’s critical to understand their medical history. Patients with SUDs are more likely to have a history of both substance addiction and chronic pain. Healthcare professionals should enquire about the patient’s history of substance abuse, including the substance used, the length of time used, and any prior addiction treatment.

2. Use Validated Pain Assessment Tools

Validated pain assessment tools can help healthcare providers accurately assess pain in patients with SUDs. The Brief Pain Inventory (BPI) and the Visual Analog Scale (VAS) are commonly used in clinical settings. The BPI assesses pain intensity, pain interference with daily activities, and the location of the pain. The VAS is a simple tool that asks patients to rate their pain on a scale of 0 to 10.

3. Consider Co-occurring Mental Health Conditions

Co-occurring mental health disorders, including depression and anxiety, are more common in patients with SUDs. These conditions can impact pain perception and should be considered during pain assessment. Healthcare providers should ask about the patient’s mental health history and consider the use of validated mental health assessment tools.

4. Monitor for Signs of Addiction

Patients with SUDs are at increased risk of developing an addiction to pain medication. Healthcare providers should monitor patients for signs of addiction, such as increased tolerance, withdrawal symptoms, and drug-seeking behavior. It’s important to balance pain management with the risk of addiction and consider alternative pain management strategies, such as non-opioid medications and non-pharmacological interventions.

5. Involve a Multidisciplinary Team

Managing pain in patients with SUDs requires a multidisciplinary team approach. Healthcare providers should involve addiction specialists, mental health professionals, and pain management specialists to provide comprehensive care. Collaboration between healthcare providers can help reduce the risk of addiction while providing effective pain management for patients with SUDs.

The Challenges of Managing Pain in Patients with SUDs

Risk of Addiction and Overdose

Patients with SUDs have a higher risk of developing an addiction to pain medications. This risk is particularly high for opioids, which are commonly prescribed for chronic pain. Additionally, patients with SUDs have a higher risk of overdosing on pain medications due to their tolerance levels. Therefore, it is crucial to carefully monitor the use of pain medications in these patients to prevent addiction and overdose.

Abuse of Pain Medications

Patients may have a history of abusing drugs, including pain medications. They may try to obtain more pain medications than prescribed or misuse them in other ways. This can lead to serious health consequences, such as respiratory depression and organ damage. It is important to screen these patients for a history of drug abuse and closely monitor their use of pain medications to prevent abuse.

Limited Treatment Options

One may have limited treatment options for pain management. Many pain medications, including opioids, are not recommended for these patients due to their addiction potential. Additionally, non-pharmacological treatments such as physical therapy and acupuncture may not be sufficient for managing chronic pain. Therefore, healthcare providers must work with these patients to develop individualized pain management plans that balance the risks and benefits of different treatment options.

Stigma and Misunderstanding

An individual with SUDs may face stigma and misunderstanding from healthcare providers when seeking pain management. They may be viewed as drug seekers or as having caused their own pain due to their substance use. This can lead to inadequate pain management and a lack of trust between the patient and the healthcare provider. It is important for healthcare providers to approach these patients with empathy and understanding and to work collaboratively with them to develop effective pain management plans.

Strategies for Identifying and Managing Patients with Substance Use Disorders

Screening and Assessment

Screening patients for SUDs is the first step in identifying those who may need further assessment and treatment. Screening can be done using standardized tools such as the Alcohol Use Disorders Identification Test (AUDIT) or the Drug Abuse Screening Test (DAST). A positive screen should prompt further assessment to determine the severity of the disorder and the appropriate level of care.

Brief Interventions

Brief interventions are short, focused conversations with patients who are at risk for or have mild to moderate SUDs. These interventions are designed to motivate behavior change and can be delivered by primary care providers or other healthcare professionals. Brief interventions may include providing education about the risks of substance use, discussing the patient’s goals and values, and offering advice on how to reduce or stop substance use.

Referral to Treatment

Patients with moderate to severe SUDs may require referral to specialized treatment programs. Treatment options may include inpatient or outpatient rehabilitation, medication-assisted treatment, or behavioral therapy. Referral to treatment should be accompanied by ongoing support and follow-up to ensure that patients are engaged in treatment and making progress toward recovery.

Collaborative Care

Collaborative care involves a team-based approach to managing patients with SUDs. Primary care providers, mental health professionals, and addiction specialists work together to provide comprehensive, coordinated care. Collaborative care may include regular check-ins with patients, medication management, and behavioral therapy.

Stigma Reduction

The stigma surrounding SUDs can be a significant barrier to identifying and managing patients with these disorders. Healthcare providers can play a role in reducing stigma by using person-first language, avoiding judgmental language, and treating patients with SUDs with respect and empathy. Providers can also advocate for policies that reduce stigma and improve access to care for patients with SUDs.

Balancing the Risks and Benefits of Pain Management in Patients with Substance Use Disorders

Choose the Right Type and Dosage of Medication

When it comes to pain management in patients with substance use disorders, choosing the right type and dosage of medication is crucial. Opioids are commonly used to treat pain. It can be highly addictive and pose a risk of overdose. Alternative medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, may be more appropriate for some patients. It is also important to start with a low dosage and monitor the patient closely for any signs of misuse or adverse effects.

Use a Multimodal Approach

In addition to medication, a multimodal approach to pain management can be effective in patients with substance use disorders. This includes physical therapy, acupuncture, massage therapy, as well as non-pharmacological interventions. By combining different approaches, patients may be able to achieve pain relief without relying solely on medication.

Balancing the risks and benefits of pain management in patients with substance use disorders requires a thoughtful and individualized approach. By understanding the patient’s history and current situation, choosing the right medication and dosage, using a multimodal approach, monitoring the patient closely, and collaborating with us at Momentum Medical as your healthcare provider as we can help patients manage their pain while minimizing the risk of relapse or addiction. Contact us now!