What are best practices for managing Pain in Individuals with Serious Illness and Comorbid Substance Use Disorder and what are the risks associated with it?

According to the National Institutes of Health, depression, anxiety, and delirium in those who are terminally ill are highly prevalent disorders that are frequently under-diagnosed. Consequently, the failure to diagnose and treat them can prevent the preventable death of an elderly patient in hospice. The WHO recommends a ladder approach to pain management for hospice populations while using multimodal analgesia including opioids as well as opioid sparing strategies including Non-opioids medications and adjuvant therapies.

In palliative care/hospice settings, pain, serious illness and comorbid SUD may be more common in home population than previously reported. This is further complicated by the risks of diversion as diverted prescription drugs are often obtained from family and friends. In hospice settings, there is little oversight and Large quantities of opioids may be in the home.

Whenever opioids are used, tools such as the Opioid Risk Tool (ORT), Revised Screener and Opioid Assessment for Patients with Pain
(SOAPP-R) and the Diagnosis, Intractability, Risk, Efficacy (DIRE) are recommended to evaluate the risks associated with prescribing narcotics and identify aberrant behaviors. More information can be found here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1291326/

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