The Gentle Art of Saying No: How to Establish Appropriate Boundaries With Chronic Pain Patients
Effective pain management has been deemed a human right, but some chronic pain patients perceive that to mean they are entitled to opioid analgesics for prolonged pain control. In response to these expectations, providers may feel pressured to say "Yes" and continue prescribing opioids, thereby reinforcing the patient's beliefs and reliance on medication. This has contributed to a dramatic rise in opioid analgesic misuse and deaths from prescription drug overdose. In fact, the CDC has identified opioid misuse as a "public health epidemic" and released new guidelines in March 2016. While a collaborative relationship is optimal for pain management, there may be times when a practitioner saying "No" is the best treatment. Many providers feel uncomfortable setting boundaries; however, boundary setting is important work because rights as a provider are also important. When reasonable limits are placed on a patient and the patient continues to step beyond those limits, it is imperative that providers maintain boundaries and be consistent in their message. Participants will learn about the gentle art of saying "No" and how to use a decision tree when making pain management decisions. Sample cases will be presented along with recommended treatment strategies.