title: Universal precautions in pain medicine: a rational approach to the treatment of chronic pain.
abstract: 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.
authors.affiliation: The Wasser Pain Management Center, Mount Sinai Hospital, Toronto, Ontario, Canada. dgourlay@cogeco.ca
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Gourlay
authors.forename: Howard A
authors.initials: HA
authors.lastname: Heit
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Almahrezi
mesh_terms: D000700:Analgesics / Q000009:adverse effects* / Q000627:therapeutic use*; D002908:Chronic Disease; D006801:Humans; D010146:Pain / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000700:Analgesics