Opioids and the proper treatment of mu receptor pain
Friday, May 19, 2017
The topic of opioid misadventures has received a significant amount of attention in both the healthcare media and national political talking points. Traditional solutions focus on reducing the availability of opioids.
However, the mistreatment of patients with chronic mu receptor pain represents a major preventable vector to this healthcare crisis. Our efforts may be better applied by addressing the proper treatment of mu receptor pain.
Pharmacists can play a significant role in resolving this problem. They must learn to apply a new paradigm that includes identifying patients with mu receptor pain in which opioid use is indicated, interviewing those patients to define their pain, educating patients to enable them to differentiate and quantify the types of pain they may be having, developing a treatment plan, and following the patient's progress.
The pharmacist should review the patient's documented past medical history when available — keeping in mind that practitioners may be biased in their evaluation of the patient, perceiving all chronic pain patients as drug-seeking abusers. A meeting with the patient occurs next, during which the pharmacist will ask the patient to describe her pain, including its history, the quality and quantity of pain, whether there is a temporal association, what makes it better or worse and what therapies she has tried.
During the interview process it is important that the pharmacist educate the patient regarding the different types of pain, such as mu receptor pain, neuropathic pain, etc. Explain that people may have more than one type of pain, and each type is treated as a separate disease.
Opioids should only be used to treat the mu receptor pain. The patient should be taught the correct use of the Wong-Baker FACES Pain Rating Scale and should understand that her pain relief goal is "5" and not "0." The patient must also understand that improving mood is necessary for success in controlling chronic pain.
The interview process also provides the pharmacist with an opportunity to explore whether the patient is simply seeking to abuse opioids. A fairly reliable indicator of abuse is when the patient tells you he is allergic to medications other than his drug of choice or states that other medications don't work.
State databases providing patient monitoring of opioids may be useful, but it is important to realize the abusers and pseudo-abusers exhibit similar behaviors, including using multiple practitioners. The difference is in their motivation; the abuser is seeking a "high," while the pseudo-abuser is seeking pain relief. Abusers are the product of their own appetites. Pseudo-abusers are the product of inappropriate treatment by healthcare practitioners.
The interview process concludes with the patient and pharmacist agreeing to a plan, including follow-up. Explain that short-acting opioids are not an appropriate solution to treating chronic mu receptor pain and will result in treatment failure.
If break-through pain occurs, they should notify you immediately. Most instances of break-through pain represent mood rather than medication failure. Follow up with the patient on a regular basis, and within a day of change of therapy.
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