This scenario presents a professional challenge due to the inherent complexities of managing chronic pain, the potential for diversion and misuse of controlled substances, and the pharmacist’s ethical and legal responsibility to ensure patient safety while facilitating appropriate pain management. The pharmacist must balance the patient’s reported pain with objective indicators and the prescriber’s intentions, all within the framework of professional standards and regulatory requirements. Careful judgment is required to avoid both under-treatment of legitimate pain and over-prescribing that could lead to harm. The best approach involves a comprehensive assessment that prioritizes patient safety and adherence to professional standards. This includes engaging in a direct, non-judgmental conversation with the patient to understand their pain experience, current medication use, and any challenges they face. Simultaneously, it necessitates a collaborative discussion with the prescriber to clarify the treatment plan, review the patient’s history, and discuss any concerns regarding the prescription’s appropriateness or potential risks. Documenting this entire process, including the rationale for any actions taken, is crucial for accountability and continuity of care. This approach aligns with advanced practice standards in pain management pharmacy, which emphasize interprofessional collaboration, patient-centered care, and risk mitigation for controlled substances. It upholds the pharmacist’s role as a guardian of public health and a trusted member of the healthcare team. An incorrect approach would be to dispense the prescription without further inquiry, assuming the prescriber’s judgment is infallible. This fails to acknowledge the pharmacist’s professional responsibility to assess the appropriateness of all dispensed medications, particularly controlled substances, and could inadvertently contribute to patient harm or diversion. Another incorrect approach would be to refuse to dispense the prescription outright based solely on a subjective feeling of concern, without first attempting to gather more information or consult with the prescriber. This could lead to patient abandonment and undertreatment of legitimate pain, violating the principle of beneficence. A further incorrect approach would be to contact the patient’s family or friends to inquire about their medication use without the patient’s consent. This violates patient confidentiality and privacy, undermining the trust essential for effective healthcare. Professionals should employ a systematic decision-making process when faced with such dilemmas. This involves: 1) Identifying the core issue and potential risks. 2) Gathering all relevant information from the patient, prescriber, and available records. 3) Consulting professional guidelines and regulatory requirements. 4) Evaluating potential courses of action based on ethical principles (beneficence, non-maleficence, autonomy, justice) and legal obligations. 5) Collaborating with the prescriber and other healthcare professionals as needed. 6) Documenting the decision-making process and the final action taken.

This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the pharmacist’s professional responsibility to ensure safe and effective medication use, particularly in the context of controlled substances for pain management. The pharmacist must navigate patient autonomy, the potential for misuse or diversion, and their ethical duty to prevent harm, all within the framework of relevant regulations. Careful judgment is required to balance these competing interests. The best professional approach involves a direct, empathetic, and informative conversation with the patient to understand the underlying reasons for their request and to educate them about the risks and benefits of the proposed medication change. This approach prioritizes patient-centered care while upholding professional standards. By engaging in open dialogue, the pharmacist can assess the patient’s understanding, identify potential red flags for misuse, and collaboratively explore safer alternatives or necessary adjustments to the treatment plan. This aligns with ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm), as well as regulatory requirements that mandate pharmacists to exercise professional judgment in dispensing controlled substances. An incorrect approach would be to immediately refuse the request without further investigation. This fails to acknowledge the patient’s concerns and may alienate them, potentially leading them to seek medications from less reputable sources. Ethically, it bypasses the opportunity to understand the patient’s needs and explore safer solutions. Legally, it could be seen as a failure to adequately assess the patient’s condition and treatment requirements. Another incorrect approach would be to fulfill the request without any further inquiry or documentation. This disregards the pharmacist’s professional responsibility to ensure the appropriateness of the prescription, especially for controlled substances. It opens the door to potential diversion, misuse, and adverse drug events, violating the pharmacist’s duty of care and potentially contravening regulations regarding the dispensing of controlled substances, which often require verification of legitimate medical purpose. Finally, an incorrect approach would be to contact the prescriber and insist on a different course of action without first speaking with the patient. While collaboration with the prescriber is crucial, bypassing the patient in this manner can undermine the therapeutic relationship and may not address the patient’s underlying issues. The pharmacist’s primary role is to dispense safely and effectively, which includes understanding the patient’s perspective before escalating to the prescriber, unless immediate safety concerns necessitate it. Professionals should employ a decision-making framework that begins with active listening and empathetic engagement with the patient. This should be followed by a thorough assessment of the patient’s condition, medication history, and understanding of their treatment. If concerns arise, the next step is to consult relevant professional guidelines and regulations. Collaboration with the prescriber is essential, but it should be informed by the patient interaction. Documentation of all interactions and decisions is paramount.

