• [Show abstract] [Hide abstract]
    ABSTRACT: Safe and effective management of chronic pain in pregnancy is challenging. Use of over-the-counter analgesics, opioids, opioid substitution therapies, complementary and alternative therapies, antidepressants, and anxiolytics each have benefits and risks for the mother and neonate that must be considered. Because of their potency, opioids are often used despite associated risks for adverse effects, abuse, diversion, and addiction. Development of a pain management protocol for the counsel and care of pregnant women with pain is necessary.
    Journal of Obstetric Gynecologic & Neonatal Nursing 08/2014; 43(5). DOI:10.1111/1552-6909.12487 · 1.03 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Opioid treatment agreements generally are used in pain treatment to delineate the terms and consequences of opioid use and abuse.
    The patient 10/2014; DOI:10.1007/s40271-014-0094-8 · 1.96 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Prior studies have demonstrated poor physician adherence to opioid management guidelines in primary care. The objectives of this qualitative study were to understand physicians' and patients' perspectives on recommended opioid management practices and to identify potential barriers and facilitators of guideline-concordant opioid management in primary care. Individual semi-structured interviews were conducted with 14 primary care physicians and 26 of their patients receiving long-term opioid therapy. Data were analyzed using a qualitative immersion/crystallization approach. We identified three major barriers and one facilitator to use of recommended opioid management practices. Major barriers were inadequate time and resources available; relying on general impressions of risk for opioid misuse; and viewing opioid monitoring as a "law enforcement" activity. The third barrier was most apparent for physicians in the context of drug testing and for patients in the context of opioid agreements. Beliefs about the need to protect patients from opioid-related harm emerged as a major facilitator, especially among patients. We hypothesize that future interventions to improve opioid management in primary care will be more effective if they address identified barriers and use a patient-centered framework, in which prevention of opioid-related harm to patients is emphasized as the primary goal.
    Journal of Pain 08/2014; DOI:10.1016/j.jpain.2014.08.006 · 4.22 Impact Factor