Event 2: Pain Interview

Stop Trying to Cure Me and Start Listening

• Ensure that she feels listened to, that her story has been heard and understood.
• Her story is all that this distressed patient has:
  • Authentic dialogue is required
  • Treatment requires a partnership
• Source of her pain may be a complex past trauma
• Experience of suffering need be told:
  • to allow the patient to understand her status
  • to allow the team to understand how to direct effective treatment

What are the Differing Perspectives?

What does it feel like to be the:

• Patient and family
• Interprofessional team members

What Professional Knowledge Applies?

• Listening to the patient
• Biopsychosocial complexity of pain
• Risk screening and safe practices for chronic opioid therapy
• Establish diagnoses and treatment goals
• Interprofessional teamwork

Calculating the Morphine Equivalent Dose “MED"

Download to computer or hand-held device from Washington State Agency Medical Directors Group guideline

http://agencymeddirectors.wa.gov/mobile.html

(or, Google: “AMDG_opioid”)

Morphine Equivalent Dose

• Methadone 40 mg = 320 mg
• Oxycodone 40 mg  =   60 mg
• Total MED    = 380 mg

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Pain Metrics: Using Patient Reported Outcomes

Opioid Risk Tool

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Catherine's Risk of Addiction

Opioid Risk Tool score: 13

Scoring

• 0-3: low risk
•  4-7: moderate risk
•  > 8: high risk

Risk of Sleep Apnea

STOP-BANG

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Reference

Chung et al, 2008

Sleep Disorder Breathing Risks

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Reference

Walker JM., et al. 2007

Inappropriate Medicines for Chronic Pain

Sedative/Hypnotic Medications in Chronic Pain?

• Lack of evidence of muscle relaxant effectiveness with prolonged use
• Increases respiratory depression
• Causes drowsiness
• Often promotes deactivation

Not recommended for use in the elderly

Skeletal “Muscle Relaxants”

• Carisoprodol*
• Butalbital*

*Benzodiazepines

Short-acting

• Alprazolam
• Lorazepam

Long-acting

• Chlordiazepoxide
• Clonazepam
• Temazepam

Toxicities

• Tolerance
• Dependency
• Abstinence syndrome
  • *Includes life threatening withdrawal
• Addiction
• Rebound insomnia

Non-benzodiazepine Hypnotics

“The Z-drugs”

• Zolpidem
• Zaleplon
• Eszopiclone

Test Your Knowledge

Question 1

Treatment of chronic pain includes

Question 2

Patients with chronic pain should be monitored over time for: