Talking to Patients About Acute Pain

Open-ended communication and proactive education are essential in the pharmacy setting.

Many pharmacists hold misconceptions regarding their patients’ experience of pain and their use of pain medications. Communication barriers can affect a pharmacist’s ability to deliver quality care to patients seeking relief in the form of advice or a medical recommendation. Open-ended communication and proactive education regarding pain management are essential in the pharmacy setting. It is important for pharmacists to gain the trust of patients so that they can individualize care.

Postoperative pain is a concern among health care providers in both inpatient and outpatient settings. Ineffective management of postoperative pain can lead to negative physical and psychological outcomes for a patient. The acute pain from an operation may then develop into chronic pain, which can negatively impact a patient’s quality of life.

CD is a retired 65-year-old woman who is a loyal customer at your pharmacy. She enjoys traveling, gardening, and jogging around the neighborhood with her new dog. Ever since you have known CD, she has been very active, and she likes talking about her adventures during your counseling sessions. Over a month ago, CD told you that an injury was going to require her to have surgery. You wished her luck and told her she would be okay, even as you sensed a hesitant tone in her voice. Today, CD stops in the pharmacy to pick up yet another new prescription for pain. You notice she is not her usually energetic self and when you ask how she is doing, she doesn’t give you her trademark smile or the high-spirited attitude that originally helped you get to know her. CD appears to be in pain. You counsel her on new pain medication and quickly explain the concept behind a brown bag session. You tell her that since her surgery you have noticed that she has been prescribed a number of new medications and that you think she would be a good candidate to participate in a brief review. You ask CD if she would be interested in bringing in all of her medications and going over them with you to ensure their proper use. CD smiles and sighs with relief. She is happy someone will listen to her talk about her pain and sets up an appointment to meet with you tomorrow.

To prepare for the session, you pull up CD’s pharmacy profile so you are able to compare it with what is in her brown bag:

• Celecoxib 200 mg twice daily
• Ibuprofen 600 mg every 8 hours as needed
• Hydrocodone/APAP 5 mg/500 mg every 4 to 6 hours as needed
• Fluoxetine 20 mg daily
• Atenolol 50 mg daily
• Atorvastatin 40 mg daily

CD arrives the next day for your appointment. She empties her brown bag and you notice these additional medications:

• OTC naproxen 250 mg every 8 hours as needed
• Calcium carbonate 500 mg as needed
• Adult multivitamin once daily
• OTC acetaminophen 500 mg every 4 to 6 hours as needed
• OTC brand Advil (ibuprofen) 200 mg as needed
• Oxycodone 20 mg every 12 hours (filled over a month ago at hospital pharmacy, 15 tablets remain)
• OTC fiber, 4 capsules daily

As you review the medications for accuracy, CD tells you that since her surgery she has had uncontrolled pain and is unhappy. Her sleep schedule and daily routine have all been impacted by her perception of pain. You ask about her medication regimen. CD unknowingly admits to overuse yet she expresses that the medications do not seem to relieve her pain and newly developed anxiety. She dislikes feeling tired, irritable, nauseous, and constipated. She refuses to take the prescribed oxycodone.

You ask CD about her goals, and she tells you she just wants some relief so she can “go back to her life” before her surgery and the uncontrolled pain. You and CD briefly discuss some of your concerns. CD has been self-treating and is on many duplicate OTC medications (of which her health care providers are unaware), which may lead to toxicities and complications. Her anxiety over her pain may be having a negative effect on her weight and blood pressure and her quality of life is not ideal.

Because of your brown bag session, CD is very interested in participating in the MTM session you offer as follow-up. You also inform her that you will be contacting her providers. You would like to suggest that they perform laboratory work to monitor for any toxicities that may have resulted from her medication overuse and that they help her to streamline her pain management regimen and address her ongoing pain and symptoms.

Dr. Drury works as a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin. She earned her doctor of pharmacy from Midwestern University College of Pharmacy. Her blog, Compounding in the Kitchen, appears on www.PharmacyTimes.com.