F11.20_Pain_Wright.pptx

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Joanne Wright, RN

HIM Student

Leadership Conference

June 4, 2016

F11.20

Making Sure You have a

Future

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Pain

M79.60

5 M25.56

1 M79.62

1 M79.64

2 M79.67

5 M25.55

1 G89.22

G44.02

1 R68.84

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Pain Classification

• Central

Nerves

• Diabetic

neuropathy

• Central

Nerves

• Diabetic

neuropathy

Neuropat

hic

Neuropat

hic

• Peripheral

Nerves

• Broken leg

• Peripheral

Nerves

• Broken leg

Nocicepti

ve

Nocicepti

ve

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Sources of Pain

Obvious

• Surgery

• Kidney

stone

• Fracture

• Burn

• Heart

attack

Really?

• Wallet

• Texting

• Driving

• Cheese

• Flip

(5)

Pain Timeline

Acute

Chroni

c

Chroni

c

• _{Persists although injury healed}

• _{May result from nerve damage}

• _{Source may be unknown}

• _{Short duration}

• _{< 3 to 6 months}

• _{Resolves as the}

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Pain Assessment Tools

Acut

e

Acut

e

• _Rest

• _Movement

• _{Location and}

Intensity

Numeric Analogs Visual

Ratings

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Pain Assessment Tools

Chroni

c

Chroni

c

• Multi-dimensional

• _{Life Impact}

• _{Pain History}

• _{Physical Exam}

• _{Diagnostic Tests}

IMMPACT: Initiative on Methods,

Measurement, and Pain Assessment in

Clinical Trials

(8)

Pain Treatment

Recent History (Past 25 years)

Migraine

Liberal use of Opioids

Cultural

Migraine

Head Wash (Yaxti-

_Wanjol)

Medieval

(9)

Opioid

Heroin

Mor

phin

e

Cod

eine

Hyd

roco

don

e (V

icod

in)

Oxy

cod

one

(Pe

rcoc

et,

Perc

oda

n)

Fen

tan

yl

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Pain-Pill Epidemic

• _{Opioid Analgesic sale}

increase quadrupled

1999-2010

• _{5% (US) consuming:}

-99% Hydrocodone

-80% Oxcodone

-65%

Hydromorphone

Increase

d

Dosages

Pain

Relief

(11)

(12)

Statistically Significant

Increase in Drug Overdose

Deaths

/

(13)

Source: http://adai.uw.edu/pubs/infobriefs/ADAI-IB-2015-01.pdf

>1

4 2011-2013

2002-2004

(14)

40 and

Under

40 and

Under

40-70’s

40-54

• _Recreational

use

• _{Medical Use}

• _Medical

Treatment

• _Multiple

Medical

Problems

• _Legitimate

Prescription

s

(15)

Strategies

Federal

• _{FDA prescription}

supplies

• _{Abuse resistant design}

• Labeling

• Legal Reforms: Public

(16)

Opioid Over Dose: CDC

(17)

Federal-Senate Bill 524

Substance Use Disorders in Rural communities

Naloxone Distribution

Expanding

Access to

Treatment

Expanding

Access to

Treatment

Mental Health

and Substance

Task Force

Public Health

Safety

Partnerships

Public Health

Safety

Partnerships

Implementatio

n of Syringe

Service

Programs

Implementatio

n of Syringe

Service

Programs

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Strategies

State

• Drug Registries

• Prescription Drug

Monitoring Programs

(PDMP)

• Pharma vs. State

Lawsuits

(19)

State Actions

Massachusetts: House Bill 4056 signed

into law March 14, 2016



_{Limits on days supplied}



_{Manufacturers must manage}

unwanted drugs disposal



_{Strengthen addiction prevention and}

treatment

Wisconsin



_{Increased government oversight}

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PDMP Effectiveness

• _{Collect data from Pharmacies}

• _{Authorized users}

• _{Sources of prescription drug}

diversion (Fraud, forgeries, Doctor

shopping, improper prescribing,

dispensing)

• _{Patient Safety}

• _{Impact Prescribing patterns}

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Strategies

Personal

• _{Drug Contracts}

• Safe Storage

• Safe Disposal

• Acute In-patient

coverage without

pre-authorization

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Treatment Programs

• _{Hazelden and Betty Ford}

Merger

• _{Group Therapy}

• _{Drop-in Lectures}

• _{Medication Assistance}

• _{Chronic Pain}

• _{Healthcare Workers}

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Personal Guidelines

Alternate

Treatment

Plans

Set Goals

Non-opioid

Alternativ

es

Non-opioid

Alternativ

es

Immediat

e Release

Immediat

e Release

Start Low

Go Slow

Start Low

Go Slow

Reduce,

Taper,

Discontin

ue

Reduce,

Taper,

Discontin

ue

Question

Rx

Combinati

ons

Question

Rx

Combinati

ons

(24)

Clinical Improvement Strategies

• _{Structured Approach}

• _{Step Care Primary to Tertiary}

Specialists

Intensity and

Pain

Intensity and

Pain

Mood

Sleep Effect

_Risk

Risk

Dosage

Calculation

Dosage

Calculation

Longitudinal

Tracking

Longitudinal

Tracking

_Interference

Functional

Referral

Functional

Interference

Referral

Psych/Social

Referral

Psych/Social

Referral

Multi

Discipline

Referral

Multi

Discipline

Referral

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Information is the Key

• _{Patient-generated health data}

(PGHD) into electronic health

records (EHRs)

