Managing Pain in the Crosshairs of an Opioid Crisis and HCAHPS-related Demands

Each clinician should involve their patient in a pain plan that best meets the patient’s needs using multimodal methods.
Each clinician should involve their patient in a pain plan that best meets the patient’s needs using multimodal methods.

In health care, pain is an issue about which clinicians and patients are often left struggling to communicate. Clinicians can often feel frustrated by pain's subjective nature. In the current climate of an opioid crisis and with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) focus on patient satisfaction, the discussion has arisen how best to meet what appears to be on the surface competing priorities. One of the 9 topics currently covered on the HCAHPS is pain management; however, changes are expected in 2018.

The pain domain will remain on the survey but will no longer be a part of the value-based purchasing metric. Concerns had been previously raised regarding whether the increase in opioid use had coincided with pressure to ensure HCAHPS satisfaction.1

Opioid overdoses and prescribing practices have become a priority for the US Department of Health and Human Services (HHS); more than 165,000 people have died from prescription opioid overdoses since 1999.2 There is an ethical obligation to find the best way to help patients; however, we need to be clear about the data.3 The data on the opioid crisis is reflective of chronic pain not related to cancer and should not be exclusively interpreted for patients with cancer.

Pain in patients with cancer needs to be carefully evaluated and all potential pathways explored, especially for patients with advanced cancers and those who are experiencing breakthrough pain. Mismanagement may lead to increased episodes of discomfort and poor quality of life.

The same principles used in noncancer pain should be followed in managing cancer-related pain. We should discuss addiction and tolerance with our cancer patients and realize that risks do exist and discuss them.4  

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