As the incidences of both cancer and substance use disorders (SUDs) continue to pose significant challenges to healthcare systems globally, the interdisciplinary approach to managing cancer-related pain in patients with SUDs has gained substantial attention. A recent study published in the peer-reviewed journal “Seminars in Oncology Nursing,” authored by Tonya Edwards, Toya Foster, and Jeannine M. Brant, has shed considerable light on this matter. The study provides vital insights into the assessment and management of pain in this unique patient population.
The article, sourced from diverse materials, including peer-reviewed articles, book chapters, and internet sources, emphasizes the fundamental principle that patients should be routinely assessed for SUDs. It advocates for a stratification of pain management according to patient risk, underscoring the importance of adopting an interdisciplinary approach that sees oncology nurses playing a pivotal role. This piece seeks to elaborate on the article’s conclusions, explain the complexities involved in managing such patients, and reflect on the guidelines for healthcare providers.
Pain Management in the Context of Substance Use Disorders
Cancer pain is a multifaceted issue that affects the quality of life and can impede treatment. When coupled with SUDs, pain management becomes even more complex due to the risk of relapse or misuse of prescribed analgesics, particularly opioids. The risk of aberrant behaviors, defined as actions that deviate from medically accepted use of medications, further complicates the scenario.
Strategies for Assessing and Monitoring Patients
Integrating substance abuse assessments into routine cancer care is paramount for identifying patients with SUDs or those at risk of developing them. Standardized screening tools and urine drug tests are among the assessment approaches endorsed to monitor patients effectively. Moreover, fostering honest patient-provider communication is crucial for tailoring pain management strategies that account for the nuances of each patient’s history with substance use.
An Interdisciplinary Approach
An interdisciplinary team is essential for successfully managing pain in patients with SUDs. This approach calls for the collective expertise of oncologists, palliative care specialists, addiction professionals, mental health experts, and oncology nurses, among others. The formation of a Compassionate high alert team (CHAT), as indicated in the research, is one such approach that provides a framework for collective decision-making and interventions.
Pain Management Interventions
Pain management should be personalized and may include non-opioid analgesics, opioid therapy under strict monitoring, and adjuvant therapies like cognitive-behavioral therapy. The management plan should also incorporate strategies to mitigate the risk of diversion and misuse, including the use of pain contracts and frequent reassessments.
Best Practice Recommendations
Healthcare providers must remain vigilant for signs of aberrant drug-taking behaviors while providing compassionate care. Balancing effective pain management with minimizing the potential for misuse requires constant reevaluation and adjustment of therapeutic regimens. Providers must also be prepared to address psychological and social issues that may arise in patients with a history of SUDs.
Ethical Considerations and Patient Rights
Ethical dilemmas often surface when managing pain in patients with SUDs. Providers must navigate the patient’s right to pain management against the potential risks associated with opioid prescribing. Upholding ethical standards involves avoiding prejudice and providing equitable care, ensuring patients with SUDs are not unjustly denied appropriate pain relief.
Implications for Oncology Nurses
Oncology nurses are fundamental in the assessment, monitoring, and management of cancer pain in patients with SUDs. Education and training specific to SUDs are crucial for oncology nurses to carry out these roles effectively. In addition, they must remain knowledgeable about local regulations and guidelines related to prescribing controlled substances.
The Role of Policy and Guidelines
Policies and clinical guidelines must provide clear directives for managing cancer pain in the context of SUDs. These should include guidance on prescribing practices, risk stratification, and the use of alternative pain management therapies.
Limitations and Future Research
The article acknowledges the paucity of research specifically addressing the management of cancer pain in patients with a history of SUDs. Further studies are warranted to refine assessment tools, determine the most effective pain management strategies, and explore the broader societal impacts of SUDs on cancer care.
Conclusion
Managing cancer pain in patients with SUDs presents unique challenges that call for meticulous assessment and a deeply collaborative interdisciplinary approach. The insights provided by the studied article highlight the complexities faced by healthcare providers and offer guidance in formulating patient-centric pain management strategies.
References
1. Edwards, T., Foster, T., & Brant, J. M. (2020). Managing Cancer Pain in Patients with Opioid and Substance Use Disorders. Seminars in Oncology Nursing, 35(3), 279-283. https://doi.org/10.1016/j.soncn.2019.04.009
2. American Society of Clinical Oncology. (2016). Management of Chronic Pain in Survivors of Adult Cancers: ASCO Clinical Practice Guideline Summary. Journal of Oncology Practice, 12(9), 757-762. https://doi.org/10.1200/JOP.2016.015743
3. Starrels, J. L., & Becker, W. C. (2017). Systematic Review: Treatment Agreements and Urine Drug Testing to Reduce Opioid Misuse in Patients with Chronic Pain. Annals of Internal Medicine, 152(11), 712-720. https://doi.org/10.7326/0003-4819-152-11-201006010-00004
4. Paice, J. A., Portenoy, R., Lacchetti, C., Campbell, T., Cheville, A., Citron, M., … Bruera, E. (2016). Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. Journal of Clinical Oncology, 34(27), 3325-3345. https://doi.org/10.1200/JCO.2016.68.5206
5. Passik, S. D., & Kirsh, K. L. (2004). Opioid Therapy in Patients with a History of Substance Abuse. CNS Drugs, 18(1), 13-25. https://doi.org/10.2165/00023210-200418010-00002
Keywords
1. Cancer pain management
2. Substance use disorders
3. Opioid therapy guidelines
4. Interdisciplinary approach in oncology
5. Pain assessment tools