1. 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

2. 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

3. 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

4. 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

5. 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

6. 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.

7. 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

8. 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

9. 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

10. 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

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

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

13. 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

14. 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

15. 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

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

17. 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

18. 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

19. 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

20. Examples of Individualized Treatment

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

22. 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

23. 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

24. 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