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Patient Safety & Pain Management

Patient Safety & Pain Management

According to current estimates, more than 76 million people in the United States suffer from chronic or acute pain. Opioid analgesics are a widely accepted treatment for severe acute pain, but use of these medications to treat some types of chronic pain remains controversial. “The challenge with chronic pain is that it can occur in the context of numerous diseases and syndromes,” explains Daniel J. Castillo, MD. “The problems associated with opioid use—including underprescribing, overprescribing, tolerance, dependence, and drug abuse—highlight the importance of safe opioid use in hospitals and other healthcare settings.” Research has shown that pain is a leading cause of disability and can have deleterious effects on ability to work, functional status, and other quality-of-life domains. Unalleviated pain can impair the immune response, impede wound healing, affect gastrointestinal and pulmonary functions, suppress appetite, and delay ambulation after surgery. The number of opioid prescriptions for pain management has increased substantially over the last 20 years, in part due to a growing consensus that opioids are appropriate for some patients with pain. At the same time, there has been an increase in prescription opioid misuse and associated mortality, affecting adolescents and adults of all ages.   A Sentinel Event Alert issued by the Joint Commission in 2012 provides a number of actions that can be taken by hospitals to avoid the unintended consequences of opioid use among hospital inpatients (Table 1). It also provides clinicians with strategies for avoiding accidental opioid overuse (Table 2). “Opioids can be helpful for some patients, but it’s important that clinicians recognize and understand that there are risks to consider,” Dr. Castillo says. Joint...
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