|
|
|
|
|
|
Individuals
with Chronic Pain Keep Quiet |
|
The
Americans Living with Pain Survey polled 800 individuals with chronic
pain and found that they often denied their pain, delayed seeing a
physician, and, when they did seek medical help, they tended to steer
away from treatment. The survey was released May 6, 2004, from the
American Chronic Pain Association. The
survey revealed that 72% of individuals with chronic pain have lived
with it for >3 years, while a third have lived with it for >10
years. Also, 44% of those who have consulted a physician about the
pain delayed doing so; 53% of those who eventually visited their
physician did so because the pain was getting worse. Although
respondents were hesitant about seeking medical help, the majority
admitted that pain had a major impact on their lives. The survey also
revealed the following: 1
in 6 said that it had negatively affected their careers 45%
said that it had adversely impacted their personal relationships 51%
of those employed said that it had affected their productivity |
Pseudoaddiction:
A patient with pain may exhibit the same signs as a drug abuser. This can
occur when a patient is treated suspiciously and feels a stigma has been
attached to there use pain medications. This may come from a media story
exaggerating a celebrity’s use of prescription medication or it may come
from the way a customer is treated in the pharmacy. As trained professional we
have the responsibility of preventing harmful behavior with prescription
medication, but we have an even larger responsibility to provide care for
patients and prevent suffering. These
patients may feel their supply of pain medication will be “cut off”. They
respond to this pressure by doctor and pharmacy shopping to stockpile their
pain medication. This type of behavior can easily be eliminated by
guaranteeing the patient’s pain medication. Do not hesitate to recommend to
a patient and physician how to best use and prescribe pain medication. We
certainly have experience dealing with patients in pain. Healthcare
professionals must usually rely on highly subjective methods—otherwise known
as instinct. To offer clinicians a more objective and comprehensive tool for
identifying patients at risk for aberrant drug behavior, Inflexxion, a disease
management company, has teamed up with the National Institute on Drug Abuse
and Endo Pharmaceuticals to develop the Screener and Opioid Assessment for
Patients with Pain (SOAPP).
The
new screening tool, created in consensus with 26 pain and addiction experts,
is a self-administered, pencil-and-paper questionnaire, which asks patients a
series of questions regarding their pain, drug history (Rx or otherwise—see
"Some
medication-related questions included in the SOAPP"
box), family history of substance use, and other topics. The answers are
intended to offer insight into which chronic pain patients considered for
long-term opioid therapy may actually be at risk for drug abuse.
"Until
now, there has not been an accepted, validated way for physicians to predict
which patients will likely misuse opioids," noted Robert N. Jamison,
Ph.D., study investigator, chief psychologist, Pain Management Center of
Brigham & Women's Hospital, Harvard Medical School. This tool helps raise
a clinician's awareness of patients who may have greater difficulty modulating
their medical use of these drugs and require extra help in monitoring and
management.
Another
possible benefit of SOAPP is to help clinicians reluctant to prescribe opioids
to realize that many patients may receive these medications with little
likelihood of addiction. "We know not all individuals become addicted
when placed on opioids for pain. The worry over this complication can lead to
undertreatment of pain," noted Jamison. By addressing and potentially
alleviating these concerns, SOAPP may allow providers to feel greater
confidence and reconsider a potentially beneficial therapy for certain
patients, he said.
Investigators
evaluated SOAPP in a pilot study recently presented during a poster session at
the 2nd Joint Meeting of the American Pain Society (APS) and the Canadian Pain
Society in
Can
incorporating SOAPP into practice really help, and is it practical? Jamison
noted that it takes about 10 minutes to go through the SOAPP, which
"contains questions that a busy clinician should ask anyway." It is
possible to not answer the questions truthfully, he said, but
"information found to be contrary to what the patient reported would help
the clinician conclude that an individual is unreliable and thus may not be a
good candidate for continued opioid therapy."
No
man-made screening can take the place of human intervention. Thus, "the
most useful role a pharmacist can play in the management of chronic pain
patients is to ensure that these patients are using only one pharmacy to fill
their narcotic scripts, and to be in contact with the treating physician
regarding any aberrant behaviors, such as the use of multiple physicians,
requests for early refills, payment for scripts in cash to avoid insurance
restrictions, and, of course, the use of false scripts," commented Edward
Michna, M.D., director of the Pain Trials Center at Brigham & Women's
Hospital and Instructor of Anesthesia at Harvard Medical School. Awareness of
the many off-label uses of medications for pain and increasing insurance
restrictions, such as prior authorization, is also pertinent.
•
How often have you felt a need for higher doses of a medication to treat your
pain?
•
How often do you take more medication than you are supposed to?
•
How often have you taken medication other than how it was prescribed?
•
How often have your medications been lost or stolen?
•
How often have you felt a craving for a medication?
•
How often have others expressed concern over your use of medication?
•
How often has more than one doctor prescribed a pain medication for you at the
same time?
(Elena Beyzarov. New tool helps identify patients at risk for opioid abuse. Drug Topics Jun. 21, 2004;148:HSE17)
ACTION
ALERT FOR
Act
now to prevent further cuts
A
House committee bill (PCB 05-01) includes language that would reduce
pharmacy
reimbursements by nearly $30 million. The reductions would be the
lower
of AWP-17% or WAC plus 5% for pharmacies that bill Medicaid more than
$75,000
per month. Additionally, there is a provision that would limit
coverage
to three branded and three generic medications per month.
ACT
NOW… Use the
and
urge them to oppose this harmful measure. Simply use the link below to
access
the
http://capwiz.com/ascp/state/main/?state=FL THANK YOU!
Immunization
Bill#1557
if passed would allow Pharmacist Immunization Programs. Check this site for
committee members to contact to encourage this Bill:
http://www.myfloridahouse.gov/committees_detail.aspx?id=2258&sessionID=38Officers:
Please
update your information or renew membership by mail to: Attn Jeff Broxson,
Dues
can continue to be paid at meetings. Please do not try to renew or leave
changes on the voice mail.
|
|
