Review ArticleAdherence Monitoring with Chronic Opioid Therapy for Persistent Pain: A Biopsychosocial-Spiritual Approach to Mitigate Risk
Section snippets
Persistent Pain Requires a Comprehensive Approach
According to the American Academy of Pain Medicine (2012), at least 100 million Americans suffer from persistent pain, which is more than the number affected by diabetes, heart disease, and cancer combined. Undertreatment or mismanagement of pain can cause delays in healing as well as changes to the central nervous system (Cheatle & O’Brien, 2011). This problem is exacerbated by a lack of consideration of the complex biologic interplay with psychologic, social, and spiritual issues involved
SUD and Persistent Pain
Preliminary research of SUD in persistent pain patients has cited a wide range of prevalence from 0%–50%, depending how a SUD is defined (Hojsted & Sjogren, 2007). However, most authorities believe the rate of SUD in persistent pain patients is relatively low if the patient has no significant risk factors for SUD and if opioid treatment is conducted using adherence monitoring strategies (Cheatle & O’Brien, 2011; Gallagher & Rosenthal, 2008; Gourlay, Heit, & Almahrezi, 2005). It is important to
The Biopsychosocial Approach
The biopsychosocial model has been internationally accepted as the model for pain management (Fillingim, 2009; Jacobson & Mariano, 2001; Melzack & Wall, 1996). There are three overlapping components of the biopsychosocial model that have been well studied, and these are physical pain, psychologic pain, and social/cultural pain (Altilio & Otis-Green, 2011; Grinstead, 2007; Keefe, Rumble, Scipio, Giordano, & Perri, 2004; Merskey & Bogduk, 1994; Merskey & Spear, 1967; Turk & Melzack, 2011).
Incorporating Risk Stratification into the Biopsychosocial-Spiritual Model
Risk stratification is designed to assess a person's risk for misusing or abusing opioid medications, or for developing or relapsing into addiction. Evaluating risk requires the clinician to assess two main areas: behavior related to pain and opioid use, and mental health.
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2022, Pain Management NursingCitation Excerpt :Respect for human dignity reduces the harms associated with these two conditions, and therapeutic actions can include listening, empathizing, encouraging, and offering hope (Matteliano et al., 2014). People with pain and SUD have unique attributes and experiences that can be misinterpreted, judged, or disregarded (American Nurses Association [ANA], 2015; Matteliano et al., 2014; Tracy, 2017). Within the American Nurses Association The Code of Ethics for Nurses with Interpretive Statements are statements that hold all nurses accountable to assessing and treating pain in those with SUD in a stigma-free and respectful way regardless of socioeconomic status, personal attributes, or other health problems (ANA, 2015).
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2019, Drug and Alcohol DependenceCitation Excerpt :Next, a recent study found that spirituality and religiosity interventions compared to others, were statistically significantly and more effective in helping people recover from substance use problems (Hai et al., 2019). We recommend that clinicians explicitly incorporate religiosity and spirituality in OUD treatment (Matteliano et al., 2014). The practice is not new (Heinz et al., 2007; Miller, 1998) and others have provided guidelines on how to do this in clinical settings (Christensen et al., 2018; Koenig, 2000).
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2019, Pain Management NursingCitation Excerpt :As leaders in the holistic view of patients, nurses continue to use a vast array of treatment modalities. Through the incorporation of the biopsychosocial-spiritual model of pain, nurses understand the risk of undertreated pain as well as the risk of overmedicating pain with opioids (Matteliano, St. Marie, Oliver, & Coggins, 2014). Removing the barriers to access of medical cannabis for clinical care will provide options in managing pain while helping patients regain function.
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Acknowledgement of the grant: Portions of this work were prepared by Barbara St. Marie during a postdoctoral traineeship on an NIH T32 in Pain and Associated Symptoms (NR011147).