Florida Doctor

2018 Summer issue

Florida Doctor Magazine. Helping Doctors to a better practice and better life

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16 f l o r i d a d o c t o r pproximately 100 million U.S. adults are burdened by chronic pain, totaling more than diabetes, cancer and heart disease com- bined. ose estimates do not account for acute pain and children. Pain is the most common reason for seeking health care and, as a presenting complaint, accounts for up to 70% of emergency department (ED) visits. Yet is oen un- dertreated—especially in children, women and minority groups. Additionally, up to 80% of post-operative patients experience pain and oen look to the ED for relief post-discharge. ere has been an up- heaval in pain management over the past decade. Initially, there was a period of re- newed focus on improving the assessment and treatment of pain. Reasons for this new era of pain management included a number of factors, including the emerging research on the neurobio- logical and genetic complexity of pain, recognition of long term consequences of untreated acute pain (post-traumat- ic stress disorder, sleep disturbances, depression, etc.), growth of pain special- ists and new methods or procedures for treating pain, hospital grading based on pain-related patient satisfaction scores and other factors. Unfortunately, this period was followed by a rapid rise in opioid pre- scribing, addiction, overdoses and deaths leading to a new emphasis on opioid stewardship. Prescribing limits, non-opi- oid and non-pharmacologic methods of treating pain came to the forefront. Pain is Multifactorial Pain is multidimensional—affecting people physically, psychologically, socially and spiritually. How pain is perceived by an individual and how that individual copes with their pain is influenced by sev- eral factors. ese factors can vary from individual-to-individual and can include the patient's beliefs, previous experiences, demographics and perceived care by the treating medical team. Psychosocial Influences on Pain Health disparities research indicate that patients living in rural areas and who are of lower socioeconomic status tend to report higher levels of chronic pain, pain related disability and depression. Depres- sion and pain oen co-exist, with 30-60% of pain patients also reporting depression. Mood disorders and other psychiatric disorders have been linked to the devel- opment of chronic pain. is co-existence has important clinical and financial impli- cations, in that these patients oen report more pain, greater functional disability, worse clinical prognosis and accrue high- er healthcare costs. Pain catastrophizing is an exaggerative cognitive response to an anticipated or actual painful stimulus and affects how individuals experience and express pain. People who catastrophize tend to magnify their pain, ruminate about their pain and feel helpless in managing their pain. Catastrophiz- ing shares similarities with depression and anxiety. It has been associated with pain-related outcomes such as reported pain severity, activity interference and disability, depression, changes in social support networks, more frequent health- care visits and narcotic usage. Genetic Influences Genetic polymorphisms play an integral role in how patients respond to painful stimuli and treatment. For example, pop- ulations within certain ethnic groups are known to carry genetic mutations of the A The Changing Landscape of Pain Management and Opioid Legislation The Expanding Opiod Epidemic Has Prompted Broader Focus on Education, Policies, Regulation and Compliance Sophia Sheikh, MD, FACEP BETTER CARE: Pain Management Pain Has Several Contributing Influences • Age • Gender • Ethnicity • Socioeconomic Factors • Psychiatric Conditions • Pain Catastrophizing • Culture and Religion • Genetics • Previous Pain Experiences • Patient Perceptions • Patient Expectations

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