Opioid therapy for chronic pain: Difference between revisions
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(/* Recommendations for patients with chronic pain (DO NOT EDIT) {{cite web |url=http://www.guideline.gov/content.aspx?id=16313&search=opioid+therapy+guidelines |title=National Guideline Clearinghouse | VA/DoD clinical practice guideline for m...) |
(/* Recommendations for patients with chronic pain (DO NOT EDIT) {{cite web |url=http://www.guideline.gov/content.aspx?id=16313&search=opioid+therapy+guidelines |title=National Guideline Clearinghouse | VA/DoD clinical practice guideline for m...) |
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| colspan="1" style="text-align:center; background:LightGreen"|'''Obtain Comprehensive Assessment Including: History, Physical Examination, and a Review of Diagnostic Studies''' | | colspan="1" style="text-align:center; background:LightGreen"|'''Obtain Comprehensive Assessment Including: History, Physical Examination, and a Review of Diagnostic Studies''' | ||
A comprehensive patient assessment should be completed to identify clinical conditions that may interfere with the appropriate and safe use of OT. The comprehensive assessment should include: | A comprehensive patient assessment should be completed to identify clinical conditions that may interfere with the appropriate and safe use of OT. The comprehensive assessment should include: | ||
Medical history | '''Medical history''' | ||
Age, sex | * Age, sex | ||
History of present illness, including a complete pain assessment (see Annotation C below) | * History of present illness, including a complete pain assessment (see Annotation C below) | ||
History of injury, if applicable | * History of injury, if applicable | ||
Past medical and surgical history | * Past medical and surgical history | ||
Past psychiatric history (including depression, anxiety, other emotional disorders, risk of suicide including family history and previous suicidal attempts) | * Past psychiatric history (including depression, anxiety, other emotional disorders, risk of suicide including family history and previous suicidal attempts) | ||
Medications (including current and past analgesics, their effectiveness, side effects, and tolerability, as well as drugs that may interact with OT) | * Medications (including current and past analgesics, their effectiveness, side effects, and tolerability, as well as drugs that may interact with OT) | ||
Substance use history (personal, family, peer group) | * Substance use history (personal, family, peer group) | ||
Family history | '''Family history''' | ||
Social history (including employment, cultural background, social network, marital history, and legal history, other behavioral patterns [i.e., impulse behaviors]) | * Social history (including employment, cultural background, social network, marital history, and legal history, other behavioral patterns [i.e., impulse behaviors]) | ||
Review of systems | '''Review of systems''' | ||
Allergies | * Allergies | ||
Abuse (sexual, physical, and mental) | * Abuse (sexual, physical, and mental) | ||
'''Physical examination''' | |||
Physical examination | * A general examination | ||
A general examination | * A pain-focused musculoskeletal and neurologic examination | ||
A pain-focused musculoskeletal and neurologic examination | * Mental Status Examination (MSE) (including level of alertness, ability to understand and follow instruction, and suicidal ideation) | ||
Mental Status Examination (MSE) (including level of alertness, ability to understand and follow instruction, and suicidal ideation) | * Review of diagnostic studies and assessments | ||
* Evaluation of occupational risks and ability to perform duty | |||
Review of diagnostic studies and assessments | |||
Evaluation of occupational risks and ability to perform duty | |||
Information from the pain history and physical exam should be reviewed to ensure that the patient has had an adequate therapeutic trial of non-opioid medication therapies. | Information from the pain history and physical exam should be reviewed to ensure that the patient has had an adequate therapeutic trial of non-opioid medication therapies. | ||
A urine drug test (UDT) (also referred to as urine drug screen [UDS]) should be used to screen for the presence of illegal drugs, unreported prescribed medication, or unreported alcohol use prior to starting therapy. [B] | * A urine drug test (UDT) (also referred to as urine drug screen [UDS]) should be used to screen for the presence of illegal drugs, unreported prescribed medication, or unreported alcohol use prior to starting therapy. [B] | ||
Patients on chronic OT should be assessed for suicide risk at onset of therapy and regularly thereafter. High suicide risk is a relative contraindication for OT. | * Patients on chronic OT should be assessed for suicide risk at onset of therapy and regularly thereafter. High suicide risk is a relative contraindication for OT. | ||
OT should be used only after careful consideration of the risks and benefits | * OT should be used only after careful consideration of the risks and benefits | ||
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Revision as of 11:41, 28 November 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Management of Opioid Therapy for Chronic Pain Working Group. VA/DoD clinical practice guideline for management of opioid therapy for chronic pain. Washington (DC): Department of Veterans Affairs, Department of Defense (DO NOT EDIT) [1]
Recommendations for patients with chronic pain (DO NOT EDIT) [1]
| Assessment of patient |
"1. A trial of opioid therapy (OT) is indicated for a patient with chronic pain who meets all of the following criteria:
" |
| "2. The ethical imperative is to provide the pain treatment with the best benefit-to-harm profile for the individual patient." |
| Obtain Comprehensive Assessment Including: History, Physical Examination, and a Review of Diagnostic Studies
A comprehensive patient assessment should be completed to identify clinical conditions that may interfere with the appropriate and safe use of OT. The comprehensive assessment should include: Medical history
Family history
Review of systems
Physical examination
Information from the pain history and physical exam should be reviewed to ensure that the patient has had an adequate therapeutic trial of non-opioid medication therapies.
|