title: Toxicology in Pain Management.
abstract: Toxicology testing in pain management has become the standard of care. The Center for Disease Control and Prevention published guidelines including urine drug testing prior to initiating opioid therapy and for monitoring prescription and illicit drugs. Physicians must know indications for toxicology testing, and the frequency based upon risk stratification. This includes personal and family history of alcohol or substance related disorders, mental illness and smoking. Knowledge of opioid metabolism and various matrices to test are described. Additional knowledge of presumptive vs definitive testing along with algorithms and medical necessity with evidence-based clinical standards are discussed.
authors.affiliation: The Center for Pain Recovery, 18444 West, 10 Mile Road, STE 102, Southfield, MI 48075, USA. Electronic address: Dr@painrecoverymd.com.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Schwarz
authors.affiliation: Laboratory Operations, Alere Toxicology, 9417 Brodie Lane, Austin, TX 78748, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: George
authors.affiliation: Department of Pathology, Wayne State University School of Medicine, 540 East Canfield, Detroit, MI 48201, USA; Consolidated Laboratory Management Systems, 24555 Southfield Road, Southfield, MI 48075, USA.
authors.forename: Martin H
authors.initials: MH
authors.lastname: Bluth
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use / Q000652:urine; D059350:Chronic Pain / Q000652:urine*; D006801:Humans; D010146:Pain / Q000652:urine*; D059408:Pain Management / Q000379:methods*; D015813:Substance Abuse Detection / Q000379:methods*; D019966:Substance-Related Disorders / Q000652:urine
chemical_list: D000701:Analgesics, Opioid
keywords: Drug testing; Pain management; Pain medicine; Toxicology