This scenario presents a professional challenge due to the inherent risks associated with compounding sterile products, particularly when a critical quality control parameter is compromised. The pharmacist must balance patient safety, regulatory compliance, and the efficient use of resources. Careful judgment is required to determine the appropriate course of action without jeopardizing the integrity of the medication or the trust of the prescriber and patient. The best professional practice involves immediately quarantining the affected batch of compounded sterile product and initiating a thorough investigation into the root cause of the temperature excursion. This approach prioritizes patient safety above all else, adhering to fundamental principles of sterile compounding and quality control. Regulatory frameworks, such as those outlined by the United States Pharmacopeia (USP) General Chapters and , mandate that compounded sterile preparations must be maintained within specific temperature ranges to ensure their stability, potency, and sterility. A temperature excursion indicates a potential breach in the environmental controls designed to protect the product, necessitating a comprehensive review of the compounding process, storage conditions, and environmental monitoring data. This proactive investigation allows for the identification and correction of any systemic issues, preventing future occurrences and ensuring that only safe and effective medications are dispensed. Ethically, the pharmacist has a duty to protect the patient from harm, which includes dispensing medications that meet all quality standards. An incorrect approach would be to dispense the remaining product from the affected batch without further investigation, assuming the excursion was minor and unlikely to impact the product’s quality. This disregards the potential for compromised sterility or potency, violating USP guidelines and the pharmacist’s ethical obligation to ensure product integrity. Such an action could lead to patient harm and significant regulatory repercussions. Another incorrect approach would be to simply discard the entire batch without attempting to identify the cause of the temperature excursion. While discarding the product is a necessary step if it is deemed unsafe, failing to investigate the root cause means that a potentially recurring problem remains unaddressed, increasing the risk of future compromised batches and patient exposure. This misses a critical opportunity for quality improvement and system enhancement. Finally, an incorrect approach would be to rely solely on the prescriber’s judgment to determine the suitability of the product after the temperature excursion. While collaboration with the prescriber is important, the ultimate responsibility for ensuring the quality and safety of compounded medications rests with the pharmacist. Delegating this critical quality control decision to the prescriber, who may not have direct knowledge of compounding processes or environmental monitoring, is a failure of professional responsibility and regulatory compliance. Professionals should employ a decision-making framework that begins with identifying the potential risks to patient safety. This involves understanding the implications of deviations from established protocols and guidelines. Next, they should consult relevant regulatory standards and ethical codes to guide their actions. A systematic approach to problem-solving, including thorough investigation and documentation, is crucial. Finally, open communication with all stakeholders, including patients, prescribers, and regulatory bodies when necessary, is essential for maintaining trust and ensuring optimal patient care.

