INTRODUCTION TO CHRONIC, PERSISTENT PAIN
Health care providers are seeing larger numbers of patients with chronic, persistent pain than ever before. The causes of the pain are varied, but they all still have the potential for disability, decreased functionality, and decreased quality of life. The number of patients with chronic pain has increased nationally to the point that many health care providers consider chronic pain to be a major national public health problem (Trescot et al., 2008).
What we do know about most nurse practitioners is that they feel that their basic nurse practitioner education did not prepare them to treat patients with chronic pain. In a survey of 400 nurse practitioners, 62% of the respondents felt they had been prepared to assess patients with chronic pain, whereas 38% indicated they did not feel prepared. When treatment of chronic pain was queried, only 44% of the respondents felt they had been prepared to treat chronic pain, whereas 56% felt they had not been prepared (D'Arcy, 2009a). When asked to choose which of the concerns were most important when prescribing opioids for chronic pain, the same survey group indicated the following concerns from most important to least important:
2. Fear of regulatory oversight
4. Not knowledgeable enough about medications
5. Don't want to be seen as different from other prescribes (D'Arcy, 2009a)
These fears of regulatory oversight and legal consequences are also colored by fears of addicting patients to opioids when long-term opioid therapy is used to treat chronic pain. When the survey respondents were asked how comfortable they were with prescribing opioids for 12 months or more when the patient had chronic pain, only one third of the respondents felt they had a good comfort level with the practice (D'Arcy, 2009a). These findings are consistent with those of other surveys on pain management knowledge and attitudes that have been used for several years.
Despite national efforts to teach patients and prescribers about chronic pain by declaring 2000 to 2010 as the Decade of Pain Control and Research, we have made little headway. Moreover, pain is still undertreated. Although only approximately 5% of patients in primary care develop a substance abuse disorder/addiction with long-term opioid use, including all of those patients who have been exposed to opioids and those patients who had never used opioids, these outdated perceptions still persist (Fishbain, Cole, Lewis, Rosomoff, & Rosomoff, 2008). Although there are other studies that categorize substance abuse disorders and opioid misuse differently and have different statistical findings, the endpoint is that true addiction is not as common as prescribers perceive it to be, and most patients with chronic pain can tolerate long-term opioid therapy successfully.
Who are these patients with chronic pain and what are their complaints? Because chronic, persistent pain is now considered a chronic illness, how can these patients cope with the long-term nature of the condition? What types of treatments are available? What is the best way to assess pain in these patients? The following chapters of this book will answer these questions and provide evidence-based information on many aspects of chronic, persistent pain.
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