Educating Patients About Pain Medications – Practical Pain Management – Last updated on: October 28, 2014
Former US Surgeon General C. Everett Koop, MD, famously said, “Drugs don’t work in patients who don’t take them.” Medications also don’t work in, and can even harm, patients who don’t take them as intended.
In a meta-analysis of research studying medication adherence and treatment outcomes, nonadherence accounted for 33% of hospital admissions for adverse drug events.
Nonadherence to an analgesic regimen could result in untreated pain or adverse events, which can cause decreased productivity and increased employee absences. Poor provider– patient communication has been identified as a barrier to adherence.
In 1999, the Institute of Medicine urged clinicians to counsel patients on prescribed medications.
Every patient has a story, and so does every drug.
After you know the patient’s pain story and decide a medication should be part of their treatment plan, it’s your job to properly introduce the patient to the medication by sharing the drug’s story with the patient.
This includes nonprescription and prescription analgesics, non-opioids and opioids, and topical and systemic analgesics.
An easy way to cover all of the important pieces of information a patient needs is by remembering the elements of any story: Who, What, Why, When, How, and Where (Figure 1).
First and foremost, a patient needs to know “who,” which, for a medication, is the brand and/or generic name. If the patient is prescribed or dispensed a generic version of their medication, often they will be more familiar with the drug’s brand name due to direct-to-consumer advertising
In the case of acetaminophen, it is important to explain that “acetaminophen,” “APAP,” “paracetamol,” and “Tylenol” are all the same medication so patients know to avoid an overdose situation.
The “what” in a medication’s story includes the dosage form and strength prescribed, as well as what the patient can expect from the drug in terms of therapeutic and adverse effects
For an opioid prescription, the patient needs to know they may experience drowsiness and/ or nausea initially, and constipation for the duration of therapy.
It would be prudent to explain how to prevent constipation, as well as explain about any medications they will be taking to manage this adverse effect.
Therapeutic effects should be explained in terms of reduction in pain scores, as recorded in pain diaries, and improvement in daily functioning. These will vary based on the patient’s story.
Therapeutic goals go hand in hand with “why” you are giving the patient this particular drug.
Of course, a prescription label will contain your directions for when and how to take the medication. However, going over this information with the patient will reinforce it and often reveal interacting foods or drugs the patient might be taking.
In addition, educating the patient on when and how can uncover misunderstandings the patient might have.
A friend of mine was prescribed medication for high blood pressure without being told anything about it except what it was for: lowering blood pressure.
Later, she claimed it didn’t work at all because even after taking it, her blood pressure was still high hours later.
No one told her the medication has no immediate effect and must be taken continuously to bring about changes.
The patient also needs to know when to follow up with you to monitor the efficacy and safety of their regimen.
Part of “how” includes how to take or use the medication including swallowing a tablet or capsule whole versus allowed dosage formulation manipulation (crushing, chewing, etc), application of a transdermal patch, or application of a topical analgesic
Another good way to remember all the pieces of information a patient needs to know about their medications is to use the guide provided by the National Council on Patient Information and Education (Table 2). The table features “Questions to Ask About Prescription Medications,”
Fears, Myths, and Misconceptions
While providing factual information about analgesics as described above is critically important in achieving therapeutic success, it is equally important to explore patients’ health care beliefs and fears or thoughts about analgesics.
Another important factor is how the prescriber introduces the use of analgesics to the patient. Reid et al reported that cancer patients found opioid therapy to be a more acceptable option to manage their pain when health care providers displayed confidence in opioid therapy, and adverse effects were well managed
More than a decade ago, Ward et al explored patients’ concerns about reporting pain and using pain medications, referring to these concerns as “patient-related barriers to pain management.”
After reviewing the literature and conducting a series of studies, the authors summarized into eight categories patients’ concerns that prevent accurate reporting of pain and reluctance to take medications :
- Fear of addiction
- Concern about drug tolerance
- Belief that side effects from analgesics are even more bothersome than pain
- Fatalism about the possibility of achieving good pain control
- Belief that “good” patients do not complain about pain
- Fear of distracting a physician from treating the disease
- Belief that pain signifies disease progression
- Fear of injections
Clearly, patients often have strong opinions about analgesic therapy, and opioids in particular.
This was last updated only 2 years ago in 2014, and by now, patients’ concerns about not wanting to take opioids are being encouraged.
It seems reasonable for health care practitioners to acknowledge the elephant in the room and ask patients, “Do you have any fears or concerns about using medications to treat your pain?”
Patients are often relieved to be asked this question and are happy to share their fears once you have legitimized their concerns. Lechnry and Lechnry published a patient handout designed to confront likely patient concerns about the questions pain practitioners may pose regarding previous drug use and misuse. The authors stated that sharing this handout with patients dramatically reduced complaints and misunderstandings from patients in their practice.
Acute and chronic pain are pervasive, and medications play a large role in the management of pain.
Practitioners need to be able to interact with patients
- to explore those patients’ beliefs and fears about analgesic therapy,
- to project confidence in the practitioners’ recommendations and monitoring plans, and
- educate patients on how to use the recommended medications safely to maximize therapeutic response.