Scenario Analysis: This scenario presents a professional challenge due to the inherent complexity of pain management, the potential for diversion and misuse of controlled substances, and the critical need for accurate and comprehensive patient record-keeping. Ensuring patient safety while adhering to strict regulatory requirements for controlled substance dispensing and management demands meticulous attention to detail and a robust understanding of pharmacy practice standards. The pressure to efficiently process prescriptions must be balanced with the ethical and legal obligation to verify the legitimacy and appropriateness of each dispensed medication. Correct Approach Analysis: The best professional practice involves a systematic and thorough verification process for all controlled substance prescriptions, particularly those related to pain management. This approach prioritizes patient safety and regulatory compliance by requiring the pharmacist to confirm the prescriber’s identity and licensure, verify the prescription’s authenticity (e.g., through prescriber contact if necessary), assess the patient’s history for potential red flags (e.g., early refills, multiple prescribers), and ensure the dispensed medication aligns with the patient’s diagnosed condition and treatment plan. This aligns with the fundamental ethical duty of a pharmacist to dispense safely and effectively, and with regulatory frameworks that mandate due diligence in dispensing controlled substances to prevent diversion and abuse. Incorrect Approaches Analysis: One incorrect approach involves dispensing the prescription solely based on the prescriber’s signature and the patient’s presence, without further verification. This fails to meet the standard of care and regulatory expectations for controlled substances. It bypasses crucial steps to identify potential fraud, prescription forgery, or inappropriate prescribing practices, thereby increasing the risk of diversion and patient harm. This approach neglects the pharmacist’s responsibility to act as a gatekeeper for potentially abusable medications. Another incorrect approach is to rely on the patient’s assertion that the prescription is legitimate and that they are experiencing significant pain, without independently verifying the prescriber’s credentials or the prescription’s validity. While patient rapport is important, it cannot substitute for due diligence. This approach is ethically flawed as it places undue trust in a potentially unreliable source and fails to protect against prescription fraud or misrepresentation. A third incorrect approach is to delegate the entire verification process to pharmacy technicians without direct pharmacist oversight and final approval. While technicians play a vital role in the dispensing process, the ultimate responsibility for verifying the legitimacy and appropriateness of a controlled substance prescription rests with the licensed pharmacist. This delegation, without adequate supervision and review, constitutes a failure in professional responsibility and a potential breach of regulatory requirements. Professional Reasoning: Professionals should adopt a risk-based approach to dispensing, with heightened scrutiny for controlled substances, especially those used in pain management. This involves establishing clear protocols for prescription verification, including prescriber identification, prescription authenticity checks, patient history review, and assessment of the prescription’s appropriateness for the patient’s condition. When in doubt, pharmacists should err on the side of caution and seek clarification from the prescriber or consult relevant professional guidelines and regulatory resources. A culture of continuous learning and vigilance regarding emerging trends in prescription drug abuse and diversion is also essential.

This scenario presents a professional challenge due to the inherent risks associated with medication safety, informatics, and regulatory compliance in a high-volume pain management pharmacy. The integration of electronic health records (EHRs) and dispensing systems, while intended to enhance efficiency and safety, introduces potential vulnerabilities such as data integrity issues, interoperability challenges, and the risk of human error in data entry or interpretation. Ensuring compliance with the relevant regulatory framework, which in this context is assumed to be the United States’ federal and state pharmacy laws and professional guidelines (e.g., DEA regulations for controlled substances, state board of pharmacy rules, HIPAA), requires a proactive and systematic approach to process optimization. The best approach involves a comprehensive, multi-faceted strategy that prioritizes continuous monitoring, robust data validation, and clear communication protocols. This includes implementing automated checks within the informatics system to flag potential discrepancies in prescriptions, patient profiles, or dispensing records, especially for controlled substances. Regular audits of dispensing data against prescription orders and patient records are crucial to identify and rectify errors promptly. Furthermore, establishing clear protocols for pharmacists and technicians regarding data entry, verification, and the handling of alerts generated by the informatics system is paramount. This approach directly addresses the regulatory expectation for accurate record-keeping, patient safety, and the prevention of diversion or misuse of controlled substances, aligning with the principles of good pharmacy practice and federal/state mandates. An incorrect approach would be to rely solely on manual review of dispensing logs without leveraging the full capabilities of the informatics system for automated flagging and validation. This overlooks the potential for systemic errors and increases the likelihood of missed discrepancies, violating the regulatory expectation for diligent record-keeping and oversight. Another unacceptable approach is to implement system alerts without establishing clear, documented procedures for how these alerts are to be investigated and resolved by qualified personnel. This creates a situation where critical safety information may be ignored or misinterpreted, leading to potential patient harm and regulatory non-compliance. Finally, a reactive approach that only addresses identified errors after they have occurred, rather than implementing preventative measures, fails to meet the standard of care and the proactive compliance expectations mandated by regulatory bodies. Professionals should employ a decision-making framework that begins with understanding the specific regulatory requirements applicable to their practice setting. This involves identifying potential risks within their operational processes, particularly those related to medication safety and data management. The next step is to evaluate existing informatics systems and workflows to determine how they can be optimized to mitigate these risks and ensure compliance. This often involves a combination of technological solutions (e.g., system configurations, automated checks) and procedural enhancements (e.g., training, clear protocols). Continuous evaluation and adaptation of these processes are essential to maintain a high standard of practice and regulatory adherence.

