The critical role of nursing in successful opioid withdrawal in chronic non-cancer pain

Abstract

Maintenance opioid use in chronic non-cancer pain treatment is widespread and controversial. A recent article in Mayo Clinic Proceedings examined this issue and concluded that, “patients who have symptomatically severe and functionally disabling pain, while receiving maintenance opioid therapy, can obtain significant benefit from rehabilitative treatment that incorporates opioid withdrawal.” 1Rome, J.D. et al., Mayo Clinic Proceedings, 2004). The purpose of the present study is to describe the process of opioid withdrawal undertaken in a multidisciplinary pain rehabilitation program with the emphasis on the specific roles nurses play in the success of this intervention. A multidisciplinary approach is utilized, with two levels of nursing care, aimed at improving patient’s emotional and physical functioning and quality of life. A key component in this pain rehabilitation effort is a conservative philosophy of analgesic use for chronic non-cancer pain. Opioid medications are discontinued, while self-management strategies are implemented including exercise, relaxation skills, moderation and healthy lifestyle changes. The masters prepared Clinical Nurse Specialist (CNS) and baccalaureate prepared RN, supervised by the MD, assist patients with medication changes using a systematic, gradual method of reducing and discontinuing opioids for chronic pain management. The CNS structures opioid tapers utilizing prescriptive privileges, advanced assessment, and education/interventions focusing on chemical health and wellness. The RN monitors daily opioid tapers including monitoring patient self-administration of medications, assessing withdrawal symptoms, and reinforcing alternative coping techniques for pain management. Measures of pain severity, interference due to pain, activity level, perceived life control, affective distress, depression and catastrophizing have been used to compare opioid and nonopioid groups within this pain rehabilitation center. This paper will illustrate specific interventions utilized by pain rehabilitation nurses that directly contribute to successful opioid withdrawal and improvement in emotional and physical functioning for patients with chronic pain. 1Rome, J.D. et al., Mayo Clinic Proceedings, 2004). Maintenance opioid use in chronic non-cancer pain treatment is widespread and controversial. A recent article in Mayo Clinic Proceedings examined this issue and concluded that, “patients who have symptomatically severe and functionally disabling pain, while receiving maintenance opioid therapy, can obtain significant benefit from rehabilitative treatment that incorporates opioid withdrawal.” 1Rome, J.D. et al., Mayo Clinic Proceedings, 2004). The purpose of the present study is to describe the process of opioid withdrawal undertaken in a multidisciplinary pain rehabilitation program with the emphasis on the specific roles nurses play in the success of this intervention. A multidisciplinary approach is utilized, with two levels of nursing care, aimed at improving patient’s emotional and physical functioning and quality of life. A key component in this pain rehabilitation effort is a conservative philosophy of analgesic use for chronic non-cancer pain. Opioid medications are discontinued, while self-management strategies are implemented including exercise, relaxation skills, moderation and healthy lifestyle changes. The masters prepared Clinical Nurse Specialist (CNS) and baccalaureate prepared RN, supervised by the MD, assist patients with medication changes using a systematic, gradual method of reducing and discontinuing opioids for chronic pain management. The CNS structures opioid tapers utilizing prescriptive privileges, advanced assessment, and education/interventions focusing on chemical health and wellness. The RN monitors daily opioid tapers including monitoring patient self-administration of medications, assessing withdrawal symptoms, and reinforcing alternative coping techniques for pain management. Measures of pain severity, interference due to pain, activity level, perceived life control, affective distress, depression and catastrophizing have been used to compare opioid and nonopioid groups within this pain rehabilitation center. This paper will illustrate specific interventions utilized by pain rehabilitation nurses that directly contribute to successful opioid withdrawal and improvement in emotional and physical functioning for patients with chronic pain. 1Rome, J.D. et al., Mayo Clinic Proceedings, 2004).