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A Message From the Coordinator
April, 2012

 Changing Standards of Care in Pain Management

They are startling statistics.  Since 2007, prescription opioids have been involved in more overdose deaths than heroin and cocaine combined.  In 2009, for the first time, drug overdose actually exceeded motor vehicle collision as the leading cause of accidental death.

In spite of these statistics, your Oregon Pain Management Commission (OPMC) supports the rational use of opioids in appropriate treatment plans for pain management.  But because of these statistics, medical practices that were once utilized in a hit or miss fashion are rapidly becoming standards of care in pain management. The OPMC supports these standards of care because they mean better and safer treatment for individuals with pain.
It is obvious from some of the questions that I have received recently that new pain management standards can come as a surprise to patients and their families—even to those who have been using medications for a number of years.  I would like to share information about evolving standards of care in pain management so that you can be fully aware of these practices.  It is important to understand and accept these practices so that you don’t spend your energy being upset or angry; these standards are ultimately designed to protect your well being.  If you understand your healthcare provider’s reasoning, it may be easier to accept that he or she is still supporting you.  The more you understand, the less likely you will be offended by the actions that you are requested to take.
Due to the diseases that can be passed through human blood, a Universal Precautions approach was developed to dealing with healthcare procedures that involve blood and body fluids.  You are probably quite familiar with this.  The Universal Precautions approach requires that healthcare workers treat every individual as if they potentially have infectious disease in their blood.  It also requires that they use appropriate measures to avoid such potential pathogens.  That is why every time a healthcare worker draws blood, they put on gloves with every patient
A new standard in pain management is to take a Universal Precautions approach to dispensing opioid medications.  So a Universal Precautions approach in the world of pain management means that healthcare workers screen every individual as if every individual has the potential for misusing or becoming addicted to drugs.
Universal Precautions means your provider will ask about your history and use of any types of medications.  This will include opioids and the use of alcohol or other addictive substances.  The provider will also ask about your family history of substance abuse or addiction.  The intent here is not to insult, offend, or accuse you, but to determine if medications have an appropriate and safe place in your treatment plan.
Universal Precautions actions may include the following.  You may be asked to sign a pain medication agreement or “contract” that requires you to only receive pain medications from one healthcare provider.  It may require you fill your prescriptions from one pharmacy.  Your physician will also sign this agreement because it is a statement of mutual responsibility.   
Your agreement may require you to come in for follow-up visits and to periodically submit a urine sample or to submit to other testing to monitor how your medications are affecting your body.  It is important for your provider to know that you are taking the medications that are part of your treatment plan.  It is also important to know that you are not taking any other medications that you and your provider have not agreed upon.
 You may be asked occasionally to bring your medications in for a “pill count” to determine that you are taking the right amount of medication on the right schedule.  You may also be asked to agree never to share your medications with anyone else and to keep your medications in a safe locked area.
All of the above actions are designed to assure that your treatment plan is working well for you.  These actions will also help monitor behaviors that could lead to the misuse of drugs, the development of an addiction issue, or lapses in caution that could let your medications fall into unsafe hands.
These standards of care should spur you to discuss your treatment plan with your provider.  The medication agreement is designed to remind you of the importance of an ongoing dialogue with your provider about how your medications are working or if they are not working well to control your pain.  It is also designed to remind you that the worst thing you can do is to adjust your medications on your own.  It would be a tragedy for an individual to die of an over dosage of their prescription medications because they thought that simply increasing their pain medication by a pill or two wouldn’t be harmful.
When you and your healthcare provider commit to standards of pain management that include these actions, you are both committing to having a trusting and honest relationship.  Your provider’s signature is a commitment to you.  It is a commitment to give you clear instructions about your pain management plan and to remain available to answer your questions and concerns.  It is also a commitment to reassess and adjust your treatment plan so that you can take control of your pain and get back to performing those functions that are important to you. 
Your signature is a commitment to ongoing straightforward communication; if problems arise, you have committed to working on finding a solution with your healthcare provider.  When you see standards of pain management in this light, they appear positive rather than as a punishing barrier to addressing the pain in your life.

Kind Regards,
Kathy Kirk, RN