Brighton Center for Recovery not only treats patients suffering from drug and alcohol addiction, but we also help educate individuals interested in the addiction recovery field. We have designed special training programs and fellowships for medical students and social work students. Not only Brighton Center for Recovery, but addiction hospitals and clinics all over the country need passionate and effective addiction recovery doctors, nurses and staff, which is why we place a high value on the continuing education of students in this field.
Suggested Guidelines for Management of Acute Pain in Recovering Patients
Management of acute pain (e.g. post-operative, post-trauma) should be a concern for both the recovering patient and those providing their care. Precipitating a relapse is a major issue for the recovering patient and is always possible if pain is not properly managed. There is very little how-to information in the organized medical literature. The following are some how-to suggestions based on available literature, discussions with physicians and patients and the experiences of a number of physicians caring for recovering patients. These should help facilitate adequate, appropriate, and safe treatment of acute pain in recovering patients.
- Recovering patients have a lower pain threshold than non-recovering patients.
- Recovering patients have a higher tolerance for narcotics than non-recovering patients.
- Recovering patients are traditionally under treated for acute pain.
- Recovering patients receiving narcotics may attempt to manipulate the situation to obtain more medication for a longer time than necessary.
- A recovering patient is very concerned about relapsing (may or may not acknowledge this).
- Dosage has very little to do with precipitating relapse.
- Know patient’s previous addiction history, e.g. drug(s) of choice, when and how got into recovery, quality of recovery, relapses —when/how.
- Avoid prescribing drug(s) of choice
- Use adequate doses to control pain, which may be 25-30% more than dose for non-recovering patient of some age, sex, weight, type of operation.
- Use non-narcotics and non-medication techniques when possible.
- Physician needs to be willing to address patient’s concerns. Involving the patient in the process will assure the patient and/or family that relapse is not inevitable or probable if situation is properly addressed.
- Discuss what options are available if active relapse should occur.
- Actively utilize existing support systems (e.g. AA/NA sponsor).
- Real physiologic withdrawal (not psychological) may occur even after short (24 hrs.) use of narcotics due to cellular memory.
- Meet with the patient and any others involved with the patient.
- Establish (as close as possible) dosage, frequency of analgesic(s) to be used.
- Establish duration of each dosage and frequency schedule (i.e. establish an appropriate taper schedule) based on the physician’s experience and the patient’s expected reasonable needs.
- Involve anesthesiologist in planning pre- and post-operative care (use a recovering one if possible).
- Emphasize NO PRN medication except in unusual, unexpected, or exceptional circumstance (e.g. dressing change in burn injury patient.)
- If possible, do not discharge a patient who is taking any mood altering medication (s).
- Many liquid medications contain alcohol unless labeled or ordered otherwise.
- Plan ahead-most operative procedures are elective (even open heart procedures may be elective).
- Use local anesthesia when possible (e.g. MARCAN infiltrated into surgical wound site to decrease P/O pain.).
- Increase 12-step meetings pre- and post-operation.
- Use PCA only with the greatest of reservations, if at all.
- Use regional anesthesia whenever possible.
- Outpatient Prescription Pain Medications: only prescribe the exact number needed (e.g. QID x 3 days — dispense only 12). No refills.
- For more information contact The American Chronic Pain Association at ACPA