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Opioids are commonly prescribed to treat and manage chronic and severe pain; however, their potential for abuse and dependency is a concern. Chronic and unrelenting pain can have significant psychological, physical, and emotional stress on individuals. Several strategies are employed to mitigate intractable pain that does not respond to nonsteroidal anti-inflammatory drugs (NSAIDs), with opioids being widely recognized as the cornerstone of pain management protocols. In recent years, there has been emerging and growing evidence indicating the potential efficacy of cannabinoids in managing chronic pain. This activity offers an overview of the signs and symptoms of adverse events and the crucial aspects of monitoring, intervention, and other pertinent considerations in opioid therapy and cannabinoids for patients with chronic pain. These key points are indispensable for fostering effective collaboration among interprofessional team members responsible for patient care. Objectives: Identify patients with chronic pain and provide education regarding the limitations of opioids and cannabinoids, including potential incomplete pain relief, mechanisms of action, and associated risks and adverse effects, emphasizing the importance of multimodal treatment approaches. Elucidate the signs and symptoms of opioid-related drug abuse by identifying behavioral changes in individuals, such as social withdrawal, increased secrecy, or sudden financial difficulties, in order to ensure the optimal effectiveness and safety of opioid and cannabinoid treatment. Identify and navigate legal issues associated with cannabis use by thoroughly understanding the potential benefits, risks, and State regulations governing its use for both medical and recreational purposes. Assess patients' pain levels, treatment response, functional outcomes, and potential adverse effects of opioid and cannabinoid therapy, ensuring ongoing monitoring and optimization of pain management strategies. Access free multiple choice questions on this topic.

In the human body, pain is an inherent alarm system that activates when there is actual or potential damage, directing an individual's attention toward the issue.[1][2][3] Pain is a frequently cited reason for seeking healthcare or medical assistance. Pain encompasses various elements, including nociception, the perception of pain, suffering, and pain behaviors. Although pain is a fundamental mechanism, it can become burdensome when it persists for an extended period, leading to suffering and pain-related behaviors. Chronic and unrelenting pain can cause psychological, physical, and emotional distress, adding further strain to individuals.[4] The search for an ideal pain relief medication has been an ongoing endeavor since ancient times, as certain types of pain still lack definitive treatment options. Several strategies have been developed to address intractable pain that does not respond to nonsteroidal anti-inflammatory drugs (NSAIDs), with opioids being the mainstay in many pain management protocols. In recent years, there has been growing and promising evidence suggesting the potential effectiveness of cannabinoids in the management of chronic pain.[5][6]

Chronic pain can significantly affect an individual's lifestyle due to its somatic and psychological effects. Therefore, optimal chronic pain management often requires a multidisciplinary approach involving healthcare professionals such as pain medicine specialists, internists, and psychiatrists. This condition is addressed well by using potent analgesics, including opioids, which can provide effective pain relief. However, it is essential to closely monitor patients by scheduling regular follow-up visits to assess their response to treatment, address any emerging adverse effects, and make necessary adjustments in dosage as needed. For accurate conversion and appropriate dosing of opioids, pharmacists should be consulted as they possess the expertise to provide precise dosing information for the prescribed medications and perform medication reconciliation to prevent potential drug interactions. Moreover, due to the potentially fatal effects of opioids, patients should be thoroughly educated about the adverse signs and symptoms associated with opioid use and the potential for drug abuse and dependence. Nurses are vital in monitoring patients for respiratory depression, a potential adverse effect of opioid use. Pain management specialists are responsible for monitoring and managing the patient's pain and ensuring the accurate dosing of prescribed medications. They utilize various tools (such as clinical examinations) and validated questionnaires (such as the Pain Assessment in Advanced Dementia (PAINAD) or the Dallas pain questionnaire for back pain) to evaluate the severity and characteristics of pain in patients.[73] Pharmacists are responsible for accurately dosing prescribed medications, including opioids, CBD, dronabinol, and nabilone. In the case of opioid overdose, the involvement of critical care physicians and emergency medicine clinicians plays a crucial role.

Nurses are vital in monitoring patients for respiratory depression, a potential adverse effect of opioid use. Pain management specialists are responsible for monitoring and managing the patient's pain and ensuring the accurate dosing of prescribed medications. They utilize various tools (such as clinical examinations) and validated questionnaires (such as the Pain Assessment in Advanced Dementia (PAINAD) or the Dallas pain questionnaire for back pain) to evaluate the severity and characteristics of pain in patients.[73] Pharmacists are responsible for accurately dosing prescribed medications, including opioids, CBD, dronabinol, and nabilone. In the case of opioid overdose, the involvement of critical care physicians and emergency medicine clinicians plays a crucial role. The incidence of CBD toxicity has been reportedly increasing; therefore, it is recommended to consult the Poison Control Center or a medical toxicologist for the latest information and guidance in cases of suspected toxicity.[74] In the perioperative period, anesthetists play a crucial role in caring for patients with cannabis use disorder. An interprofessional team approach involving clinicians (such as physicians, nurses, nurse practitioners, and physician assistants), specialists, pharmacists, and toxicologists is highly beneficial in improving the outcomes related to cannabis and opioids for pain management and preventing adverse effects.

Pain is a common and chief complaint among patients in both ambulatory and hospital settings. Clinicians effectively manage pain by obtaining a thorough history from the patient, conducting a comprehensive physical examination, investigating for accurate diagnosis appropriately, and incorporating evidence-based medicine for treating pain.[75] Healthcare professionals should examine the etiology of pain in their patients. For managing acute musculoskeletal pain and inflammation, healthcare professionals should consider prescribing NSAIDs as the initial pain relief approach before recommending opioids or cannabis to patients.[76] The American Gastroenterological Association guidelines suggest dicyclomine for managing spasmodic pain associated with irritable bowel syndrome. Intraarticular injection of corticosteroids is recommended for patients in cases of osteoarthritis. Fibromyalgia should be considered in patients exhibiting multiple tender points during a physical examination and with standard laboratory results. Regarding treatment, FDA-approved medications, such as duloxetine, pregabalin, and milnacipran, can be prescribed to help manage fibromyalgia symptoms.[77] The first-line medications for treating trigeminal neuralgia are carbamazepine and oxcarbazepine. Diabetic neuropathy or postherpetic neuralgia responds well to gabapentin medication.[78] If the pain is intractable and not responding to other treatment options, opioids or CBD may be considered.