1-Unit 11 Medications For Pain Management. Peer Response Due 11-15-23. 800w. 4 References

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Peer Response

Instructions:

Please read and respond to at least two of your peers’ initial postings. You may want to consider the following questions in your responses to your peers:

Compare and contrast your initial posting with those of your peers.

How are they similar or how are they different?

What information can you add that would help support the responses of your peers?

Ask your peers a question for clarification about their post.

What most interests you about their responses?

Please be sure to validate your opinions and ideas with citations and references in APA format.

Mojgan

Week 11, Medications for Pain Management

Why are many parties, including the U.S. Government, concerned about the use of opioids for pain management?

        Opioids are highly valuable in the medical field for their effectiveness in managing pain. However, they also pose significant concerns that affect numerous patients and entire countries. Recent surveys reveal that the United States consumes about 85% of the world’s opioid supply, considering both legal and illegal usage. In the U.S., over 60 million people receive at least one opioid prescription annually. Shockingly, around 20% of them do not adhere to prescribed usage. An additional 20% admit to sharing their medication with others, leading to over 2 million people becoming addicted to opioids due to medical treatment (Stahl, 2021).

        One primary reason for this concern is the development of tolerance and reduced efficacy. As patients use these medications to manage their pain, their bodies become accustomed to the dosage, resulting in decreased effectiveness over time. To attain the same therapeutic outcome, patients frequently need to escalate their dosage. This not only impacts the patient’s well-being but also places a substantial burden on governments.

        Addiction is a significant concern in the context of opioid use. Patients often find it challenging to discontinue or substitute opioids due to the dependency they develop. The sudden cessation of opioids can result in withdrawal symptoms and discomfort, driving some individuals to seek these medications in illegal markets to avoid the distressing side effects of withdrawal. Unfortunately, prescription opioids frequently find their way into the illegal market, where they can be sold and misused, causing negative impacts on both individuals and governments.

        Another substantial concern is the potential for severe side effects. The potent nature of these medications increases the risk of accidental overdoses, which can be life-threatening. Opioids have the capacity to suppress respiration, potentially leading to fatal outcomes. Consequently, physicians must carefully consider several crucial factors before prescribing opioids (Stahl, 2021).

Which mental health disorders are commonly associated with patients who also need pain relief?

        Mental health patients often use pain medications for various reasons. Researchers are increasingly uncovering the intricate connections between pain and mental disorders. These two conditions frequently co-occur and can mutually influence each other, potentially through shared neural processes (Yao et al., 2023). One common factor is the presence of physical symptoms associated with mental health conditions. For example, individuals with generalized anxiety disorders may endure symptoms like headaches, muscle tension, and gastrointestinal issues, which can lead to the use of pain-relief medications. Unfortunately, some patients may misuse opioids and develop addiction.

        Another reason for resorting to pain medications is the presence of comorbidities. Conditions such as depression and anxiety often co-occur and can exacerbate an individual’s perception of pain. In the mental clinic where I am working, most patients who suffer from mood disorders, particularly depression, also experience anxiety disorders. Notably, mental health conditions frequently overlap with substance use disorders, particularly opioid use disorder (OUD) (Murray-Krezan et al., 2023). In such cases, the management of pain may necessitate the use of medications.

        Substance abuse disorders can also contribute to the high usage of medications. Individuals with mental health issues who struggle with substance abuse may be more inclined to take multiple medications, including pain relievers. Furthermore, certain medications used to treat mental health conditions may have side effects. For example, selective serotonin reuptake inhibitors (SSRIs) can cause gastrointestinal discomfort. To alleviate this, pain medications may be prescribed. Depression, anxiety, substance use disorders, personality disorders, psychotic disorders, and various other mental health conditions can indeed result in pain and discomfort, which may require treatment.

What is an MME and how is it calculated?

         MME, short for ‘Morphine Milligram Equivalents,’ serves as a useful tool for healthcare providers when comparing different opioid medications. It assists in monitoring opioid therapy, assessing the risk of overdose, and making informed decisions about opioid prescriptions. This is particularly crucial when patients are prescribed multiple opioids or when transitioning between different opioid medications. For instance, 1 milligram of hydrocodone is equivalent to 1 MME. Therefore, if a patient is taking 1 mg of morphine, the prescriber can replace it with 1 mg of hydrocodone. To calculate MME, the prescriber multiplies the dosage in milligrams by the conversion factor.

