ACUTE PAIN MANAGEMENT OF THE CHRONIC PAIN PATIENT ON OPIATES - A SURVEY OF CAREGIVERS AT UNIVERSITY-OF-WASHINGTON-MEDICAL-CENTER

Objective: The provision of acute pain management for the chronic pain patient can pose a challenge. We sought to characterize management is sues. Subjects/setting: An anonymous survey was distributed to 270 phy sicians and 212 nurses at University of Washington Medical Center (UWM C) in an attempt to characterize management issues. Design: Caregivers were queried regarding treatment modalities, efficacy of anxiolysis, patient attributes, concern of the quantity of medication, criteria fo r patient evaluation, and other management issues. Results: Of the res pondents, 61.8% were physicians, and 38.2% were nurses. The mean durat ion in practice was 7.7 years. The responses from the two groups were similar. Seventy-five percent reported using different pain-evaluation techniques for chronic pain patients than those utilized for the ''av erage'' patient. Pain scores were used frequently in the average patie nt, whereas ability to perform activities was used more commonly in th e chronic pain patient (p < 0.0001). Half of the respondents expressed concern regarding the amount of medication used and level of sedation . The same proportion found anxiolysis to be a helpful adjunct. The us e of a time-contingent ''pain cocktail'' as an oral medication was a u seful strategy for 88% of respondents. The least labor-intensive modal ity reported was patient-controlled analgesia (PCA) for 84.5% of respo ndents; intravenous opiate fusion, 5.3%; and epidural analgesia, 11.2% . Conclusions: The survey describes caregiver concerns regarding this patient population, including medication use, sedation, length of hosp ital stay, and evaluation techniques.