How to manage pain in addicted patients
Yvonne D'Arcy MS, CRNP, CNS

August 2010 
Volume 40  Number 8
Pages 60 - 64
  PDF Version Available!

YOU LEARN IN REPORT that the post-op patient you'll be caring for today has a history of opioid addiction. Do you feel confident that you can adequately manage the patient's post-op pain without exacerbating addiction issues?Patients with a history of addiction are often undertreated for acute pain despite reporting high pain intensity levels. Clinicians may label their repeated requests for more medication as "drug seeking" and administer inadequate medication dosages. But the reality is that because of opioid tolerance, these patients may need much more medication to control acute pain than opioid-naïve patients.Many healthcare practitioners think giving opioids to a patient addicted to opioids is a high-risk practice, but every patient has a right to adequate pain relief. The American Society of Pain Management Nurses has issued a position statement affirming that patients with a history of addiction need to have their pain treated and that they'll need higher doses of medication for pain.1Patients actively using illicit substances or misusing prescription drugs and patients with a history of addiction can expect to have a difficult time when they have pain unless the healthcare providers understand the issues surrounding addiction and pain relief. This article will dispel misconceptions and provide guidelines for managing pain in these patients. The following case studies help illustrate some common misconceptions about pain control and addiction.Admitted with acute abdominal pain related to a complete small bowel obstruction (SBO), Sara, 28, also has chronic low back pain from a car crash she was involved in as a teenager. She takes prescription opioids daily to control her chronic pain and allow her to teach high school science.After surgery to relieve the SBO, Sara requests pain medication well before it's due and consistently rates her pain as an 8/10 (8 on a 0-to-10 point numeric pain intensity rating scale).One evening, a nurse administering

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