A Systematic Approach to the Treatment of Chronic Pain

An Excerpt from PainEDU

Many clinicians may have reluctance to prescribe opioids for patients in pain outside of the most controlled of situations (i.e., when the patient is a hospital inpatient). Clinicians have fear of regulatory scrutiny and investigation if they prescribe these medications on a regular basis.

Experts in the field of pain management have suggested using common medical approaches and paradigms, similar those used as part of routine clinical practices for other medical conditions. This can help allay some fears and concerns on both sides of the “opiophobic fence.” It also has the potential to improve the confidence level for clinicians to use opioids when they are the appropriate choice for the treatment of patients in chronic pain.

The term “universal precautions” originated from an infectious disease model that addressed an approach to patients when there was a deficiency of significant risk assessment information. Past behavior or practices were not reliable indicators of safe and reasonable approaches, especially with at-risk patients. In 2005, Gourlay, Heit, et al., proposed a “universal precautions”¹ approach to the use of opioids in the pain patient. They are not proposed as complete but rather as a good starting point for those treating chronic pain. As with universal precautions in infectious diseases, by applying the following recommendations, patient care is improved, stigma is reduced, and overall risk is contained.”

Utilizing an approach like universal precautions for all patients who are appropriate candidates for chronic opioid therapy has the potential to unify treatment plans, allow for unbiased application of treatment standards and monitoring, and can potentially reduce the under-treatment of pain when opioids are part of the indicated solution. Although it has been ten years since this approach was recommended, to many it continues to provide a systematic, reproducible method for safe and appropriate use of chronic opioid therapy today.

References:

Gourlay DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Med. 2005 Mar-Apr;6(2):107-12.

Passik SD, Weinreb HJ. Managing chronic nonmalignant pain: Overcoming obstacles to the use of opioids. Adv Ther. 2000;17(2):70-83.