Excerpt

The management of chronic noncancer pain (CNCP) in patients with a comorbid substance use disorder (SUD) is challenging for both patients and clinicians; however, it can be done successfully. This TIP advises clinicians to conduct a careful assessment; develop a treatment plan that addresses pain, functional impairment, and psychological symptoms; and closely monitor patients for relapse. Even the best treatment is unlikely to completely eliminate chronic pain, and efforts to achieve total pain relief can be self-defeating. Patients may benefit when clinicians team with other professionals (e.g., psychologists, addiction counselors, pharmacists, holistic care providers). Patients must also assume a significant amount of responsibility for optimal management of their pain. Educating patients, family members, and caregivers in this process, and helping patients improve their quality of life, can be gratifying for everyone involved.

Contents

• Consensus Panel
• What Is a TIP?
• Foreword
• 1. Introduction
  • Chronic Pain Impact
  • Audience
  • Purpose
  • Definitions
  • Pain and Addiction Basics
  • Neurobiology of Pain
  • Chronic Pain
  • Pain’s Effect on Health
  • Neurobiology of Addiction
  • Risk Factors for Addiction
  • Cross-Addiction
  • The Cycle of Chronic Pain and Addiction
  • Summary of TIP
  • Key Points
• 2. Patient Assessment
  • Elements of Assessment
  • Assessment Tools
  • Assessing Pain and Function
  • Screening for Substance Use Disorders
  • Referring for Further Assessment
  • Psychiatric Comorbidities
  • Assessing Ability To Cope With Chronic Pain
  • Evaluating Risk of Developing Problematic Opioid Use
  • Ongoing Assessment
  • Treatment Setting
  • Key Points
• 3. Chronic Pain Management
  • Overview of Pain Management
  • The Treatment Team
  • Treating Patients in Recovery
  • Nonpharmacological Treatments
  • Treating Psychiatric Comorbidities
  • Opioid Therapy
  • Treating Patients in Medication-Assisted Recovery
  • Tolerance and Hyperalgesia
  • Treating Pain in Patients Who Have Active Addiction
  • Acute Pain Episodes
  • Assessing Treatment Outcomes
  • Key Points
• 4. Managing Addiction Risk in Patients Treated With Opioids
  • Promoting Adherence
  • Urine Drug Testing
  • Inclusion of Family, Friends, and Others
  • Nonadherence
  • Tools To Assess Aberrant Drug-Related Behaviors
  • Documenting Care
  • Managing Difficult Conversations
  • Workplace Safety
  • Drug Diversion
  • Discontinuation of Opioid Therapy
  • Key Points
• 5. Patient Education and Treatment Agreements
  • The Value of Patient Education
  • Providing Effective Education
  • The Internet as a Source of Patient Education
  • Education Content
  • Opioid Information
  • Methadone Maintenance Therapy Information
  • Treatment Agreements
  • Key Points
• Appendix A Bibliography
• Appendix B Assessment Tools and Resources
• Appendix C CFR Sample Consent Form and List of Personal Identifiers
• Appendix D Resources for Finding Complementary and Alternative Therapy Practitioners
• Appendix E Field Reviewers
• Appendix F Acknowledgments

This publication was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) by the Knowledge Application Program (KAP), a Joint Venture of The CDM Group, Inc., and JBS International, Inc., under contract numbers 270-04-7049 and 270-09-0307, with SAMHSA, U.S. Department of Health and Human Services (HHS). Christina Currier served as the Government Project Officer.

Suggested citation:

Substance Abuse and Mental Health Services Administration. Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders. Treatment Improvement Protocol (TIP) Series 54. HHS Publication No. (SMA) 12-4671. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.

The views, opinions, and content of this publication are those of the authors and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS.