Expectations Instead of Medications: Managing Patient Pain

Expectation management is a critical tool to leverage in the opioid epidemic.

Posted Dec 23, 2018

Opioid deaths have risen by 345 percent over the past six years, according to a recent article published on the Journal of American Medical Association Network. These deaths are a direct result of opioid addiction—an ongoing battle between patient and pain relief. The euphoric feeling that opioids (codeine, morphine, heroine, etc.) produce is easy to become attached to.

It’s also easy to build up a tolerance to opioids resulting in the need for a higher dosage. It’s not uncommon for some addicted patients to “double-doctor-dip,” or find more than one doctor to obtain multiple prescriptions.

Because of the high addiction and death rate, various states have begun restricting opioid access. This has left many patients fighting an addiction without proper help or support. Even professionals that can help break an opioid addiction don’t know the best way to stop patients from using these drugs.

Research has shown that one rehabilitation solution doesn’t exist, and no rehabilitation program is one-size-fits all. Still, it has been widely shown that once patients begin to use less of an opioid drug, they do begin to feel better and pain does begin to subsist. But what if prescription pain-relief could be avoided completely? What if the answer centered around managing patient expectations?

Complete pain relief is not something that most patients ever attain, even with pain-relief medications—medications that come with their own host of side-effect and problems like addiction. A recent study conducted in New Zealand showed that one in six people report chronic pain, but only 30 percent of those people ever experience complete pain relief. In short, patients expecting complete pain relief are going to be let down if doctors do not begin to manage these expectations.

A few ways to help patients understand pain tolerance include:

  • Practicing transparency: Pain isn’t going to subside completely. Telling a patient that pain will go away is not only false (in most cases), it’s also irresponsible. Instead, teaching patients to tolerate some level of pain helps to manage expectations.
  • Providing alternate ways to “treat” pain or relieve pain in the moment. These can include meditation, stretching exercises, and mindfulness techniques.
  • Taking the time to explain that pain is a result of injury. While medications and alternative therapies can help manage pain, it’s not something that will go away while injured.
  • Taking the time to explain patient options: It’s important to tell patients that pain is not always relieved by surgery, and that, in fact, surgery usually increases pain in the short term. Complications can also arise during surgery and even with medications prescribed during the recovery process.
  • Encouraging or building support groups: Talk therapy in the form of a support group might be effective at relieving pain—and a lot less addictive. With every injury or chronic pain diagnosis, doctors should be offering hotlines and websites filled with local support group information.
  • Emphasizing the importance of family and friend support systems. When surgery is planned, even emergency surgery, the explanation of pain expectations and plan for treatment should include the person that will care for the patient after surgery. Often it is suggested that patients have a caretaker, but that person is rarely included in conversations about post-operation realities.
  • Helping to develop a "pain plan." Similar to birth plans that have become mainstay of childbearing for women in 2018, a pain plan should involve the team (patient, family member/friend caring for patient post surgery and medical team).

Over the counter or non-prescription medications and treatments are also valid ways to help patients handle pain. Some of those options include:

  • Acetaminophen alternating with ibuprofen (tylenol and advil) is as effective for most patient’s pain as narcotic prescription medication.
  • Ice: This may seem like a no-brainer, but ice can really help to alleviate post-surgery or chronic pain.
  • Stool softeners: If a patient stops using narcotics, stool softeners can help to alleviate constipation caused by these drugs (and, in turn, cut back on unnecessary suffering).
  • Sleep medication: Pain can often lead to insomnia, which increases anxiety causing additional pain. Sleep is often the most important part of recovery.

Another often overlooked remedy is time. A realistic pain timeline should be discussed with patients and be exclude the use of opioids or other heavy drugs as much as possible. Pain is not something that can be escaped following an injury, but it doesn’t have to be completely numbed either. What’s most important is that patients know what to expect, how to manage pain with alternate methods, how to create a recovery plan using support systems, and that most pain will become more manageable or subside with time. Swapping opioids or other pain relievers for complete transparency may not be a complete solution, but it is a start.

References

June 2018, The Burden of Opioid-Related Mortality in the United States

Tara Gomes, PhD1,2; Mina Tadrous, PharmD, PhD1; Muhammad M. Mamdani, PharmD, MA, MPH1,2; et al

J Prim Health Care. 2015 Jun 1;7(2):130-6.

Patient expectations for chronic pain management.

Bhana N1, Thompson L1, Alchin J2, Thompson B3.