From the Guidelines
When communicating with a pain doctor about a patient receiving narcotic medications, pharmacists should ask specific questions about the diagnosis, treatment plan, and monitoring parameters to ensure safe and effective pain management. Begin by requesting the precise pain diagnosis and etiology, including whether the condition is acute, chronic, neuropathic, or inflammatory, as this information is crucial in determining the best course of treatment 1. Ask about previous treatments attempted before opioid therapy was initiated and their outcomes, as well as relevant laboratory tests such as liver function tests, kidney function tests, and urine drug screens, including their frequency and most recent results 1. Inquire about the expected duration of opioid therapy, dose titration plans, and exit strategy, as these are essential in minimizing the risks associated with long-term opioid use 1. Ask about concurrent medications that might interact with opioids or exacerbate side effects, particularly benzodiazepines, muscle relaxants, or other CNS depressants, as these can increase the risk of adverse events 1. Additionally, request information about the patient's risk assessment for opioid misuse using tools like the Opioid Risk Tool or SOAPP-R, any pain contracts in place, and non-pharmacological therapies being utilized, as these can help identify patients at high risk of opioid misuse and ensure that they receive appropriate monitoring and support 1. Some key points to consider when assessing a patient's pain include:
- Causes, onset, type, site, absence/presence of radiating pain, duration, intensity, relief and temporal patterns of the pain 1
- Presence of trigger factors and signs and symptoms associated with the pain 1
- Presence of relieving factors 1
- Use of analgesics and their efficacy and tolerability 1
- Description of the pain quality, including aching, throbbing, pressure, cramping, gnawing, sharp, shooting, stabbing, tingling, or ringing 1
- Interference of pain with the patient's daily activities, work, social life, sleep patterns, appetite, sexual functioning, mood, well-being, and coping 1
- Impact of the pain, the disease, and the therapy on the physical, psychological, and social conditions 1
- Presence of a caregiver, psychological status, degree of awareness of the disease, anxiety and depression, suicidal ideation, social environment, quality of life, spiritual concerns/needs, problems in communication, and personality disorders 1
- Presence and intensity of signs, physical and/or emotional symptoms associated with cancer pain syndromes 1
- Presence of comorbidities, such as diabetic, renal, and/or hepatic failure 1
- Functional status 1
- Presence of opiophobia or misconception related to pain treatment 1
- Alcohol and/or substance abuse 1 By asking these questions and considering these factors, pharmacists can help ensure that patients receive safe and effective pain management, while minimizing the risks associated with narcotic medications.
From the FDA Drug Label
To ensure that the benefits of opioid analgesics outweigh the risks of addiction, abuse, and misuse, the Food and Drug Administration (FDA) has required a Risk Evaluation and Mitigation Strategy (REMS) for these products Under the requirements of the REMS, drug companies with approved opioid analgesic products must make REMS-compliant education programs available to healthcare providers Healthcare providers are strongly encouraged to do all of the following: Complete a REMS-compliant education program offered by an accredited provider of continuing education (CE) or another education program that includes all the elements of the FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain Discuss the safe use, serious risks, and proper storage and disposal of opioid analgesics with patients and/or their caregivers every time these medicines are prescribed.
The pharmacist should request information from the pain management specialist regarding:
- The patient's diagnosis and medical status
- The patient's prior analgesic treatment experience
- The patient's risk factors for addiction, abuse, and misuse
- The patient's severity of pain
- The dosage and administration instructions for the opioid analgesic
- The results of any laboratory tests or other diagnostic procedures that may be relevant to the patient's treatment with opioids 2
- The patient's history of substance abuse or addiction 2
- The patient's current medications and potential interactions with the opioid analgesic 2
Key points:
- The pharmacist should request information about the patient's medical status and prior treatment experience
- The pharmacist should discuss the safe use and risks of opioid analgesics with the patient and/or their caregiver
- The pharmacist should be aware of the patient's risk factors for addiction, abuse, and misuse
- The pharmacist should follow the FDA's REMS guidelines for opioid analgesics 2
From the Research
Information Request from Pain Management Specialist
When prescribing narcotics (opioids), a pharmacist should request the following information from a pain management specialist regarding a patient's diagnosis and laboratory results:
- Patient's medical history, including current and past medical conditions 3
- Current medication list, including dosages and frequencies 4, 3
- Laboratory results, such as urine drug screens and blood work 3
- Diagnosis and treatment plan for the patient's pain condition 5, 3
- Any concerns or issues related to the patient's pain management, such as signs of aberrant drug-taking behaviors 3
Laboratory Results
The pharmacist should request laboratory results to:
- Monitor the patient's response to opioid therapy 3
- Identify potential interactions with other medications 4
- Detect any signs of opioid misuse or abuse 3
Collaboration with Pain Management Specialist
The pharmacist should collaborate with the pain management specialist to: