presented by Dan Rhon
Financial Financial— Dan Rhon receives compensation from MedBridge for the production of this course. He also receives grant funding for clinical research from the National Institutes of Health (NIH) and the Congressionally Directed Medical Research Program (CDMRP) Owner, Clinically Relevant Technologies (CRTech, LLC) – Mobile Apps for Clinicians Teach continuing education courses for MedBridge, Inc and Evidence in Motion, LLC Nonfinancial Dan Rhon works as a contractor within the Department of the Defense. None of what I say should be taken as if it is endorsed or approved by the DoD or any US Government component
Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.
Dan Rhon, PT, DPT, DSc, OCS, FAAOMPT
Dr. Dan Rhon is a clinician, active researcher, and assistant professor at Baylor University in Texas. He received an MPT and DSc through Baylor University, and then a DPT through Temple University. He attended a manual therapy clinical fellowship at Brooke Army Medical Center in Texas, is a fellow in the American Academy of Orthopaedic…Read full bio
1. Opioid Use for Pain Management in the Health System
Over the last two decades, the use of opioids for pain management have led to what has been termed an “epidemic” by the US Center for Disease Control and Prevention. Three distinct waves lead to tremendous number of deaths from overdose. The problem will be framed against the backdrop of society, pharmaceutical companies, and models of health care delivery. This chapter will provide an overview of the history of opium leading up to its current use in traditional medicine for the management of pain. The risk of misuse was initially thought to be very low (~1%), but it turns out the risk is much higher, closer to 30-40%.
2. A Refresher on Pain
In order to understand the current opioid problem, and because the primary goal of opioid therapy is pain relief, it is critical to have a solid understanding of what exactly pain is. It often comes across as a fairly objective perception; however, it is much more subjective and the pain experience can vary widely between individuals. Only with a solid understanding of nociception mechanisms and the physiology behind the pain experience can someone truly understand the benefit and limitations of opioids to manage pain.
3. Opioid Mechanisms: Physiology and Efficacy
This chapter will provide a foundation for defining opioids and understanding their mechanisms of action. It will review how they work in the human system, as well as their purported mechanisms for delivering analgesia, how it affects the central and peripheral nervous systems. The biological and physiological mechanisms for analgesia appear fairly straight forward, but what do clinical trials tell us about the effectiveness of opioids for managing chronic non-cancer pain? Understanding the capabilities and limitations of opioids will help improve the conversations clinicians have with their patients about expectations with their use.
4. The Down-Side: Adverse Effects and Associated Comorbidities
The most commonly discussed consequence of opioid use is overdose, which can lead to death. However, opioids influence many different body systems and adversely affects health in many different ways. In addition to the more common short-term adverse events, such as nausea, constipation, vomiting, and respiratory depression, other longer-term effects can influence health and must be considered. This is important information for clinicians to understand so that they can better inform patients of the long-term consequence of opioid use.
5. The Role of Non-Physician Providers in Managing Pain
At the end of the day, knowledge that can lead to meaningful action is of most value. The evidence is overwhelming, but clinicians are often at a loss for what to do. As this often appears as a prescription management problem, clinicians that are not credentialed to prescribe narcotics often feel helpless about what they can do. The truth is that proper management of chronic pain can reduce opioid use, and all clinicians can contribute. Success will only come from a truly interdisciplinary approach. Properly identifying and addressing factors that may contribute to the chronic pain experience (e.g., sleep, nutrition, physical activity, psychosocial factors), can reduce the need for opioid utilization.
This is a viewer submitted question and answer session, which will be facilitated by Dan Rhon.