Opioids Are Not Always the Answer

May 18, 2018

As the opioid crisis continues in the United States, helping patients find effective and safer ways to manage their pain becomes increasingly important. During a session at the 43rd Annual Congress in Washington, DC (https://congress.ons.org/), Jeannine Brant, PhD, APRN, AOCN®, FAAN, of Billings Clinic in Montana, instructed nurses on ways to treat cancer-related pain (https://ons.confex.com/ons/2018/meetingapp.cgi/Session/1543) and discomforts other than (or in addition to) opioid pain medicines.

Opioids medications have been an important part of acute and cancer pain management because they generally have fewer side effects than many treatment modalities. However, their use can be controversial when improper patient selection and overprescribing occurs, especially in the era of increased substance abuse and overdosing. According to data in Brant’s presentation:

As an example, providers should screen cancer survivors for pain at each encounter, prescribing systemic nonopioid analgesics and adjuvant analgesics to relieve chronic pain and/or to improve function, and using opioids in selected patients with cancer that are still experiencing distress and pain, but only if they are not responding to more conservative pain management.

When it comes to choices for more conservative pain management treatments, options include both nonopioid pharmacologic and nonpharmacologic. Nonopioid pharmacologic options are:

Other nonopioid pharmacologic options that are likely to be effective according to Brant are antidepressants (specifically tricyclics and serotonin-norepinephrine reuptake inhibitors), NMDA receptor antagonists, and cannabis.

Nonpharmacologic options and procedures that are recommended for practice include:

Brant noted that the nonpharmacologic options likely to be effective are psychoeducational interventions and medical improv. For other nonpharmacologic options, effectiveness is not established because of small sample sizes in studies, lack of rigor in conducting the study, and more. Continued studies are needed in areas of pain control such as acupuncture, scrambler therapy (a rapidly changing electrical impulse that sends a non-pain signal to block painful stimuli), and yoga.

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