        An example can make it easier to understand. If a patient is taking 10 milligrams of oxycodone per dose twice a day. We need to multiply the dosage in milligrams by the conversion factor to find the MME for that particular dose. Since 1 milligram of oxycodone is equivalent to 1.5 MME, the MME per dose is 10 mg x 1.5 MME/mg = 15 MME. For two doses a day, it would be 15 MME x 2 = 30 MME per day. In other words, if the patient takes 20 mg oxycodone per day, the equivalent amount is 30 mg morphine per day (de Souza Renato et al., 2022).

References

de Souza Renato, L. P., Abrão João, G. L. V., Vila, M. S., Ester, W., & Cagnoni, B. A. (2022). Impact of a multimodal analgesia protocol in an Intensive Care Unit: A pre-post cohort study.
 Cureus, 14(3)https://doi.org/10.7759/cureus.22786

Murray-Krezan, C., Dopp, A., Tarhuni, L., Carmody, M. D., Becker, K., Anderson, J., Komaromy, M., Meredith, L. S., Watkins, K. E., Wagner, K., & Page, K. (2023). Screening for opioid use disorder and co-occurring depression and post-traumatic stress disorder in primary care in New Mexico.
 Addiction Science & Clinical Practice, 18, 1-9. 
https://doi.org/10.1186/s13722-023-00362-5Links to an external site.

Stahl, S. M. (2021). 
Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (5th ed.).

Yao, C., Zhang, Y., Lu, P., Xiao, B., Sun, P., Tao, J., Cheng, Y., Kong, L., Xu, D., & Fang, M. (2023). Exploring the bidirectional relationship between pain and mental disorders: a comprehensive Mendelian randomization study: Official Journal of the Italian Society for the Study of Headaches.
 The Journal of Headache and Pain, 24(1), 82. 
https://doi.org/10.1186/s10194-023-01612-2Links to an external site.

Ruth

Initial Post:

Why are many parties, including the U.S. Government, concerned about the use of opioids for pain management?

For many decades now, there has been a concern with opioid abuse by the population, leading to many opioid use disorders causing their death. It is believed that opioids have been easily accessible either by prescription or illegally. In response to lowering the demand for opioids, the federal government enacted a new law between 2016 and 2018 to lower the demand and supply of opioids to reduce harm. There have been over 500,000 deaths since the year 2000 due to opioid abuse. This was slightly reduced after the law was first implemented. However, the numbers increased tremendously with the COVID-19 pandemic due to limited access to care and isolation (Congressional Budget Office, 2022).

Which mental health disorders are commonly associated with patients who also need pain relief?

Research shows that chronic pain and mental health problems can contribute to or exacerbate one another. People currently experiencing chronic pain are at risk for mental health disorders, including depression, anxiety, and substance use disorders. Approximately 35-45% of people with chronic pain experience depression. Pain can also affect sleep and increase stress levels, which contributes to generalized anxiety disorder and depression (American Psychiatric Association, 2020). 

What is an 
MME, 
and how is it calculated?

MME is the morphine milligrams equivalent (MME) calculation that prescribers must utilize when prescribing opioids. Calculating the total daily dose of opioids helps identify patients who may benefit from closer monitoring, reduction, or tapering of opioids, prescribing of naloxone, or other measures to reduce the risk of overdose. To calculate the MME, first, we need to determine the daily amount of opioids the patient is currently taking. Once the total amount and name of the opioid are selected, we can convert each one by multiplying the dose by the conversion factor following the table below. The last step is to add all the amounts, which would be our MME (CDC, n.d.). 

The goal is to prescribe the lowest dose possible with the lowest risk <20MME/day with desired effects. Use extra precautions when increasing to ≥50 MME daily, such as monitoring and assessing pain and function more frequently. Discuss reducing the dose or tapering and discontinuing opioids if the benefits do not outweigh the harms. Consider offering naloxone. Avoid or carefully justify increasing dosage to ≥90 MME/day (CDC, n.d.).

References:

American Psychiatric Association. (2020). Chronic Pain and Mental Health Often Interconnected. 
Psychiatry. 

https://www.psychiatry.org/news-room/apa-blogs/chronic-pain-and-mental-health-interconnected#:~:text=An%20estimated%2035%25%20to%2045,with%20chronic%20pain%20experience%20depression.&text=Pain%20can%20also%20be%20a,Association%20of%20America%20(ADAA)Links to an external site.
.

CDC. (n.d.). Calculating total daily dose of opioid for safe dosage. 

https://www.cdc.gov/opioids/providers/prescribing/pdf/calculating-total-daily-dose.pdfLinks to an external site.

Congressional Budget Office. (2022). The Opioid Crisis and Recent Federal Policy Responses. 

https://www.cbo.gov/system/files/2022-09/58221-opioid-crisis.pdfLinks to an external site.

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