This scenario is professionally challenging because it requires a pharmacist to navigate the specific requirements for verifying proficiency in comprehensive pain management, a specialized area with significant patient safety implications. Misinterpreting the purpose or eligibility criteria for such a verification process could lead to inappropriate delegation of responsibilities, inadequate patient care, or non-compliance with professional standards. Careful judgment is required to ensure that only qualified individuals undertake these critical tasks. The best approach involves a thorough understanding of the regulatory framework governing pharmacy practice and specialized services. This includes identifying the specific purpose of the Comprehensive Pain Management Pharmacy Proficiency Verification, which is to establish a standardized method for assessing and confirming a pharmacist’s advanced knowledge, skills, and competencies in managing patients with complex pain conditions. Eligibility for this verification is typically defined by the regulatory body or professional organization and often includes specific educational prerequisites, supervised practice experience, and successful completion of a comprehensive assessment. Adhering to these defined criteria ensures that the verification process is robust, reliable, and serves its intended purpose of enhancing patient safety and quality of care in pain management. An incorrect approach would be to assume that general pharmacy licensure or experience in dispensing pain medications automatically qualifies a pharmacist for comprehensive pain management verification. This fails to recognize that comprehensive pain management requires specialized knowledge beyond routine dispensing, including pharmacotherapy, non-pharmacological interventions, patient assessment, risk management, and interdisciplinary collaboration. Another incorrect approach would be to bypass the formal verification process based on anecdotal evidence of a pharmacist’s perceived expertise or informal mentorship. This undermines the integrity of the verification system and lacks the objective evidence required to assure competence. Finally, an incorrect approach would be to interpret the verification process as a mere administrative hurdle rather than a critical quality assurance measure. This mindset can lead to a superficial engagement with the requirements, potentially resulting in a failure to adequately assess or demonstrate the necessary proficiencies. Professionals should approach situations requiring specialized verification by first consulting the relevant regulatory guidelines and professional standards. They should then meticulously review the stated purpose and eligibility criteria for the specific verification process. If there is any ambiguity, seeking clarification from the issuing authority is paramount. This systematic and evidence-based approach ensures that decisions are grounded in regulatory compliance and ethical responsibility, ultimately safeguarding patient well-being.

Scenario Analysis: This scenario is professionally challenging because it requires a pharmacist to balance the need for efficient and effective preparation for a high-stakes verification exam with the potential for information overload and the risk of relying on outdated or irrelevant resources. The Comprehensive Pain Management Pharmacy Proficiency Verification exam demands a thorough understanding of complex pharmacological principles, patient management strategies, and regulatory compliance within the specific jurisdiction. A poorly planned preparation strategy can lead to wasted time, increased anxiety, and ultimately, a failure to meet the required proficiency standards, potentially impacting patient care and professional standing. Careful judgment is required to select resources that are current, authoritative, and directly aligned with the exam’s scope. Correct Approach Analysis: The best professional practice involves a structured, multi-faceted preparation strategy that prioritizes official guidance and evidence-based resources. This approach begins with a detailed review of the examination blueprint and any official study guides provided by the verifying body. Subsequently, it involves consulting current, peer-reviewed literature and established clinical guidelines relevant to pain management, such as those published by recognized professional organizations or regulatory agencies within the specified jurisdiction. Integrating these authoritative sources with practical application through case studies and mock examinations ensures a comprehensive understanding and allows for the identification of knowledge gaps. This method is correct because it directly addresses the requirements of the verification process by focusing on validated information and practical application, minimizing the risk of relying on anecdotal or outdated advice. It aligns with the ethical obligation to maintain professional competence and provide safe, effective patient care. Incorrect Approaches Analysis: Relying solely on informal online forums and anecdotal advice from colleagues, without cross-referencing with authoritative sources, is professionally unacceptable. This approach risks exposure to misinformation, outdated practices, or opinions not grounded in current evidence or regulatory requirements. Such a strategy fails to meet the professional obligation to base practice on the best available evidence and regulatory standards, potentially leading to the acquisition of incorrect knowledge. Focusing exclusively on memorizing drug facts and dosages without understanding the underlying pharmacodynamics, pharmacokinetics, and patient-specific factors is also professionally inadequate. While factual recall is important, the verification exam likely assesses the ability to apply this knowledge in complex clinical scenarios. This approach neglects the critical thinking and clinical reasoning skills necessary for comprehensive pain management, thereby failing to demonstrate true proficiency. Adopting a preparation timeline that is overly compressed and reactive, cramming information in the final days before the exam, is a flawed strategy. This method hinders deep learning and retention, increasing the likelihood of superficial understanding and performance anxiety. It does not allow for the assimilation of complex information or the development of robust clinical judgment, which are essential for demonstrating proficiency in pain management. Professional Reasoning: Professionals facing this situation should employ a systematic approach to preparation. This involves: 1) Understanding the Scope: Thoroughly reviewing the exam’s objectives and content outline. 2) Resource Identification: Prioritizing official examination materials, regulatory guidelines, and evidence-based clinical practice guidelines from reputable professional bodies within the jurisdiction. 3) Structured Learning: Developing a study plan that allocates sufficient time for each topic, incorporating diverse learning methods such as reading, case study analysis, and practice questions. 4) Self-Assessment: Regularly evaluating knowledge gaps through mock exams and targeted review. 5) Continuous Learning: Recognizing that proficiency is an ongoing process, and preparation for verification is an opportunity to enhance current knowledge and practice.

