As our population continues to age, more and more Pharmacists and Pharmacy Technicians are becoming involved in the treatment of acute and chronic pain. It is estimated by the Centers for Disease Control (CDC) that approximately 11% of adults suffer from some degree of daily pain and that currently millions of Americans every year are treated for their chronic pain with opioid and other pain medications.
Acute and chronic pain not only cripples patients but also leads to a total loss to the US economy due to increases in healthcare costs and losses in productivity in the range of from $550 million to $635 billion (in 2010 dollars). Read on to learn more about the essentials of pain management and how this will affect you in your role as a Pharmacy Technician.
The Role of the Pharmacy Technician in Pain Medication Reconciliation
Medication reconciliation refers to the process on admission to a hospital or outpatient facility whereby a Pharmacist or Pharmacy Technician interviews a patient and obtains a complete and accurate pain medication history that is then documented in the patient’s electronic medical record.
This information is then compared with any new pain medications ordered by the acute care provider in the hospital (the hospitalist) and is also coordinated with daily pain medications prescribed by the patient’s community physicians.
The supervising Pharmacist and the Pharmacy Technician can then review important lab results which could affect which pain medications should be ordered (such as a complete blood count (CBC), a comprehensive metabolic panel (SMA-20) and imaging and test results necessary to complete their diagnostic evaluation).
The Pharmacist, with the assistance of the Pharmacy Technician, can then apply the 10 Universal Precautions in Pain Management and can make pain medicine recommendations to the treating attending Physicians.
The 10 Universal Precautions in Pain Management
Despite the fact whether the patient’s pain is acute or chronic, the 10 Universal Precautions in pain management can be applied by Pharmacists and Pharmacy Technicians who are part of the treating medical team in order to ensure successful treatment of the patient’s pain.
The 10 Universal Precautions in Pain Management include:
- Making a diagnosis as well a differential diagnosis
- Conducting psychological assessments screening for addiction potential
- Obtaining informed consent
- Utilizing a treatment agreement
- Conducting pre and post-intervention assessments of pain levels and level of functioning
- Conducting an appropriate trial treatment with opioid with and without adjuvants
Understanding the Difference Between Acute and Chronic Pain and their Treatments
By definition, acute pain is pain resulting from an accident or injury or other conditions and lasts less than 6 months in duration.
Ineffective treatment of acute pain can lead to a progression from acute pain to chronic pain requiring an increased dosage of opioid in order to achieve a pain-free state.
According to the Centers for Disease Control (CDC), the majority of patients with acute pain should be treated with an opioid for no more than 3 days and rarely for more than 7 days.
Chronic pain typically lasts more than 6 months in duration
The 4 A’s of Pain
Another important aspect of effective pain treatment is regularly assessing the “4 A’s of Pain”. This includes assessing:
This refers to the effectiveness of pain control (analgesia) and involves a frank discussion with the patient concerning the level of his/her pain control which helps to create realistic goals for pain management.
Trials of different types of opioid and non-opioids and resultant pain levels can help determine the best-individualized pain management program.
This category involves the patient’s ability to perform both activities of daily living and other functional activities.
This allows for individualized pain treatment plans to maximize the patient’s ability to function daily, to work, to exercise and to engage in hobbies and social gatherings.
3. Adverse Effects
This involves determining side effects from the different pain medications which have been prescribed.
Prescribers must always be aware of the fact that opioids have numerous and potentially harmful side effects such as sedation, respiratory depression and constipation.
4. Aberrant Drug-related Behaviors.
This usually involves periodic urine drug screening to determine if patients are also using illegal street drugs.
It also allows for a determination to see if patients are “doctor shopping.”
The Pain Assessment PQRSTU Method is another diagnostic tool which the Pharmacist and the Pharmacy Technician can use when evaluating patients for adequate pain control.
This method is based on the following:
- P – Evaluating what causes the pain, what worsens the pain and what makes the pain better
- Q – Having the patient describe the pain as dull, sharp, radiating etc.
- R – Having the patient describe the region of the body affected
- S – Having the patient describe the severity of the pain on a scale of 1-10
- T – Having the patient describe the timing and severity of the pain
- U – Having the patient describe how the pain affects their normal activities
As the population continues to age, more and more patients are being treated with pain medications. Pharmacists and Pharmacy Technicians continue to play an increasing role in medication reconciliation and ensuring the safe and proper use of opioid and other pain medications. Evaluating patient’s initial pain levels and assessing the adequate and safe treatment of their pain remains the mainstay of the Pharmacy Technician’s role in pain management.