TY - JOUR
KW - Alcoholism/diagnosis/epidemiology
KW - Analgesics, Opioid/administration & dosage/therapeutic use
KW - Buprenorphine, Naloxone Drug Combination/therapeutic use
KW - Chronic Pain/drug therapy
KW - Humans
KW - Opioid-Related Disorders/diagnosis/epidemiology/therapy
KW - Pain Management/methods
KW - Primary Health Care
KW - Quality Improvement
AU - W. C. Becker
AU - J. S. Merlin
AU - A. Manhapra
AU - E. L. Edens
A1 - 
AB - BACKGROUND: Patients, providers, communities and health systems have struggled to achieve balance between access to opioid treatment for chronic pain and its potential harmful consequences: especially misuse, addiction and overdose. We developed an interdisciplinary clinic embedded within primary care (the Opioid Reassessment Clinic-ORC) with the goal of improving the quality of care of patients with co-occurring chronic pain and issues related to opioid safety, efficacy and/or misuse. CASE DESCRIPTIONS: We present three cases referred to the ORC that highlight complex clinical scenarios related to assessment and treatment of patients with chronic pain and issues related to opioid safety, efficacy and misuse. DISCUSSION AND EVALUATION: In the context of the three cases, with respect to assessment, we discuss: making the diagnosis of opioid use disorder; allowing the patient space to endorse lack of efficacy; identification of co-occurring hazardous alcohol use; and recognizing barriers to multimodal pain care. With respect to treatment, we discuss: making a change in treatment with which the patient may not agree; effectiveness of buprenorphine/naloxone for the treatment of chronic pain; responding to low efficacy; and making continued opioid therapy contingent on engagement with substance abuse treatment. CONCLUSIONS: The core components of our approach-biopsychosocial assessment and multimodal treatment planning with an emphasis on promoting functional goals and safety using clear communication and a patient-centered stance-should guide providers in the management of similar clinical scenarios. More evidence is needed to definitively guide specific interventions and points of clinical equipoise.
BT - Addiction science & clinical practice
C5 - Opioids & Substance Use; Education & Workforce
CP - 1
CY - England
DO - 10.1186/s13722-016-0050-0
IS - 1
JF - Addiction science & clinical practice
N2 - BACKGROUND: Patients, providers, communities and health systems have struggled to achieve balance between access to opioid treatment for chronic pain and its potential harmful consequences: especially misuse, addiction and overdose. We developed an interdisciplinary clinic embedded within primary care (the Opioid Reassessment Clinic-ORC) with the goal of improving the quality of care of patients with co-occurring chronic pain and issues related to opioid safety, efficacy and/or misuse. CASE DESCRIPTIONS: We present three cases referred to the ORC that highlight complex clinical scenarios related to assessment and treatment of patients with chronic pain and issues related to opioid safety, efficacy and misuse. DISCUSSION AND EVALUATION: In the context of the three cases, with respect to assessment, we discuss: making the diagnosis of opioid use disorder; allowing the patient space to endorse lack of efficacy; identification of co-occurring hazardous alcohol use; and recognizing barriers to multimodal pain care. With respect to treatment, we discuss: making a change in treatment with which the patient may not agree; effectiveness of buprenorphine/naloxone for the treatment of chronic pain; responding to low efficacy; and making continued opioid therapy contingent on engagement with substance abuse treatment. CONCLUSIONS: The core components of our approach-biopsychosocial assessment and multimodal treatment planning with an emphasis on promoting functional goals and safety using clear communication and a patient-centered stance-should guide providers in the management of similar clinical scenarios. More evidence is needed to definitively guide specific interventions and points of clinical equipoise.
PP - England
PY - 2016
SN - 1940-0640; 1940-0632
SP - 3
T1 - Management of patients with issues related to opioid safety, efficacy and/or misuse: a case series from an integrated, interdisciplinary clinic
T2 - Addiction science & clinical practice
TI - Management of patients with issues related to opioid safety, efficacy and/or misuse: a case series from an integrated, interdisciplinary clinic
U1 - Opioids & Substance Use; Education & Workforce
U2 - 26818474
U3 - 10.1186/s13722-016-0050-0
VL - 11
VO - 1940-0640; 1940-0632
Y1 - 2016
ER -