Here are key points to consider as you work to improve pain management:
In addition to the systems problems addressed in this module, there are a few areas of pain treatment that either have not been well-studied or that pose ongoing challenges. Most research on pain focuses on acute pain (e.g., surgery) or cancer pain in people mostly under age 80. For all other groups, the confidence with which we can promise relief is compromised by a limited database. This is not to say that pain cannot be relieved, just that no one can reliably tell you about the success rate, the difficulties and complications, and the appropriate non-opioid modalities. This is likely to change over the next few years, as research on symptoms and their treatment increases. Keep in touch with the American Alliance of Cancer Pain Initiatives, the Wisconsin Cancer Pain Initiative, the Mayday Pain Project and the Roxane Pain Institute for updates.
The fear of abuse and actual abuse of opioid drugs is a major concern. The rates are very low. However, a very few patients may be interested in drug diversion or be prone to abuse. The appropriate practice responses are beyond our scope here, but the sources listed above have excellent information. However, advocates for better pain relief must be prepared to deal responsibly with this concern generally, and with regard to specific patients.
This text is derived from the book Improving Care for the End of Life : A Sourcebook for Health Care Managers and Clinicians.