American Society for Pain Management nursing position statement: pain management in patients with substance use disorders.

The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high-quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations.

[1]  A. Lipman,et al.  Pain: Substance Abuse Issues in the Treatment of Pain , 2009 .

[2]  R. Bland Psychiatric Disorders in America: The Epidemiologic Catchment Area Study , 1992 .

[3]  B. Naliboff,et al.  Introduction of a self-report version of the Prescription Drug Use Questionnaire and relationship to medication agreement noncompliance. , 2008, Journal of pain and symptom management.

[4]  Leonard J. Paulozzi,et al.  Vital signs: overdoses of prescription opioid pain relievers---United States, 1999--2008. , 2011, MMWR. Morbidity and mortality weekly report.

[5]  N. Volkow,et al.  Neurocircuitry of Addiction , 2010, Neuropsychopharmacology.

[6]  Definitions related to the use of opioids for the treatment of pain. , 2001, WMJ : official publication of the State Medical Society of Wisconsin.

[7]  T. Bien Mindfulness-Based Relapse Prevention for Addictive Behaviors: A Clinician's Guide , 2011 .

[8]  J. de Zeeuw,et al.  [Acute and chronic pain]. , 2005, Medizinische Klinik.

[9]  D. Lee,et al.  2010: U.S. Drug and Alcohol Policy, Looking Back and Moving Forward , 2010, Journal of psychoactive drugs.

[10]  S. Butler,et al.  Development and validation of the Current Opioid Misuse Measure , 2007, PAIN.

[11]  J. Haddox,et al.  Opioid pseudoaddiction — an iatrogenic syndrome , 1989, Pain.

[12]  K. Winters,et al.  Screening for drug abuse among adolescents in clinical and correctional settings using the Problem-Oriented Screening Instrument for Teenagers. , 1997, The American journal of drug and alcohol abuse.

[13]  B. S. Marie Core curriculumn for pain management nursing , 2002 .

[14]  A. Washton,et al.  Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors , 1986 .

[15]  Dennis M. Donovan,et al.  Relapse prevention: Maintenance strategies in the treatment of addictive behaviors, 2nd ed. , 2005 .

[16]  S. Athar Principles of Biomedical Ethics , 2011, The Journal of IMA.

[17]  L. Amerson,et al.  Drug dependence as a chronic medical illness. , 2001, JAMA.

[18]  K. Winters Development of an adolescent alcohol and other drug abuse screening scale: Personal Experience Screening Questionnaire. , 1992, Addictive behaviors.

[19]  A. Mack Adolescent Substance Use: America's #1 Public Health Problem , 2012 .

[20]  S. Passik,et al.  Managing chronic nonmalignant pain: Overcoming obstacles to the use of opioids , 2000, Advances in therapy.

[21]  S. Passik,et al.  Challenges in Using Opioids to Treat Pain in Persons With Substance Use Disorders , 2008, Addiction science & clinical practice.

[22]  R. Wilcox,et al.  Neurobiological Aspects of Addictions , 2000 .

[23]  Injury in America: the role of alcohol and other drugs--an EAST position paper prepared by the Injury Control and Violence Prevention Committee. , 2001, The Journal of trauma.

[24]  E. Sellers,et al.  Challenges in the Development of Prescription Opioid Abuse-deterrent Formulations , 2007, The Clinical journal of pain.

[25]  L. Webster,et al.  Approaches to improve pain relief while minimizing opioid abuse liability. , 2010, The journal of pain : official journal of the American Pain Society.

[26]  S. Morse Medicine and Morals, Craving and Compulsion , 2004, Substance use & misuse.

[27]  A. Date,et al.  Acute Pain Management , 2009, The Perioperative Medicine Consult Handbook.

[28]  B. Lindgren,et al.  The DIRE score: predicting outcomes of opioid prescribing for chronic pain. , 2006, The journal of pain : official journal of the American Pain Society.

[29]  A T McLellan,et al.  Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. , 2000, JAMA.

[30]  K. Todd,et al.  Disparities in pain: ethical issues. , 2006, Pain medicine.

[31]  D. Carr,et al.  Pain Management: A Fundamental Human Right , 2007, Anesthesia and analgesia.

[32]  R L Brown,et al.  A two-item conjoint screen for alcohol and other drug problems. , 2001, The Journal of the American Board of Family Practice.

[33]  J. Vander Bilt,et al.  A new brief screen for adolescent substance abuse. , 1999, Archives of pediatrics & adolescent medicine.

[34]  S. Hyman Addiction: a disease of learning and memory. , 2005, The American journal of psychiatry.

[35]  M. Mccaffery,et al.  Assessment and Relief of Pain in Chemically Dependent Patients , 1992, Orthopedic nursing.

[36]  H. Heit,et al.  Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. , 2005, Pain medicine.

[37]  S. Butler,et al.  Validation of a screener and opioid assessment measure for patients with chronic pain , 2004, Pain.

