A woman with chronic pain due to inflammatory arthritis
A 54-year-old woman with chronic pain due to inflammatory arthritis presents to your clinic stating that she is having a “flare” of her arthritis but is out of her Oxycontin® and immediate-release oxycodone. She is aware that it is too early to fill her prescriptions, but she insists that she will be traveling out of state and “really needs” her medications.
Question: How do you Approach This Patient in the community setting?
What is the implications of prescribing this medication? Please provide evidence.
Sample Solution
Prescribing opioid medications such as oxycodone can have serious implications, both for the individual patient and wider public health. Opioids are highly addictive substances, with a potential for abuse, misuse, and overdose if not prescribed or used appropriately. Adverse effects of opioids include drowsiness, constipation and nausea; long-term use can lead to physical dependence and addiction. In addition, overprescribing of opioids has been linked to an increasing rate of opioid-related overdoses in recent years (1).
Given this context it is essential that clinicians exercise caution when prescribing opioids. It is important to assess the risks associated with prescribing these medications prior to making any decisions about treatment options. This includes evaluating the patient's history and risk factors for opioid misuse or abuse – including mental health issues and past drug use – as well as assessing other medical treatments which may be suitable alternatives to opioids (2).
In this case study, it appears that the patient has a diagnosis of chronic pain due to inflammatory arthritis which she believes is flaring up. Although she states that she needs her medications immediately due to travel plans out of state, it would be prudent for the clinician treating her in a community setting firstly attempt non-opioid treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs), heat therapy or steroid injections before considering prescribing opioids. Furthermore, there should be ongoing assessment of how effective any interventions are in reducing pain symptoms while minimizing side effects before consideration is given towards long term opioid therapy (3).
If evidence suggests that opioid analgesia is appropriate then close monitoring throughout the duration of treatment should take place; attention must be paid especially careful care in deciding what dose will provide sufficient benefit while avoiding adverse events such as overdose (4). The clinician must also ensure that they keep accurate records regarding all relevant information pertaining to their decision making process when prescribing these drugs (5).
Overall it is crucial for healthcare professionals working in community settings who treat patients presenting with chronic pain issues make informed decisions about whether using opioid therapeutics are safe and beneficial before proceeding with any prescription regimes (6). Taking into account all relevant factors will help ensure patients receive optimal pharmacological care without compromising safety or promoting longer term dependency on these powerful medicines.