Standardized guidelines have been suggested to manage all patients with chronic pain. By utilizing this approach, clinicians can lower the risks associated with opioid administration. These guidelines have been termed universal precautions in pain management, borrowing the concept of "universal precautions" from the infectious disease model, suggesting that it not possible for clinicians to assess all risks associated with opioid therapy (Gourlay, Heit, & Almahrezi, 2005). Therefore, it is appropriate to apply the minimum level of precaution to all patients utilizing this treatment. A more complete description of these precautionary steps is provided in this and other chapters of this book. The following steps from these guidelines are as follows:
■ Make a diagnosis with an appropriate differential
■ Psychological assessment, including risk of addictive disorders
■ Informed consent
■ Treatment agreement
■ Pre- and postintervention assessment of pain level and function
■ Appropriate trial of opioid therapy with or without adjunctive medication
■ Reassessment of pain score and level of function
■ Regularly assess the four As of pain medicine (analgesic, activities of daily living, adverse effects, and aberrant behaviors)
■ Periodically review pain diagnosis and comorbid conditions, including addictive disorders
■ Documentation that is complete and addresses all elements of assessment, medications, and treatment indications such as pain.
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