Registed Nurses' Association of Ontario

Chronic Pain Management in a Substance Dependent Patient Population

Bonnie Cheuk
Centre for Addiction and Mental Health,

I have worked in an addiction setting for several years and currently work as a registered nurse for the Centre for Addiction and Mental Health in Toronto. My clinical practice constitutes of caring for patients who have substance dependence and are using medications, including opioids, aberrantly. I have practiced with the scope of addictions to care for such clientele, most of which consists of managing their structured opioid treatment, assessing their urine samples to make sure no other substances they are taking can put them at risk for adverse events, and providing counseling such as motivational interviewing to further support clients in their treatment goals. In my practice I have come to observe that while clients seek treatment for their substance dependence, they also present with underlying chronic pain.

This has led me to become more conscientious that my patients with substance abuse issues do present with pain disorders and that the concurrent management is complicated. Although chronic pain and substance abuse are independently recognized as complex problems growing in scope and severity and that each has its own unique difficulties that contribute to poor outcomes and partial response to treatment, I have recognized that the approach to pain and addiction is somewhat still a dichotomy. There is inadequate training that combines both addiction medicine and pain management, which often leads both the practitioner and the often complex population that the practitioner serves to be disadvantaged. A substantial and very unfortunate number of patients have both these devastating problems and constitute a highly stigmatized and plainly underserved population who would benefit from additional scientific and clinical attention.

In order to enhance my knowledge of the assessment and management of pain, I applied for an Advanced Clinical Practice Fellowship (ACPF) with the RNAO, and was awarded funding to have 450 clinical hours for a self-directed learning experience in this area. Through this fellowship, I was able to spend time at the Wasser Pain Management Centre at Mount Sinai Hospital. While being mentored by clinicians who have expertise in chronic pain assessment and management, I was able to gain clinical skills in this area, enhancing my scope of practice as an addictions specialty nurse. I also was able to transfer this knowledge to my 2 colleagues in the Addiction Medicine Service through implementing standardized pain assessments in the clinic and offering pain in-services.

The goal of my RNAO fellowship was to integrate chronic pain treatment modalities to serve those clients who face both pain and chemical dependence issues. With so few practitioners having training in addiction medicine and pain management, I had hoped to become a clinician that would have the ability to integrate my knowledge of substance abuse treatment and pain management and enhance the care of these high-risk patients, improving the care that is delivered and their quality of life. I wanted to learn the art of integrating pain and addiction management, and being able to have an ACPF from the RNAO allowed me to raise the quality of care particularly for the client population with co-occurring substance use and pain and serve as a resource for my colleagues in the assessment and management of pain. The experience of having this fellowship was truly an enriching one.

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