Delivering Quality Patient Experience without Opioids?

Reconciling the Opioid Crisis with Delivering Quality Patient ExperienceSara Health – Apr 2018

The nationwide opioid crisis has called into question the use of narcotic pain relieving drugs. But as clinicians work to prevent addiction, they face a quality patient experience quandary.

It seems that doctors are now expected to give equal weight to patient pain relief, opioid restrictions, and “customer satisfaction” reviews. The skills, experience, and professionalism of doctors have been devalued to little more than gaming “customer satisfaction” surveys.

Doctors are now just providers of standardized transactional “healthcare services” to customers, who are expected to shop around for the best value, the highest patient-satisfaction scores, and preferably both.  

Like so many other social services, healthcare has been taken over by profit-seeking corporations.

Now it becomes the “customer’s” responsibility to spend the time and energy to do research to find out which facility and/or doctor would serve them best. But it’s almost impossible to find honest information. 

Medical facilities are heavily promoted using deceitful wording and the latest slick persuasion techniques to create compelling ads for their products and services, making it very hard to find honest useful information. All of healthcare is now fair game for profit-seeking.

Now that the corporatization of healthcare is almost complete, we have to choose not just our doctor but also which facility, whose assistance, and what parts will be used for a procedure.

We are expected to verify that all these parts of different healthcare corporations are included in our insurance company’s “provider network”, or face astronomical bills. They call it “choice” but I call it “delegating work to the customer”.

When Americans get sick, they have to go shopping.

Opioids prescribed for legitimate pain management reasons are often a gateway to unintentional abuse, statistics show.

No, no, no, this is absolutely not true.

It may have seemed to be true in the earlier stages of our so-called opioid crisis but has been completely repudiated by the data for years now. 

But the opioid epidemic is a complex challenge that goes beyond reducing prescribing rates.

…especially when your target (overdose deaths) isn’t caused by or even associated with the variable you’re reducing (amount of opioids prescribed).

Pain management is essential to a positive patient experience, and providers are faced with competing priorities to alleviate patient pain while preventing potential addiction.

Adequate acute pain management is a critical aspect of the overall patient experience within the four walls of the hospital, especially among patients recovering from surgery.

Providers face an imperative to mediate patient pain following a complicated medical procedure. This is not only the humane thing to do, Dessilier said, but is also essential for making sure the patient walks away from the care encounter satisfied.

Eleven percent of adults experience chronic pain, which can quickly become quality of life issue. Pain impacts the patient experience throughout their daily routines, and may limit participation in work, school, or social activities.

I was surprised to find such a completely true statement in this article.
But if they understand how severe the impact of pain is, then why are they looking for ways to reduce our pain relief?

But patients who are on long-term opioid treatment plans run a higher risk of becoming dependent on an opioid, leading to addiction [?] to the drug or to heroin

This is the first time I’ve heard that dependency leads to addiction. Usually, people (even “experts”) just confuse the terms, but here they actually claim cause and effect.

There seems to be no concern for whether a fact presented in the article is actually true and verifiable or not.

Healthcare professionals are currently observing friction between priorities for

  • patient quality of life,
  • positive patient experiences, and
  • judicious opioid management.

No pain patient I know of has “friction” between quality-of-life and taking opioids regularly. We just have friction with the doctors that want to stop prescribing us opioids, the medications that have effectively reduced our pain for years and decades.

Our biological bodies become habituated and adjusted to the regular use of this medication, which makes us physically dependent on the medication. This means we experience some withdrawal symptoms when we deprive our body of the medication it has adjusted to.

The same effect is seen even with over-the-counter drugs, like anti-constipation medicine, sleep aids, and even caffeine.

Exploring non-opioid pain management solutions

Across the country, new prescribing guidelines are aiming to reduce the use of opioids. Reduced opioid use should lead to less drug abuse, policymakers have reasoned.

Reasoned? That cannot be because there is no “reason” to expect that restricting prescribed opioids will lessen the number of drug overdoses.

Nationally, the Centers for Disease Control (CDC) has advised providers to prescribe opioids only when necessary, to prescribe the lowest dosage necessary, and to regularly monitor patients for emerging drug dependency.

This assumes that almost all pain patients have been prescribed opioids when they are not necessary. That’s the only way to justify these global restrictions on prescribed opioids for patients.

The whole document is focused on stopping all long-term prescriptions of opioids eventually, not just bringing down the dosage.

Reconciling reduced use of opioids, patient satisfaction

This is the situation I’m interested in and I’m just glad it’s finally getting some mention.

Pain management needs to be a holistic experience. If a provider is treating the whole person, and not just their pain, opioids may be less necessary.

No, it is not. But accomplishing it will allow the rest of the patient’s existence to expand into better health.

Pain management is the starting point to restore the quality of life for a patient crippled by chronic pain.

Frisch tells his patients that the joint replacement may reduce their everyday pain and quality of life, eliminating the need for opioids.

I assume it’s just a typo and careless editing that led the author to say the joint replacement will “reduce their quality of life”.

