Family History Information Helps Inform Chronic Pain Treatment Elizabeth Pestka, MS, PMHCNS-BC, APNG Cynthia Townsend, PhD, LP Emily Dresher, MSN, RN Karen Weiss, PhD, LP Joan Cronin, MS, PMHCNS-BC-LADC Susan Bee, MS, PMHCNS-BC Susan King, BSN, RN Virginia Nash, DNP, PMHCNS-BC Jacqueline Kimondo, BSN, RN Michele Evans, MS, PMHCNS-BC Mayo Clinic, Rochester, MN

Objectives Identify the prevalence of a family history of substance abuse in patients admitted to the Mayo Clinic Pain Rehabilitation Center Describe relationships between having a positive family history of substance abuse and patients’ understanding of their own risk associated with family history Discuss nursing implications of assessing and utilizing family history information in chronic pain treatment

Background for Quality Improvement Study US Centers for Disease Control and Prevention have classified prescription drug misuse as an epidemic Chronic pain patients often have risk factors for prescription drug addiction and other substance use disorders Positive family history of substance abuse is an identified risk factor

Heritability of Substance Use Disorders Evidence from twin and adoption studies report heritability of alcohol use disorders at 0.5 to 0.6 Estimates for other substance use disorders ranges from 0.3 to 0.8

Benefits of Family History Information Identify persons who are at risk for addiction in the future Identify persons who already have the condition but have not been diagnosed or treated Individualize interventions for each person based on their family history

Aim of Quality Improvement Study Strengthen clinical practice by identifying the prevalence of a family history of substance abuse in the patient populations admitted to the adult and pediatric Pain Rehabilitation Center programs at Mayo Clinic and help guide individualized treatment interventions for persons with chronic pain and a family history of a substance use disorder.

Study Population and Sample Population includes patients seeking treatment for chronic pain conditions at the Mayo Clinic Pain Rehabilitation Center in Rochester, MN between May 21, 2012 and August 10, 2012 Sample is all persons voluntarily responding to family history questions Consists of 94 adult patients Consists of 37 pediatric patients

Study Methods Patients asked to report on a family history of substance abuse disorders as part of their admission assessment Findings documented in their electronic medical record Patients asked to complete a very brief survey questionnaire at the time of admission and at dismissal from the 3 week programs Names used to connect family history data with survey responses and then eliminated

Study Survey : Patients Rated Their Response from 1 – 5 on Three Questions A family history of substance abuse increases the risk of this condition in other family members Prescribed pain medications used by chronic pain patients may be used as a substance of abuse There is benefit in education on substance abuse in a pain rehabilitation program

Data Analyisis Reported family history of a substance abuse disorder extracted from patient records with family relationship identified Family history data entered into an excel spreadsheet Survey responses, pre and post treatment, entered into the excel spreadsheet Descriptive results calculated Comparative results analyzed using SPSS

Reported Prevalence of a Family History of Substance Abuse All patients (n=131) Adult patients(n=94) Pediatric patients (n= 37)

Reported Number of Affected Family Members All patients Adult patients Pediatric patients Represents # of family members reported with substance abuse in positive histories

Pre-Survey Question on Inherited Risk A family history of substance abuse increases the risk of this condition in other family members (rate 1 strongly disagree – 5 strongly agree) Mean all rating Mean adult rating Mean pediatric rating

Pre-Survey Question on Medication Abuse Prescribed pain medication used by chronic pain patients may be used as a substance of abuse (rate 1 strongly disagree – 5 strongly agree) Mean all rating Mean adult rating Mean pediatric rating

Pre-Survey Question on Benefit of Education There is benefit in education on substance abuse in a pain rehabilitation program (rate 1 strongly disagree – 5 strongly agree) Mean all patients Mean adult rating Mean pediatric rating

Response Comparative Analysis Final data analysis is in process and will be available for presentation and discussion at the time of the conference

Adult Chronic Pain Track on Awareness of Substance Abuse Education and awareness related to substance use disorders included for patients Family history important risk factor for substance use disorders in chronic pain patients Group time spent on diagramming family pedigrees and discussing family histories of substance use disorders and their implications for each patient

Informing Chronic Pain Treatment Individualized patient education Specific counseling related to family history Motivational interviewing using a family history of a substance use disorder as a factor to support positive changes

Pediatric Chronic Pain Consideration of Risk for Substance Abuse Family history and personal use patterns are used to determine need for an appointment with a chemical dependency counselor for further evaluation and possible treatment recommendations Parent’s concerns are included in treatment planning

Examples of Individualized Treatment

Potential of Individualized Medicine Make health care not only more effective, but more efficient and affordable

Roles for Nurses in Individualized Care Clinical care focused on health promotion and disease prevention Needs of each patient and their family members comes first

Family history identifies inheritance patterns and family health risks Model regarding use of family history information in health promotion Health professional decision-making regarding health promotion/disease prevention strategies for family members influenced Likelihood of nurses engaging in practice of collecting comprehensive family history data enhanced Identification of most relevant perceived benefits to family member health promoting/disease prevention action strengthened Likelihood of family member engaging in health promoting/disease preventing activity improved Family history identifies inheritance patterns and family health risks

Summary Findings from this study provide data on prevalence of a family history of substance abuse in a population of chronic pain patients and reports attitudes about family history information Examples of how family history information related to substance abuse can support and tailor treatment for chronic pain conditions including education, counseling and motivational interviewing Nurses can help maximize the potential of individualized medicine