[38]  J. Højsted,et al.  Addiction to opioids in chronic pain patients: A literature review , 2007, European journal of pain.

[39]  B. St. Marie,et al.  Pain in critically ill patients with substance use disorder or long-term opioid use for chronic pain. , 2011, AACN advanced critical care.

[40]  S. McCabe,et al.  Adolescents' Motivations to Abuse Prescription Medications , 2006, Pediatrics.

[41]  S. Bowen,et al.  Mindfulness-Based Relapse Prevention for Addictive Behaviors: A Clinician's Guide , 2011 .

[42]  Lee N. Robins,et al.  Psychiatric Disorders in America: The Epidemiologic Catchment Area Study , 1990 .

[43]  G. Pasternak,et al.  Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. , 2009, The journal of pain : official journal of the American Pain Society.

[44]  W. White Addiction recovery: its definition and conceptual boundaries. , 2007, Journal of substance abuse treatment.

[45]  R. Jamison,et al.  Substance misuse treatment for high-risk chronic pain patients on opioid therapy: A randomized trial , 2010, PAIN.

[46]  L. Webster,et al.  Current status and evolving role of abuse-deterrent opioids in managing patients with chronic pain. , 2011, Journal of opioid management.

[47]  D. Alford,et al.  Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy , 2006, Annals of Internal Medicine.

[48]  P. Arnstein Managing Chronic Pain with Opioids: A Call for Change A White Paper by the Nurse Practitioner Healthcare Foundation , 2010 .

[49]  H. Heit,et al.  Urine drug testing in pain medicine. , 2004, Journal of pain and symptom management.

[50]  Sergio Rajsbaum,et al.  Introduction , 2007, SIGA.

[51]  D. Segal Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) , 2010 .

[52]  L. Webster,et al.  Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. , 2005, Pain medicine.

[53]  C. F. Iocolano Perioperative pain management in the chemically dependent patient. , 2000, Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses.

[54]  B. Ferrell Acute and Chronic Pain , 2003 .

[55]  J. Cain,et al.  Ethics and pain management: respecting patient wishes. , 1994, Journal of pain and symptom management.

[56]  H. Heit,et al.  Pain and Addiction: Managing Risk Through Comprehensive Care , 2008, Journal of addictive diseases.

[57]  P. Shekelle,et al.  The addiction behaviors checklist: validation of a new clinician-based measure of inappropriate opioid use in chronic pain. , 2006, Journal of pain and symptom management.

[58]  P. Arnstein Is my patient drug-seeking or in need of pain relief? , 2010, Nursing.

[59]  S. Passik,et al.  Chronic Pain Management with Opioids in Patients with Past or Current Substance Abuse Problems , 2003 .

[60]  S. Ross,et al.  The Neurobiology of Addictive Disorders , 2009, Clinical neuropharmacology.

[61]  R. Jamison Avoiding Opioid Abuse While Managing Pain: A Guide for Practitioners , 2008 .

[62]  W. Ling,et al.  The Clinical Opiate Withdrawal Scale (COWS) , 2003, Journal of psychoactive drugs.

[63]  P. Compton Treating Chronic Pain with Prescription Opioids in the Substance Abuser: Relapse Prevention and Management , 2011 .

[64]  B. Ferrell,et al.  On the meaning of "drug seeking". , 2005, Pain management nursing : official journal of the American Society of Pain Management Nurses.

[65]  R L Brown,et al.  Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. , 1995, Wisconsin medical journal.

[66]  G. Treisman,et al.  A behaviorist perspective. , 2011, Advances in psychosomatic medicine.

[67]  K. Miotto,et al.  Screening for addiction in patients with chronic pain and "problematic" substance use: evaluation of a pilot assessment tool. , 1998, Journal of pain and symptom management.

[68]  W. Compton,et al.  Projecting drug use among aging baby boomers in 2020. , 2006, Annals of epidemiology.

[69]  S. Sorajjakool,et al.  Chronic Pain, Meaning, and Spirituality: A Qualitative Study of the Healing Process in Relation to the Role of Meaning and Spirituality , 2006, The journal of pastoral care & counseling : JPCC.

[70]  William A. Frese,et al.  Opioids: nonmedical use and abuse in older children. , 2011, Pediatrics in review.

[71]  W. Gaylin A PATIENT'S BILL OF RIGHTS , 1973 .

[72]  H A Skinner The drug abuse screening test. , 1982, Addictive behaviors.

[73]  J. Streltzer Chronic Pain and Addiction , 1994 .

[74]  L. Kirisci,et al.  Validity of the Drug Use Screening Inventory for Predicting DSM-III-R Substance Use Disorder , 2001 .

[75]  P. Compton The role of urine toxicology in chronic opioid analgesic therapy. , 2007, Pain management nursing : official journal of the American Society of Pain Management Nurses.