The 5 A’s of Chronic Pain and Opioid Management

What is an opioid?

An opioid, or narcotic, is a medication prescribed to relieve moderate to severe pain by weakening pain signals from nerves to the brain. Opioids have been a standard of care in pain management for decades. They can be made synthetically or derived from the opium poppy plant.

Opioids may be prescribed when other treatment options have failed. Opioid usage can lead to dependence, overdose, or other adverse effects; therefore, proper management is needed. A list of “5 A’s” can help manage opioid use for chronic pain by detecting changes that indicate complications or an increased risk of dependence.

Analgesia

Analgesia involves assessing the effectiveness of pain relief provided by opioids over the past 24 hours. Pain levels are typically rated on a scale from zero (no pain) to ten (worst pain imaginable). This helps determine if the current opioid regimen is effectively managing pain.

Activities of daily living

This assessment examines the patient's ability to perform basic daily activities, such as personal hygiene, dressing, continence, toileting, and feeding. It also evaluates instrumental activities of daily living, which include managing finances, handling medications, shopping, meal preparation, transportation, and cleaning. Additionally, tolerance for activities like walking, standing, and sitting is reviewed.

Adverse effects

Opioids can cause a range of side effects, including dizziness, drowsiness, nausea, and constipation. It is essential to weigh these potential adverse effects against the benefits of pain relief to determine whether the opioid remains a viable option for the patient.

Aberrant Behaviors

Monitoring for aberrant behaviors is crucial in managing opioid use. This includes tracking issues such as lost prescriptions, requests for early refills, signs of substance abuse, or increased intake without medical consultation. These behaviors may indicate misuse or dependency.

Affect

The emotional impact of opioids and chronic pain is also significant. Changes in mood, including depression, anxiety, irritability, and other emotional states, are assessed. Understanding these emotional shifts helps in providing care and adjusting treatment as needed.

Additional source: New South Wales Government Agency for Clinical Innovation