Managing Chronic Pain: Practical Considerations to Improve Treatment Outcomes - Episode 4
Turning to a frontline topic in pain management, panelist Christopher Gharibo, MD, explains how informed consent offers physicians the opportunity to educate patients about opioid treatment on a recurrent basis.
According to Gharibo, informed consent in the form of treatment agreement involves setting short- and long-term goals for not only opioid compliance, but also pain score and function improvements with non-opioid therapies. If a patient does not meet the function-focused endpoints of the treatment agreement while taking opioids, then it is time for the physician to launch an exit strategy, Gharibo says.
However, moderator Jeffrey A. Gudin, MD, notes primary care physicians often make a “huge mistake” with opioid exit strategies, given “it’s so easy to start patients on opioids and it’s easy to get them tolerant to escalating doses, but it’s almost impossible to get them off opioids.”
In addition to exit strategies, Joseph Pergolizzi, MD, believes both physicians and their chronic pain patients do not pay enough attention to the social responsibility of safeguarding opioid medications.
“It’s important, I think, to not in this sense interrogate your patient, but to definitely inquire about what the living situation is at home. Do they have a bunch of teenagers that are in and out of the house? Are multiple families living there?” Pergolizzi explains. “If we look at diversion — implicit or explicit — we know that medications are getting out into the market, so these type of social responsibilities and the call for that on behalf of the patient is extremely important.”