Position Statement Discusses Therapeutic Options to Manage Chronic Pain
NCCHC has updated its position statement on Management of Noncancer Chronic Pain. First adopted in 2011, the 2018 version emphasizes the escalation of the opioid epidemic to one of the nation’s most urgent public health threats.
The statement calls for chronic pain to be addressed in a manner similar to other chronic medical conditions—that is, it should be recognized as a multifactorial, complex entity and evaluated and managed relying on national guidelines adapted for correctional use. Complex chronic care patients are common in the correctional environment. Correctional clinicians should attain additional training in assessment, management and the science of chronic pain.
Accepted and evidence-based therapeutic options, including nonpharmacologic management, should be available when medically necessary. A multifaceted and biopsychosocial approach is optimal. While acknowledging the challenges inherent in using adjunctive medications such as opiates or GABA analogues in a population with a high prevalence of substance abuse history, the statement says that when patient function remains poor, pain is not well controlled and other options have been exhausted, a therapeutic trial of medication, including opioids, should be considered.
New to the 2018 statement is a recommendation that documentation of clinical encounters to address chronic pain include the patient’s self-reported comments in addition to the clinician’s assessment and the treatment goals, as well as appropriate follow-up.