Nurse Case Management of Chronic Pain Patients Treated with Methadone
Nurse Case Management of Chronic Pain Patients Treated with Methadone
Methadone treatment in chronic pain patients is still limited owing to misconceptions about addiction, safety, and its unique pharmacokinetic and pharmacodynamic properties. Nevertheless, patients with chronic noncancer pain are frequently treated with methadone at our Pain Centre either as the first opioid of choice, for specific pain conditions, or as a second-line opioid in patients developing tolerance or intractable side effects with other opioids. The aim of this study was to examine whether a nurse case management program of chronic pain patients treated with methadone is feasible and safe in trying to improve patients' care in an ambulatory setting. This program consisted of three phases: initial primary education session, telephone follow-up during methadone titration, and a subsequent maintenance period. The nurse case manager functioned autonomously and when required reported to and consulted the physician. The study included 75 subjects and was done over a nine-month period by completing follow-up questionnaires for every call. Of a total of 194 recorded calls, 41% were unscheduled. Forty-four percent of phone calls resulted in a methadone increase and 11% led to a decrease or cessation of methadone. No patients developed serious morbidity or mortality. Fifty-seven percent of patients were either satisfied or very satisfied with their treatment. A nurse-led case management program of methadone in chronic pain patients can improve patient care in an ambulatory setting.
Approximately 30% of the Canadian population suffers from chronic pain (Moulin et al., 2002). Managing chronic pain is often challenging, many times requiring a comprehensive approach in multidisciplinary pain centers (Loeser, 2001). This approach offers multimodal treatment, including pharmacologic and nonpharmacologic interventions, physical and rehabilitation programs, cognitive behavioral approaches and invasive pain-relieving interventions. Among other factors, the success of these treatments is related to patients' support and educational programs at the pain center and the ability to closely monitor patients' progress (Wells-Federman et al., 2002).
Methadone treatment in chronic pain patients is still limited owing to misconceptions about addiction, safety, and its unique pharmacokinetic and pharmacodynamic properties. Nevertheless, patients with chronic noncancer pain are frequently treated with methadone at our Pain Centre either as the first opioid of choice, for specific pain conditions, or as a second-line opioid in patients developing tolerance or intractable side effects with other opioids. The aim of this study was to examine whether a nurse case management program of chronic pain patients treated with methadone is feasible and safe in trying to improve patients' care in an ambulatory setting. This program consisted of three phases: initial primary education session, telephone follow-up during methadone titration, and a subsequent maintenance period. The nurse case manager functioned autonomously and when required reported to and consulted the physician. The study included 75 subjects and was done over a nine-month period by completing follow-up questionnaires for every call. Of a total of 194 recorded calls, 41% were unscheduled. Forty-four percent of phone calls resulted in a methadone increase and 11% led to a decrease or cessation of methadone. No patients developed serious morbidity or mortality. Fifty-seven percent of patients were either satisfied or very satisfied with their treatment. A nurse-led case management program of methadone in chronic pain patients can improve patient care in an ambulatory setting.
Approximately 30% of the Canadian population suffers from chronic pain (Moulin et al., 2002). Managing chronic pain is often challenging, many times requiring a comprehensive approach in multidisciplinary pain centers (Loeser, 2001). This approach offers multimodal treatment, including pharmacologic and nonpharmacologic interventions, physical and rehabilitation programs, cognitive behavioral approaches and invasive pain-relieving interventions. Among other factors, the success of these treatments is related to patients' support and educational programs at the pain center and the ability to closely monitor patients' progress (Wells-Federman et al., 2002).