Police officer, deal-maker, or health care provider? Moving to a patient-centered framework for chronic opioid management

Christina Nicolaidis

Research output: Contribution to journalReview article

54 Scopus citations

Abstract

How we frame our thoughts about chronic opioid therapy greatly influences our ability to practice patient-centered care. Even providers who strive to be nonjudgmental may approach clinical decision-making about opioids by considering if the pain is real or they can trust the patient. Not only does this framework potentially lead to poor or unshared decision-making, it likely adds to provider and patient discomfort by placing the provider in the position of a police officer or a judge. Similarly, providers often find themselves making deals with patients using a positional bargaining approach. Even if a compromise is reached, this framework can potentially inadvertently weaken the therapeutic relationship by encouraging the idea that the patient and provider have opposing goals. Reframing the issue can allow the provider to be in a more therapeutic role. As recommended in the American Pain Society/American Academy of Pain Medicine guidelines, providers should decide whether the benefits of opioid therapy are likely to outweigh the harms for a specific patient (or sometimes, for society) at a specific time. This article discusses how providers can use a benefit-to-harm framework to make and communicate decisions about the initiation, continuation, and discontinuation of opioids for managing chronic nonmalignant pain. Such an approach focuses decisions and discussions on judging the treatment, not the patient. It allows the provider and the patient to ally together and make shared decisions regarding a common goal. Moving to a risk-benefit framework may allow providers to provide more patient-centered care, while also increasing provider and patient comfort with adequately monitoring for harm. Wiley Periodicals, Inc.

Original languageEnglish (US)
Pages (from-to)890-897
Number of pages8
JournalPain Medicine
Volume12
Issue number6
DOIs
StatePublished - Jun 2011

Keywords

  • Chronic Non-Malignant Pain
  • Opioid Management
  • Patient Communication
  • Patient-Centered Care

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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