As a provider, pain relief requests need to be addressed compassionately. So too does the intensity at which we treat pain. It has become increasingly apparent that the over-prescription of opioid pain medications can do more long-term harm than good. An estimated 3 to 40 percent of opioid users become addicted.1 These medications can chain patients into an unending cycle of dependence, driving them to find sources of pain relief, whether legal or illegal.
How do we help patients control their pain with the lowest course of action possible while also identifying the subset of patients who need help to reduce their craving for opioids or other pain-blunting drugs? As providers we need to ask ourselves these questions:
- Who is at risk for addiction?
- How do we treat pain with alternatives to opioids?
- How do we treat with opioids with an aim to reduce a patient’s reliance on them?
Pain management requests are very subjective. For some patients, pain is felt acutely. Their intense pain perception can be influenced by previous experience with pain, coping skills, heredity, energy level and more. Understanding your patients’ perception of pain and their potential pain influencer(s) is important.
Across our LVHN primary care offices, the following strategies are being used. They have helped us create a foundation of knowledge about our patients, while demonstrating that our provider team will not write an opioid prescription without due diligence on our part.
- Urine drug screening – These tests are performed regularly to identify those who have detectable levels of pain medication in their urine. Across LVHN primary care practices, use of urine drug screenings has increased from 49 tests in 2013 to 663 in 2016.
- Opioid prescribing data – This information is derived from Epic reports. In practice, this information built awareness that helped us reduce prescriptions written for opioids by 25 percent.
- Informed consent – We ask patients if they have enough information about the pain medication to show they understand the risks associated with taking a prescribed, controlled substance. This is in addition to a controlled substance agreement they must also sign.
- Awareness of co-occurring disorders – Patients who have an existing disorder, such as alcoholism, depression, other mental illness, anorexia, post-traumatic stress disorder, anxiety or other existing addiction (heroin, dependence on prescription drugs, etc.), are at risk for developing an addiction to opioid medications.
- Collaborative multidisciplinary committee – Providers are able to submit de-identified cases to a group of peers for direction on care management and clinical decision making. This allows for input from pain management, primary care and behavioral health clinicians to assist anyone looking for support on challenging situations related to pain management or opioid prescribing.
For more information, visit the LVH intranet for a pain toolkit designed as a resource for LVHN primary care providers.
Find help for patients
Each county (either individually or through county-to-county partnerships) has established a single-county authority (SCA) to manage drug and alcohol abuse services. Three area SCAs are listed below with links to their service information and to medication take-back sites.
If your patient is a resident of a different Pennsylvania county, click here for PA Department of Drug and Alcohol Programs.
Is your patient not a Pennsylvania resident? Find treatment through the Substance Abuse and Mental Health Services Administration (SAMHSA).
- Berks County drug and alcohol services
- Prescription drug take-back locations, including 24 Berks County police departments
- Lehigh County drug and alcohol services
- Prescription drug take-back locations, including LVH–Cedar Crest, LVH–17th Street and 10 Lehigh County police departments
- Northampton County drug and alcohol services
- Prescription drug take-back locations, including LVH–Muhlenberg and 18 Northampton County police departments
For questions or feedback on this article, contact Jennifer Stephens, DO, LVPG Internal Medicine–3080 Hamilton Blvd., at 484-661-4650.