Medical Education for Pain and Addiction: Making Progress toward Answering a Need

Schnoll, Sidney H.; Finch, James

doi:10.1111/j.1748-720x.1994.tb01303.x

Cited by 23 publications

(8 citation statements)

References 7 publications

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“…Physicians may also worry about being stigmatised by their peers for imprudent prescribing and losing professional authority over the patient 21. Combined with the limited physician education and training in both chronic pain and addiction,22 adopting a position of distrust may protect against being deceived or manipulated by untrustworthy patients who report objectively unverifiable symptoms.…”

Section: Trust and Trustworthiness In Chronic Pain Managementmentioning

confidence: 99%

What's trust got to do with it? Revisiting opioid contracts

Buchman

2013

J Med Ethics

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Prescription opioid abuse (POA) is an escalating clinical and public health problem. Physician worries about iatrogenic addiction and whether patients are 'drug seeking', 'abusing' and 'diverting' prescription opioids exist against a backdrop of professional and legal consequences of prescribing that have created a climate of distrust in chronic pain management. One attempt to circumvent these worries is the use of opioid contracts that outline conditions patients must agree to in order to receive opioids. Opioid contracts have received some scholarly attention, with trust and trustworthiness identified as key values and virtues. However, few articles have provided a critical account of trust and trustworthiness in this context, particularly when there exists disagreement about their role in terms of enhancing or detracting from the patient-physician relationship. This paper argues that opioid contracts represent a misleading appeal to patient-physician trust. Assuming the patient is untrustworthy may wrongfully undermine the credibility of the patient's testimony, which may exacerbate certain vulnerabilities of the person in pain. However, misplaced trust in certain patients may render the physician vulnerable to the potential harms of POA. If patients distrust their physician, or feel distrusted by them, this may destabilise the therapeutic relationship and compromise care. A process of epistemic humility may help cultivate mutual patient-physician trust. Epistemic humility is a collaborative effort between physicians and patients that recognises the role of patients' subjective knowledge in enhancing physicians' self-understanding of their theoretical and practice frameworks, values and assumptions about the motivations of certain patients who report chronic pain.

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Section: Trust and Trustworthiness In Chronic Pain Managementmentioning

confidence: 99%

What's trust got to do with it? Revisiting opioid contracts

Buchman

2013

J Med Ethics

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“…Although it is rare for patients without a history of an addictive disorder to become addicted in the context of pain treatment [57], many prescribing physicians unjustifiably worry that patients who are terminally ill must have careful and potentially limited use of opioids. When psychiatrists are asked to screen patients for addictive disorders (as potential gate keepers for these medications), they must focus on whether patients have one of the following: control over their medications; improved quality of life; appropriate awareness and concern about side effects associated with medication usage; concern about underlying medical problems; willingness to adhere to agreed treatment plans; and medications remaining from previous prescriptions [58]. To produce steady-state blood levels with continuous opioid-receptor occupancy, longer-acting opioids (methadone and controlled-release fentanyl, morphine, or oxycodone) administered aroundthe-clock are recommended routinely for reducing pain, increasing function, minimizing the development of tolerance, and creating a better quality of life [57].…”

Section: The Ultimate Role For Psychiatry In End-of-life Carementioning

confidence: 99%

The psychiatric management of end-of-life pain and associated psychiatric comorbidity

Cole

2003

Current Science Inc

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Involvement by psychiatrists in the care of patients who are terminally ill has been limited historically; however, psychiatrists increasingly are participating in the care of these people who are facing the most challenging times of their lives. Pain management is considered to be an area of subspecialization for psychiatrists beyond their traditional role of being psychopharmacologists and psychotherapists. Biologically focused psychiatrists are able to address neuropsychiatric disorders, including pain and depression in the medically ill, and actively improve the quality of life for dying patients and their family members. This article provides a review of the recent literature that has addressed the involvement of psychiatrists in end-of-life care. Beginning with an example of the scientific aspects of cancer-related treatment from a patient's perspective, and into the major treatment considerations, this article addresses pain, its recognition, and management challenges when the end of life approaches. The prompt recognition of frequently overlooked and underestimated concomitant depressions, delirium, dementia, and other mental disorders is important for mental health specialists. The importance of psychiatric care for patients who are terminally ill and the role of psychiatrists in the phase of care also are discussed.

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“…This reduces the chance that the patient will obtain multiple controlled substance prescriptions from multiple physicians and fill them at different pharmacies. Many pharmacists will call physicians to alert them to the problem of prescriptions from several sources 26 . Pharmacists also have methods of detecting prescription tampering or forgery.…”

Section: Guidelines For Prescribing Opioid Pain Medicationsmentioning

confidence: 99%

Addiction and Pain

Schnoll

Weaver

2003

American J Addict

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The use of opioid medications for analgesia is associated with concerns about adverse side effects and the potential for development of physical dependence, tolerance, or addiction. Pain often is undertreated, which may provoke drug‐seeking behavior by patients. Physicians must assess requests for more pain medication as stemming from either undertreatment of pain, development of physical tolerance, or addiction. Important tools for addiction screening include the use of questionnaires, patient interviews, and lab tests. In this study, the physiological and behavioral consequences of chronic pain and its treatment with opioids, along with guidelines for prescribing opioid pain medication, are presented.

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Medical Education for Pain and Addiction: Making Progress toward Answering a Need

Cited by 23 publications

References 7 publications

What's trust got to do with it? Revisiting opioid contracts

What's trust got to do with it? Revisiting opioid contracts

The psychiatric management of end-of-life pain and associated psychiatric comorbidity

Addiction and Pain

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