CONTROLLING PAIN: How substance abuse impacts pain management in acute care
Dawn Dunn MSN, RN, ANP-C
Janette Neuman DNP, RN, FNP-BC

August 2012 
Volume 42  Number 8
Pages 66 - 68
  PDF Version Available!

IN 2006, DAWN DUNN was a new associate's degree-prepared RN on a busy general medical unit. Every day during report from the offgoing nurse, she heard the same thing: "That patient's a drug seeker. She's watching the clock and asking for her pain medications the minute they're due. She's laughing and eating-she can't really be in pain." Then the healthcare provider would say something similar.Day after day in report, two or three patients would be labeled as drug seekers in Dawn's group alone. According to the American Society for Pain Management Nursing, labels such as drug seeker lead to prejudice and create barriers to care.1 Dawn asked herself, Are all these patients really drug seekers or are they actually seeking relief? Either way, how could she best help them? These two questions became the basis of her evidence-based research during her educational journey to become an NP.According to McCaffery and Pasero, "Pain is whatever the experiencing person says it is, existing whenever he says it does."2 That applies equally to patients with a history of substance abuse, yet their pain is often undertreated by clinicians who may misinterpret their reports of pain as drug-seeking behavior. Ironically, because of drug tolerance, patients who abuse or are addicted to opioids may actually require more medication to manage pain than other patients.3 Just like any other patient, they deserve to have their pain assessed and treated and their response to treatment evaluated.This article discusses why it's important to use evidence-based interventions to assess and manage pain in patients who abuse substances and the dangers of labeling these patients and failing to manage their pain. (See Who abuses substances?)Dawn decided to study the misuse of prescribed opioids, which was the main issue she'd encountered on the medical unit. She discovered that a lack of standardized, accepted definitions has led to difficulties in measuring the behaviors associated with opioid misuse and

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