• _{Data collection towards patient}

outcomes

• _{Support physician engagement}

• _{Policy, Guidelines and Procedure}

Development

• _{Foster Physician/Patient}

Collaboration

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Your Future is Bright

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Web Only References:

All reviewed between 5.1.2016-5.28.2016

AHIMA Work Group: Practice Brief. Including Patient-Generated Health Data in Electronic Health Records. Journal of AHIMA 86, no. 2 (February 2015): 54-57. Retrieved from:

http://bok.ahima.org/doc?oid=107560#.V0ohLlcYLww

Baker, C.M. Wong-Baker FACES History. October 2015. Retrieved from: http://wongbakerfaces.org/us/wong-baker0faces-history/

Ballantyne, J. Ed. Chronic Pain Management: Measurement-Based Step Care Solutions. International Association for the Study of Pain. Volume XX, Issue 8, December 2012. Retrieved from:

http://www.iasp- pain.org/files/Content/ContentFolders/Publications2/PainClinicalUpdates/Archives/PCU_20-8_web.pdf

Brandeis University. Briefing on PDMP Effectiveness. Updated September 2014. Retrieved from: http://www.pdmpexcellence.org/sites/all/pdfs/Briefing%20on%20PDMP

%20Effectiveness%203rd%20revision. pdf

Breivik,H, Borchgrevink, P.C., Allen, S.M., Rosseland, L.A., Romundstad, L., Breivik Halls, E.K., Kavarstein, G. and Stubhaug, A. Assessment of Pain. British Journal of Anaesthesia, Volume 101, Issue 1. Retrieved from:http://bja.oxfordjournals.org/content/101/1/17.full Centers for Disease Control and Prevention. Injury Prevention and Control: Opioid Overdose. Retrieved from: http://www.cdc.gov/drugoverdose/

Centers for Disease Control. Guidelines for Prescribing Opioids for Chronic Pain. Retrieved from: http://www.cdc.gov/drugoverdose/prescribing/guideline.html

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Web Only References:

Centers for Disease Control. Injury Prevention & Control: Opioid Overdose-Prescribing Data. Retrieved from: http://www.cdc.gov/drugoverdose/data/prescribing.html

Daubresse M, Chang H, Yu Y, Viswanathan S, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000 – 2010. Medical Care 2013; 51(10): 870-878.Retrieved from: http://dx.doi.org/10.1097/MLR.Ob013e3182a95d86

Erickson, M. Could Summer Flip Flops be Causing Your Pain. 5 July 2012. Retrieved from: http://www.bastatept.com/news/could-summer-flip-flops-be-causing-your-pain

Free. M.M. Baylor University Medical Center Proceedings. Cross Cultural Perceptions of Pain and Pain Control.

Proc (Bayl Univ Med Cent). 2002 Apr; 15(2): 143–145. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1276504/

Grounder C. Who Is Responsible for the Pain-Pill Epidemic? November 8, 2013.

Retrieved from: http://www.newyorker.com/business/currency/who-is-responsible-for-the-pain-pill-epidemic

Hazelden Foundation. Comprehensive Opioid Response with 12 Steps. 2013. Retrieved from https://www.hazelden.org

Helm II, S and Shiel Jr., W.C. Pain Management: Surprising Reasons You’re in Pain. Retrieved from: http://www.medicinenet.com/pain_management/page2.htm

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Web Only References:

Hill E. Reporting Chronic Care management Service: Is it Right for pain Medicine. October 13, 2015. Retrieved from:

http://www.painmed.org/practicemanagement/codingnews/reporting-chronic-care-management-service-is-it-right-for-pain-medicine/

History on the Net. The Five Most Painful Medical Treatments of the Middle Ages.

December 12, 2014. Retrieved from: http://www.historyonthenet.com/blog/most-painful-medical-treatments

Kolodny,A. Doctor: Prescription Painkillers Kill more People than Heroin. September 9, 2015. Retrieved from:

http://hereandnow.wbur.org/2015/09/09/heroin-epidemic-overprescribing

Levin, M. Opiods in Headache. Headache 2014: 54(1); 12-21 Retrieved from: http://www.medscape.com/viewarticle/819417

National Institute of Pain Control. Pain Assessment Scales. Thompson Professional Graduate Services. Retrieved from: http://www.painedu.org/Downloads/NIPC/Pain %20Assessment%20Scales.pdf

Pain Research Forum. 2016. Retrieved from:

http://www.painresearchforum.org/about/mission

Portland Press Herald. The Editorial Board. Patient Surveys Promote the Overuse of Pain Killers. February 11, 2016. Retrieved from: http://www.pressherald.com/2016/02/11/our-view-patient-surveys-promote-the-overuse-of-painkillers/

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Web Only References:

Rush University Medical Center. When Technology Hurts. Retrieved from: https://www.rush.edu/health-wellness/discover-health/when-technology-hurts The White House. Office of the Press Secretary.

Fact Sheet: Obama Administration Announces Additional Actions to Address the Prescription Opioid Abuse and Heroin Epidemic. March 29, 2016. Retrieved from:

https://www.whitehouse.gov/the-press-office/2016/03/29/fact-sheet-obama-administration-announces-additional-actions-address

University of Washington, Alcohol & Drug Abuse Institute. Opioid Trends Across

Washington State. April 2016. Retrieved from: http://adai.uw.edu/pubs/infobriefs/ADAI-IB-2015-01.pdf