title: Adherence monitoring with chronic opioid therapy for persistent pain: a biopsychosocial-spiritual approach to mitigate risk.
abstract: Opioids represent a mainstay in the pharmacologic management of persistent pain. Although these drugs are intended to support improved comfort and function, the inherent risk of abuse or addiction must be considered in the delivery of care. The experience of living with persistent pain often includes depression, fear, loss, and anxiety, leading to feelings of hopelessness, helplessness, and spiritual crisis. Collectively, these factors represent an increased risk for all patients, particularly those with a history of substance abuse or addiction. This companion article to the American Society for Pain Management Nursing "Position Statement on Pain Management in Patients with Substance Use Disorders" (2012) focuses on the intersection of persistent pain, substance use disorder (SUD), and chronic opioid therapy and the clinical implications of monitoring adherence with safe use of opioids for those with persistent pain. This paper presents an approach to the comprehensive assessment of persons with persistent pain when receiving opioid therapy by presenting an expansion of the biopsychosocial model to include spiritual factors associated with pain and SUD, thus formulating a biopsychosocial-spiritual approach to mitigate risk. Key principles are provided for adherence monitoring using the biopsychosocial-spiritual assessment model developed by the authors as a means of promoting sensitive and respectful care.
authors.affiliation: School of Nursing, State University of New York, Buffalo, New York; Pain Management and Rehabilitation Center, Buffalo, New York. Electronic address: debmatt2@gmail.com.
authors.forename: Deborah
authors.initials: D
authors.lastname: Matteliano
authors.affiliation: College of Nursing, University of Iowa, Iowa City, Iowa; Fairview Ridges Hospital, Burnsville, MN.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: St Marie
authors.affiliation: Swedish Covenant Hospital, Chicago, Illinois.
authors.forename: June
authors.initials: J
authors.lastname: Oliver
authors.affiliation: Hospice Care of the Low Country, Coastal Pain and Spine Center, Bluffton, South Carolina.
authors.forename: Candace
authors.initials: C
authors.lastname: Coggins
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D059350:Chronic Pain / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D059408:Pain Management / Q000523:psychology*; D029181:Spirituality; D019966:Substance-Related Disorders / Q000517:prevention & control / Q000523:psychology
chemical_list: D000701:Analgesics, Opioid