Intake assessment of problematic use of medications in a chronic noncancer pain clinic.
BACKGROUND
The present article outlines the process of instituting an assessment of risk of problematic use of medications with new patients in an ambulatory chronic noncancer pain (CNCP) clinic. It is hoped that the authors' experience through this iterative process will fill the gap in the literature by setting an example of an application of the 'universal precautions' approach to chronic pain management.


OBJECTIVE
To assess the feasibility and utility of the addition of a new risk assessment process and to provide a snapshot of the risk of problematic use of medications in new patients presenting to a tertiary ambulatory clinic treating CNCP.


METHODS
Charts for the first three months following the institution of an intake assessment for risk of problematic medication use were reviewed. Health care providers at the Wasser Pain Management Centre (Toronto, Ontario) were interviewed to discuss the preliminary findings and provide feedback about barriers to completing the intake assessments, as well as to identify the items that were clinically relevant and useful to their practice.


RESULTS
Data were analyzed and examined for completeness. While some measures were considered to be particularly helpful, other items were regarded as repetitive, problematic or time consuming. Feedback was then incorporated into revisions of the risk assessment tool.


CONCLUSIONS
Overall, it is feasible and useful to assess risk for problematic use of medications in new patients presenting to CNCP clinics.


CONCLUSIONS
To facilitate the practice of assessment, the risk assessment tool at intake must be concise, clinically relevant and feasible given practitioner time constraints.
Wasser Pain Management Centre, Mount Sinai Hospital, Toronto, Ontario, Canada. lpink@mtsinai.on.ca
Leah R
LR
Pink
Andrew J
AJ
Smith
Philip W H
PW
Peng
Marilyn J
MJ
Galonski
Paul S
PS
Tumber
David
D
Evans
Doug
D
Gourlay
Lesley
L
Gordon
Geoff
G
Bellingham
Satnam S
SS
Nijjar
Larry M
LM
Picard
Allan S
AS
Gordon
D000437:Alcoholism / Q000453:epidemiology / Q000517:prevention & control; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D059350:Chronic Pain / Q000188:drug therapy* / Q000453:epidemiology*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control
D000701:Analgesics, Opioid