According to Boschert (2009), a survey of health care practitioners that are typically included on a pain management team, including physicians, nurses and pharmacists, revealed the following gaps and inadequacies: (a) many health care providers do not believe that pain is real in patients who report it, and a lack of knowledge about the appropriate use of opioids that probably results in undertreatment of pain; (b) health care workers, despite all their training, allow their bias to influence the way they address the needs of their patients; and (c) one of the main challenges is to get staff to be more accepting of what patients tell them. The most reliable indicator that a person has pain is their verbally expressing that they have pain (Boschert, 2009, p
Pain specialists in each discipline of the chronic pain rehabilitation program (CPRP) who will volunteer time to help educate training participants. In addition, a dietitian, recreational therapist; social worker and other specialists may be valuable additions to the pain management treatment team depending on the unique needs of the patient (Clark & Norton, 2009)
41). In fact, the Joint Commission's policies concerning pain management are focused on ensuring that pain is managed appropriately rather than attempting to prescribe how it should be managed (Gebhart, 2009)
2). Likewise, there are some significant religious, gender and cultural differences in the experience and management of pain that must be taken into account when formulating treatment interventions (Gibbs, 2007)
Likewise, Kubotera and Fudin (2013) recommend that interdisciplinary pain management teams should also include a pharmacist. The addition of a pharmacist to the multidisciplinary pain management team is based on the rationale that, "Pain and related symptom management often involves complex polypharmacy, a keen understanding of pharmacotherapeutics across several drug classes, and collaboration with other healthcare disciplines" (Kubotera & Fudin, 2013, p
How will these factors addressed? With the veteran population aging at a rapid rate, the potential for negative outcomes in a pain management program are significant for a number of reasons. For instance, misperceptions concerning aging can result in problematic support when health care providers believe elderly patients are on an irrevocable path to a painful death which can cause overly solicitous behavior and introduce unnecessary worry for family members (Turk & Gatchel, 2002)
Review and Discussion Levels of interprofessional team needed for the optimal operation of the delivery system and supporting rationale Because pain is a complex phenomenon that is highly subjective in nature, effective treatment requires a holistic approach that takes into account a wide range of factors that may contribute to or exacerbate the pain process. There is a general consensus that an interdisciplinary team approach is most effective for achieving optimal pain management outcomes (Woods, 2011)
Low-dose ketamine or LDK may be an option for treating acute pain in an emergency setting as well as a post-operative surgical setting when combined with other pain management medications. "Use of LDK as an analgesic in a diverse ED patient population appears to be safe and feasible for the treatment of many types of pain" (Ahern et al
Topical capsaicin may be useful neuropathic pain. "Nonpharmacological methods of pain control include the use of electrical stimulation, relaxation therapies, psychosocial/manipulative therapies, and acupuncture" (CV & ER, 2015, p
"Opioid-induced hyperalgesia is a phenomenon defined by increasing pain after opioid exposure with the worsening of pain occurring when opioid doses are increased. Hyperalgesia has been described following remifentanil and morphine use, but the question remains about the associated risk with acute fentanyl exposure" (Lyons, Rivosecchi, Nery & Kane-Gill, 2015, p
In addition, they may need opioid analgesics. "Unfortunately, owing to clinicians' misconceptions about opioids and negative attitudes toward patients with OUD, such patients may be inadequately medicated and thus subjected to unrelieved pain and unnecessary suffering" (Paschkis & Potter, 2015, p
"Clinical protocols are designed to help address common problems and prevent errors. As the complexity of surgery and patients' diseases continues to increase, current knowledge of new analgesic medications, acute pain literature, and skills in regional anesthesia techniques is imperative" (Schwenk, Baratta, Gandhi & Viscusi, 2014, p
Patients with positive experiences commented on regular communication with their care team, rapid pain management, and the empathetic nature of their care providers. Patients communicate fears about the risks of opioid addiction, beliefs that following a prescribed opioid regimen is protective of developing opioid dependence, and an understanding of the broader tensions that providers face relating to the prescription of opioid therapy (Smith et al
), uninterrupted, mild pain scores (?4/10). SuPPR may represent a novel method for evaluating acute pain service performance" (Tighe, King, Zou & Fillingim, 2015, p
the medication's good effect). If the ill-effect is allowed to be the only way to achieve pain relief, opioids wouldn't be titrated to pain alleviation; rather, the patient would simply be administered a lethal quantity of potassium -- a thing that ought not to be done (Fine, 2007)