What about the chronic pain patient who is hospitalized for some acute event or episode?

Knowledge Library published on April 5, 2013 in Practice
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Kenneth L. Kirsh, PhD
Director of Behavioral Medicine
The Pain Treatment Center of the Bluegrass
Lexington, Kentucky
Hello, I am Dr. Kenneth L. Kirsh. I am the director of Behavioral Medicine at the Pain Treatment Center of the Bluegrass located in Lexington, Kentucky. We have a question about, what about chronic pain patients who get hospitalized for some acute event or episode? And really there are two main issues to think of. First, is the outside prescribing physician and when somebody is at a pain clinic or they have an agreement, we have to know that there is some wiggle room, if somebody gets hospitalized, to be able to accept acute care and simply then to report back to the outside prescribing physician. Now, for the hospitalist, that becomes a little bit different area and a little bit different approach. It has happened around the country where hospitalists have looked at chronic pain patients and simply said, “I don’t want to be involved with this. We’ll treat the other issues that brought you in, but bring your own medicines with you. We’re not going to give you any opioid medications or other pain relief.” Now, this is few and far between, we certainly hope, but these things do happen. And for hospitalists, certainly, JCAHO has the call of pain as the fifth vital sign. So we always have to assess for pain and look to make sure that we are doing something to address that. On top of this, there is really no requirement at this point to do structured risk assessments, to really start agreements with patients when they are hospitalized, etc. This may not be a bad idea. One thing to look for, states around the country and Kentucky is actually a good example of this now, are passing new laws. We are starting to see requirements to run things like prescription monitoring program reports, even for those who may end up hospitalized, especially at times of discharge, to think about what types of medicines you should give a patient to set them out back into the world with and have you communicated back with their chronic pain physicians or prescribers. So this becomes a very complicated issue for us. Its in flux and state by state, you will see some variability. So I think overall, on the hospitalist side, while it may not be truly required to do some risk assessment and some background, I think some very simple things can be done, setting the stage with even a verbal agreement about if we use opioids, how will this be done? What things will we look at? And it is always important for patients to know that JCAHO and the fifth vital sign is important, but one thing that we have always gotten off track with in this country, we sometimes think that pain needs to be treated the way the patient wants it to be treated. Now, we have to do a good job. We have to be thorough, and certainly assess and look for risk factors, etc. So certainly, for the hospitalist side, do a little bit of background. I think it is going to be a wise move. You will start to see more and more of this being required state by state, but at this time, certainly, treat with medications, hopefully reach out to the prescribing chronic pain prescriber on the outside especially when you transition them back out into the world because depending on how long they were in the hospital, we also want to be able to track pill counts, how much medicine should have been saved by them being in the hospital, what were they given, etc. And especially for prescription monitoring programs when suddenly a new physician’s name appears on the chart, on a report of this kind, we want to be able to track down dates, times, those things. Working together, we can keep pain treatment alive like this, and hopefully make sure patients get treated appropriately.
Last modified: February 1, 2013
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