A nursing dilemma: Opioid use disorder and pain management

Chronic pain is among the most prevalent and debilitating medical conditions, but also among the most controversial and complex to manage, raising a significant challenge for clinicians. How can nurses address the stigma associated with pain and opioid use and how can they play a key role in preventing and addressing the prescription opioid crisis?

In this webinar, Brittany Punches, PhD, answers these questions and discusses her research to guide nurses in understanding and addressing the complex equation of opioid use disorder and pain management.

Watch the full webinar or read the summary of key points Punches discusses below.

The War on Drugs and the “Just Say No” campaign during the crack cocaine crisis was a battle waged on morals – if you have strong morals, you just say no to drugs.

During the ’90s, the “Pain is the 5th vital sign” campaign encouraged doctors and nurses to assess patient pain as a requirement of proper care. Patient satisfaction surveys included questions on pain management and aspects of reimbursement were tied to these surveys, leading to change in prescribing habits as pharmaceutical companies aggressively promoted prescription opioids as non-addictive if used as medically prescribed.

Patients became addicted to their medication unintendedly, a concept that conflicted with the idea that drug use disorder was a moral failing. As it became clear that prescription opioids were contributing to the substance use disorder crisis, legislation and policy were put into place to control prescriptions; providers became unsure on how to manage pain and patients felt judged when asking for pain management.

Pain is not the same for each individual as there are several aspects that feed into a person’s experience with pain:

• Affect: their mental health    
• Trauma: physical and psychological
• Social: level of support, self-efficacy
• Gender/Culture: biological differences, coping strategies

“We have all of these complex factors that cause pain to be a multi-dimensional experience. We cannot just look at an individual and how much of an injury they had to their tissue to describe how much pain they should be feeling at that moment...” Dr. Punches says.

• Stepping away from misconceptions and judgments regarding chronic pain and substance use disorder.
• Being aware of negative attitudes that can create negative consequences for patients and their access to health care, including microaggressions and discrimination.
• Having an open line of communication with patients. Explaining why you can’t prescribe opioids and what you can do help patients the most.
• Educating patients about risks and alternatives can help them learn that there are non-opioids options for pain management, making sure patients have a full picture understanding of the alternatives and how they can be beneficial. 
• Understanding that patients have different levels of health literacy, as different patients are at different levels of understanding on how to manage their pain.
• Remembering that, for many lower income patients, opioids are perceived as the cheapest and most effective option. Not having the luxury of taking time off to focus on healing and their health, they look for a cheap and immediate solution so they can earn their next paycheck.
• Reaching out to the patient’s social support and working with interprofessional teams, including physical therapy, massage, cognitive behavioral therapy, and other solutions such as RICE (rest, ice, compression, elevation) and OTC medications.

Dr. Punches shares a few recommendations to help nurses advocate for their patients:

• Advocating for pain management, look at how we can help provide more alternative treatments for pain.
• Supporting harm reduction.
• Collaborating with interdisciplinary teams to support patients inside and outside of the hospital.