Opioids for Chronic Pain

VA Healthcare Network Upstate New York follows national and local Department of Veterans Affairs (VA) practice guidelines on pain management. All of our health care staff is responsible for providing good pain management to our patients. Our goals are to: Evaluate and treat pain problems effectively, in line with current medical standards and Protect against abuse or unsafe use of pain medications Overview VA Healthcare Network Upstate New York is committed to safe and effective pain treatment Treatment of chronic pain is based on a full evaluation and a treatment plan monitored by your medical provider Opioids are used only when they are right for your pain problem You must agree to important rules in order to use opioids for your pain problem If opioids are not right for your chronic pain problem, we will offer other ways to manage your chronic pain Assessing Your Pain Problem Each time we check your vital signs (heart rate, blood pressure, etc.), we will ask you for a pain rating on a scale from 0 (no pain) to 10 (pain as bad as it could be). If you tell us you would like medical help with a pain problem, we will fully evaluate your problem. A pain assessment typically includes: The location of your pain The intensity of your pain at its worst and its least How your pain started and how long it has lasted How your pain feels (sharp, dull, stabbing, burning, etc.) Whether your pain is constant, on-and-off, or follows some other pattern What things make your pain better and what things make it worse How your pain interferes with your life Physical exam and diagnostic tests Acute vs. Chronic Pain Acute pain is an alarm system that helps to keep you from further injuring yourself. In contrast, chronic pain is a false alarm or nuisance pain that continues after your body has healed as best it can. When you have chronic pain, it can be hard to know whether to ignore symptoms or to treat them as new alarms. The best approaches to chronic pain involve trying to stay active and not letting the pain run your life. Pain Treatment Pain can result from injury to muscles, joints, bones, internal organs, skin, and to nerves themselves. The first step in treating a pain problem is assessing its exact cause. Treatment is then designed to address the source of the pain, including: Medication (to reduce inflammation, soothe nerve fibers, relax muscles, turn down pain signals) Physical therapies Stress management and behavioral treatments Anesthetic treatments (nerve blocks, joint injections, epidural injections) The purpose of any pain treatment is to improve your quality of life and ability to function. If a treatment does not improve your life or is harmful in any way, it will be stopped. Opioid Pain Medications Opioids are chemicals made by the opium poppy or man-made to be similar. Opioids are helpful for some but not all pain problems. They trigger your body’s own system for decreasing pain. Some typical opioids include: Opioids are a type of prescription pain medication. They can help relieve pain but also carry important risks. Codeine Fentanyl (Duragesic) Hydrocodone (in Lortab) Hydromorphone (Dilaudid) Methadone Morphine Oxycodone (in Percocet) Risks and Side Effects Opioids are associated with certain risks, including these side effects: Sedation Constipation Lowered male hormone levels Suppressed breathing (at high doses) Opioids can be addicting for some people. The risk of becoming addicted to opioids is greater for people with prior drug abuse problems and some psychiatric problems. Some conditions that make the use of opioids dangerous: Severe memory problems Alcohol abuse Illegal drug use Liver damage Kidney damage Seizure disorder Opioids will only be prescribed for certain chronic pain problems, and only after trying other treatments first. Before prescribing opioids, our VA health care providers are required to: Fully evaluate the cause of your pain Try other therapies shown to work for your pain problem Assess medical risk factors for opioid use Assess psychological risk factors for opioid use Opioids - Part of a Complete Treatment Plan Opioids are only used for chronic pain as part of a complete treatment plan. You must have a stable relationship with your health care provider. As part of your treatment plan, you may be asked to: Sign a written treatment agreement Submit blood or urine samples for drug testing Be evaluated by behavioral health care providers You must take opioids exactly as prescribed and report side effects to your provider. Only the medical provider or clinic managing your pain treatment will renew your opioid prescription. If you go to the Emergency Department with a pain emergency requiring opioids, you will only be given enough to last until the next business day. You must then see your primary care provider to be re-evaluated. You will be monitored regularly, and your provider may stop your opioids if they are not being used safely and effectively. If opioids are not right for your chronic pain problem, we will offer other ways to manage your chronic pain. Suspected Abuse, Sale or Distribution of Opioids If you do not use opioids as instructed, you may be evaluated for drug abuse. Your medication will be strictly monitored. Lost or stolen opioids typically will not be refilled early. We may ask to speak with family members, other health care providers or pharmacies. We take selling or giving away medications very seriously. In some circumstances, we may contact police when a patient is known to be distributing prescribed drugs to others. References The following are the national and local VA practice guidelines on pain management that we follow: Department of Veterans Affairs/Department of Defense (2002) VA/DoD Clinical Practice Guideline for Postoperative Pain Management. Department of Veterans Affairs / Department of Defense (2003). VA/DoD Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain. VHA Directive 2003-921, Pain Management. VISN 2 Memorandum: 10N2-56-07, Network 2 Pain Management Policy. For More Information Contact: Karl Frohm, Ph.D. at (716) 862-8594

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