The evaluation methodology shows a scenario where a pharmacist must integrate clinical pharmacology, pharmacokinetics, and medicinal chemistry to optimize pain management for a patient with complex needs. This is professionally challenging because it requires a nuanced understanding of drug mechanisms, patient-specific factors influencing drug disposition, and the chemical properties of medications to ensure efficacy and safety, particularly in a vulnerable patient population. Careful judgment is required to balance therapeutic benefit against potential harm, considering individual patient responses and the evolving nature of pain management. The best professional approach involves a comprehensive review of the patient’s current medication regimen, including prescription, over-the-counter, and herbal products, alongside a thorough assessment of their pain profile, comorbidities, and genetic predispositions that might affect drug metabolism. This approach prioritizes a holistic understanding of the patient and their drug interactions, leveraging knowledge of pharmacodynamics (drug effects) and pharmacokinetics (absorption, distribution, metabolism, excretion) to tailor therapy. It also necessitates considering the medicinal chemistry of the chosen agents, understanding their chemical structures and how these relate to their therapeutic actions and potential side effects. This aligns with professional ethical obligations to provide patient-centered care and adhere to best practices in medication management, ensuring that treatment decisions are evidence-based and individualized. An incorrect approach would be to solely focus on the prescribed opioid analgesics without considering potential interactions with other substances the patient may be using. This fails to acknowledge the complexity of polypharmacy and the potential for synergistic or antagonistic effects that could compromise pain control or increase the risk of adverse events. Ethically, this approach neglects the pharmacist’s duty to identify and mitigate drug-related problems comprehensively. Another incorrect approach would be to recommend switching to a different class of analgesics based on general guidelines without a detailed pharmacokinetic assessment of the patient’s ability to metabolize the new agents or considering the medicinal chemistry differences that might lead to altered efficacy or side effect profiles. This overlooks the critical need for individualized therapy and the potential for unexpected outcomes due to patient-specific factors. It violates the principle of providing evidence-based, patient-specific recommendations. A further incorrect approach would be to rely solely on the patient’s subjective reporting of pain relief without objectively evaluating pharmacokinetic parameters or potential drug-drug interactions. While subjective reporting is important, it must be contextualized by objective pharmacological principles. This approach risks overlooking underlying issues contributing to inadequate pain management or adverse effects, potentially leading to suboptimal treatment and patient harm. Professionals should employ a systematic decision-making process that begins with a thorough patient assessment, encompassing their medical history, current medications, pain characteristics, and any relevant genetic information. This is followed by an in-depth analysis of the pharmacological properties of all involved agents, including their mechanisms of action, pharmacokinetic profiles, and potential interactions. Medicinal chemistry principles should inform the understanding of drug structure-activity relationships. Based on this comprehensive evaluation, individualized therapeutic strategies can be developed, continuously monitored, and adjusted as needed, always prioritizing patient safety and optimal outcomes.

