TY - JOUR
T1 - Universal precautions in pain medicine
T2 - A rational approach to the treatment of chronic pain
AU - Gourlay, Douglas L.
AU - Heit, Howard A.
AU - Almahrezi, Abdulaziz
PY - 2005/3
Y1 - 2005/3
N2 - The heightened interest in pain management is making the need for appropriate boundary setting within the clinician-patient relationship even more apparent. Unfortunately, it is impossible to determine before hand, with any degree of certainty, who will become problematic users of prescription medications. With this in mind, a parallel is drawn between the chronic pain management paradigm and our past experience with problems identifying the "at-risk" individuals from an infectious disease model. By recognizing the need to carefully assess all patients, in a biopsychosocial model, including past and present aberrant behaviors when they exist, and by applying careful and reasonably set limits in the clinician-patient relationship, it is possible to triage chronic pain patients into three categories according to risk. This article describes a "universal precautions" approach to the assessment and ongoing management of the chronic pain patient and offers a triage scheme for estimating risk that includes recommendations for management and referral. By taking a thorough and respectful approach to patient assessment and management within chronic pain treatment, stigma can be reduced, patient care improved, and overall risk contained.
AB - The heightened interest in pain management is making the need for appropriate boundary setting within the clinician-patient relationship even more apparent. Unfortunately, it is impossible to determine before hand, with any degree of certainty, who will become problematic users of prescription medications. With this in mind, a parallel is drawn between the chronic pain management paradigm and our past experience with problems identifying the "at-risk" individuals from an infectious disease model. By recognizing the need to carefully assess all patients, in a biopsychosocial model, including past and present aberrant behaviors when they exist, and by applying careful and reasonably set limits in the clinician-patient relationship, it is possible to triage chronic pain patients into three categories according to risk. This article describes a "universal precautions" approach to the assessment and ongoing management of the chronic pain patient and offers a triage scheme for estimating risk that includes recommendations for management and referral. By taking a thorough and respectful approach to patient assessment and management within chronic pain treatment, stigma can be reduced, patient care improved, and overall risk contained.
KW - Abuse
KW - Addiction
KW - Misuse
KW - Pain
KW - Prescription
KW - Universal precautions
KW - Urine drug testing
UR - http://www.scopus.com/inward/record.url?scp=17844396442&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=17844396442&partnerID=8YFLogxK
U2 - 10.1111/j.1526-4637.2005.05031.x
DO - 10.1111/j.1526-4637.2005.05031.x
M3 - Article
C2 - 15773874
AN - SCOPUS:17844396442
SN - 1526-2375
VL - 6
SP - 107
EP - 112
JO - Pain Medicine
JF - Pain Medicine
IS - 2
ER -