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CHAPTER AIMS
The aims of this chapter are to:
Discuss the roles of a systematic patient care process and clinical reasoning in assessing and resolving medication-related problems as part of a collaborative effort to provide patient-centered care in chronic pain management.
Illustrate common medication-related problems encountered in an example chronic pain management case using clinical reasoning and critical thinking techniques through utilization of the Pharmacists’ Patient Care Process.
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KEY WORDS
• Chronic Pain • Osteoarthritis • Clinical reasoning • Clinical problem-solving • Medication-related problems • Pharmacists’ Patient Care Process • Critical thinking • Cognitive biases
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Pharmacy practice in ambulatory care provides many opportunities for managing a variety of chronic disease states. Chronic pain management is one type of ambulatory care practice in which pharmacists can play a very impactful role in patient assessment, patient safety, treatment plan development, and in-depth patient education.
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Pain is defined by the International Association for the Study of Pain (IASP) as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential damage.” Chronic pain is pain that occurs for greater than 3 months or beyond the common healing time.1 At least 50 million Americans suffer from chronic pain and 19.6 million of these patients are classified as suffering from high-impact chronic pain, which is considered chronic pain that frequently limits life or work activities.2 In the United States alone, the yearly direct medical costs, costs of lost productivity, and cost of disability programs associated with chronic pain are estimated at a combined 560 billion dollars.2 Primary care providers have increased the utilization of ambulatory pharmacists for a variety of multidisciplinary chronic disease state management programs including chronic pain management.3 The Pain Management Best Practices Inter-Agency Task Force published recommendations focusing on acute and chronic pain management. These recommendations emphasized care should be individualized, multimodal, and multidisciplinary. It has been demonstrated that including pharmacists in multidisciplinary teams improves efficiency and overall patient care.4
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KEY POINT
When treating acute or chronic pain, care should be individualized and include multimodal and multidisciplinary treatment approaches.
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OUR PRACTICE—AN OUTPATIENT PHARMACIST-RUN PAIN CLINIC
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Our practice is an outpatient pharmacist-run clinic working under a collaborative agreement with primary care providers (PCPs), where pharmacists participate in the medical management of patients who struggle with chronic pain. Pharmacists receive referrals from the PCPs to perform risk assessment, medication therapy management, and extensive patient education. The patient population in this clinic ranges in age from 20 to 64 years old who present with a chronic painful condition, such as fibromyalgia, neuropathic pain-related disorders, cancer-related pain, pain due to a previous injury, and a variety of joint pains due to osteoarthritis (OA) and injuries. Some patients are managed on nonpharmacological and nonopioid ...