Scenario Analysis: This scenario presents a professional challenge rooted in balancing public health imperatives with individual patient autonomy and the practical limitations of a pharmacy setting. The pharmacist must navigate the complexities of vaccine availability, community demand, and the ethical obligation to provide accurate, accessible information and services. Careful judgment is required to ensure equitable access to immunizations while adhering to public health recommendations and professional standards. Correct Approach Analysis: The best professional practice involves proactively communicating with public health authorities and vaccine manufacturers to secure adequate supply and understand distribution timelines. This approach prioritizes informed decision-making by the pharmacist and ensures transparency with the public. By actively managing inventory, developing a clear communication strategy for patients regarding availability and appointment scheduling, and potentially collaborating with local healthcare providers for outreach, the pharmacy fulfills its role in population health impact. This aligns with public health pharmacy principles that emphasize preparedness, accessibility, and evidence-based practice in disease prevention. The ethical imperative to serve the community’s health needs is met by taking concrete steps to facilitate immunization delivery. Incorrect Approaches Analysis: One incorrect approach is to passively wait for vaccine shipments without any proactive communication or planning. This fails to address the potential for significant public health consequences arising from unmet demand and inequitable access. It neglects the pharmacist’s responsibility to be a proactive participant in public health initiatives and can lead to patient frustration and missed opportunities for immunization, thereby diminishing the population health impact. Another incorrect approach is to prioritize only patients who can demonstrate immediate need or who are willing to pay a premium for expedited service, without considering broader community access. This creates an inequitable distribution system that contradicts the public health goal of widespread immunization for community protection. It can also lead to ethical breaches related to fairness and access to essential healthcare services. A further incorrect approach is to provide incomplete or misleading information to patients about vaccine availability or eligibility. This erodes public trust, hinders informed decision-making, and can result in individuals delaying or foregoing crucial vaccinations, thereby negatively impacting population health outcomes. It violates the ethical duty of honesty and transparency. Professional Reasoning: Professionals should adopt a proactive and collaborative approach. This involves staying informed about public health directives, actively managing resources, and communicating transparently with both authorities and the public. A framework of preparedness, equitable access, and evidence-based practice should guide decision-making, ensuring that the pharmacy’s actions contribute positively to population health.

This scenario is professionally challenging because it requires a pharmacist to navigate complex patient needs across different disease states and age groups, while adhering to strict therapeutic guidelines and ensuring patient safety. The pharmacist must consider not only the efficacy of pain management but also potential drug interactions, contraindications, and the unique physiological and psychological aspects of pain experienced by individuals at various life stages, from pediatric to geriatric. Furthermore, the pharmacist must balance the need for effective pain relief with the risks associated with controlled substances, particularly in the context of chronic pain management and the potential for misuse or diversion. The best approach involves a comprehensive assessment of the patient’s pain, including its origin, intensity, duration, and impact on quality of life, alongside a thorough review of their medical history, current medications, and any co-existing conditions. This assessment should then inform the selection of an appropriate pain management strategy, prioritizing non-opioid analgesics and non-pharmacological interventions where possible, and reserving opioids for cases where other treatments are insufficient, using the lowest effective dose for the shortest necessary duration. This aligns with current best practices and regulatory guidance that emphasize a multimodal, individualized approach to pain management, focusing on functional outcomes and minimizing risks. Adherence to guidelines from bodies like the National Institute for Health and Care Excellence (NICE) in the UK, which promote evidence-based pain management strategies and the judicious use of analgesics, is paramount. An approach that solely focuses on prescribing the strongest available opioid without a thorough assessment of the patient’s pain history, other medical conditions, or potential for addiction or misuse is professionally unacceptable. This fails to consider the full spectrum of pain management options and disregards the ethical obligation to minimize harm. Similarly, an approach that dismisses a patient’s reported pain as purely psychological without a comprehensive medical workup and consideration of physiological causes is also flawed. This can lead to undertreatment of genuine pain and erode patient trust. Finally, an approach that relies on outdated prescribing practices or ignores emerging evidence on pain management, such as the risks associated with long-term opioid therapy or the benefits of alternative therapies, is not in line with professional standards and patient safety. Professionals should employ a systematic decision-making process that begins with a thorough patient assessment, followed by the identification of evidence-based treatment options. This involves consulting relevant clinical guidelines, considering patient-specific factors, and engaging in shared decision-making with the patient and their healthcare providers. Regular reassessment of treatment effectiveness and ongoing monitoring for adverse effects and potential for misuse are crucial components of responsible pain management.