“The most important thing is being candid with the patient and having an open discussion about their causes of pain, how it’s evolved over time, how their treatment has been managed and how that’s evolved over time,” Frisch explained.

But how can doctors have an “open discussion” when they have been drafted as drug warriors?

Chronic pain may not just be from one area. It’s oftentimes due to several different things. They might come in and have knee or hip pain, but that’s just one part of it.”

This seems very typical of what I hear in the pain patient community.

This means providers need to engage in more meaningful conversations about patient pain and the benefits and risks of long-term opioid use.

And then? Just because we don’t want to take opioids and doctors don’t want to prescribe them doesn’t mean we should not take them if they are effective for our pain when nothing else is.

I’ve found that once that discussion is over most patients don’t want to be on chronic pain medication,” Frisch noted.

“That’s not always the case because some have been on opioids for years and it’s become a part of a lifestyle. But once you break it down to this level, they begin to wonder what life will be like when they aren’t on pain medication.”

Many of us don’t have to “wonder” because we’ve experienced our pain without opioids… and that’s the reason we’re taking them.

“I try to educate patients on what their condition is and what are the options of treatment,” she advised.

Many of us have chronic pain precisely because our conditions are NOT treatable. Once we know that we cannot expect our painful condition to be cured or even ameliorated, we suffer from pain that serves no purpose.

Pain is meant to be our body’s most powerful and distressing alarm warning of harm to the body, superseding anything else going on to make us struggle for survival.

But if we have a chronic painful health condition (like EDS) we cannot avoid or change the condition that has set off that “alarm”, it becomes useless and even damaging when it persists for hours, days, and years. we should be allowed to turn it off, by using the wonderfully effective medications that have been developed exactly for that purpose.

“I usually try to give more than one option of treatment if appropriate; most of the time it’s appropriate. I truly believe in communicating with the patient, spending time listening to the patient, and educating the patient on what their condition is and what the options of treatment is.”

And when there are NO options for treatment…

Caring for patients when opioids are the best option

Each of these providers still sometimes uses opioids in some cases, even if they understand the risks in doing so. There isn’t necessarily anything wrong in that, De Pinto said, so long as prescribing is judicious.

Most medications have undesirable side effects, so prescribing any drugs should always be “judicious”.

“Over the course of the past 30 years, we have gone from a widespread, indiscriminate opioid prescription to a diminished prescription to opioid phobia,” De Pinto said

While healthcare professionals should not constantly turn to their prescription pad, the fundamental issue with the opioid epidemic is not the act of prescribing, De Pinto asserted. Instead, it’s with clinicians who prescribe opioids with insufficient patient education.

If this were the only problem, it could be easily fixed without taking pain relief away from millions of people.

“If we use all the tools that we have available these days – including prescription medication monitoring programs, urine drug screening tests, counting pills, and establishing a collaborative and trustworthy relationship with patients and family – we will be able to put an end to the opioid epidemic,” De Pinto asserted.

This is a perfect case of magical thinking. Opioid prescriptions and opioid overdoses are completely unrelated at this point.

No matter how many patients are prescribed opioids or tapered off of opioids, this will have no effect on the increasing numbers of people who are overdosing from illicit fentanyl out on the streets.

If they do prescribe a narcotic, providers and pharmacists need to be aware of the warning signs that the patient may be becoming addicted. Running out of pills early, losing medications, or saying they have been stolen, are some telltale behaviors for patients who are getting hooked on opioids.

Frisch looks at the patient’s prior treatment protocol to assess whether the pain should have been alleviated.

If medical care now operates according to only what “should work” we are in big trouble. Many of us have submitted to dozens of treatments that “should have worked” but didn’t.

Again, pain is a symptom of a larger medical condition. After he has treated that condition, Frisch pays careful attention to patients who are still asking for opioids.

Here, they assume that all painful conditions are treatable, even if they are genetic – this is absurd.

This happened to me when a doctor tried several therapies to alleviate what she assumed was causing my pain but none of them worked.

After that, she assumed I must be lying and didn’t want to prescribe me any more opioids for the pain that she no longer believed was there.

If we can alleviate the cause of their pain and still there is opioid consumption, that is a red flag. If I get a call from someone who has gotten an injection and they are in physical therapy and they ask for more pain narcotics, that is a red flag.”

Who gets to decide whether the pain was alleviated by whatever procedure they did?

Many chronic pain patients have had their doctors tell them that the treatment they suggested has “alleviated their pain”, even when it hasn’t. They just cannot believe that they were wrong.

Most doctors eventually reach a point where they no longer believe that you still have pain despite all the different things you’ve tried to alleviate it. Since we can’t prove our pain exists, we’re always doubted.

They key to confronting the opioid crisis is to understand that opioids do play a role in patient care.

Some patient pain thresholds do call for narcotic treatment,

I was thrilled to hear these words validating our use of opioids, but then…

and studies indicate that opioid use in pain management can improve patient satisfaction.

So they only want to improve our pain to improve their patient satisfaction ratings? It sure looks like those customer surveys are more important than patients’ quality of life.

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