Chronic Pain and Drug Seeking Patients - CME Conferences
Chronic Pain and Drug Seeking Patients - CME Conferences Chronic Pain and Drug Seeking Patients - CME Conferences
3 rd Annual Essentials in Primary Care Summer Conference: Session 1 Tuesday, July 24, 2012 Assessment Challenges Pain is subjective 1,2 No satisfactory objective measures 1,2 Pain is multidimensional Gold standard for pain assessment – Patient’s self-report 2 Clinician must consider multiple aspects of the pain experience – Sensory, affective, cognitive 3,4 1. APS. Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. 5th ed. Glenview, Ill: American Pain Society; 2003. 2. McCaffery M, Pasero C, eds. Pain: Clinical Manual. 2nd ed. St. Louis, Mo: Mosby, Inc; 1999:36-102. 3. NPC/JCAHO. Pain: Current Understanding of Assessment, Management, and Treatments. December 2001. 4. Galer BS et al. Clin J Pain. 2002;18:297-301. 5. Ramelet A-S et al. Aust Crit Care. 2004;17:33-45. 6. Craig KD et al. Clin Perinatol. 2002;29:445-457. 7. Davis MP, Srivastava M. Drugs Aging. 2003;20:23-57. Clinical Assessment: Psychosocial History Current psychiatric symptoms History of addictive disease Medical Records and Speak to previous treating physician Change in social function – work – family and relationships – recreation Medical-legal status Grace Forde, MD Chronic Pain & the Drug Seeking Patient
3 rd Annual Essentials in Primary Care Summer Conference: Session 1 Tuesday, July 24, 2012 Trial of Opioid Therapy Document realistic goals Patient education Treatment agreement and informed consent forms Begin with short-acting agents Titrate to optimal effect Aggressively manage side effects Document exit strategies Creating an Exit Strategy Upon initiating opioid therapy, agree with patient on criteria for failure of the trial Common failure criteria include: – lack of significant pain reduction – lack of improvement in function – persistent side effects – persistent noncompliance Document method for tapering off opioids if trial is not successful Grace Forde, MD Chronic Pain & the Drug Seeking Patient
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3 rd Annual Essentials in Primary Care<br />
Summer Conference: Session 1<br />
Tuesday, July 24, 2012<br />
Assessment Challenges<br />
<strong>Pain</strong> is subjective 1,2 No satisfactory objective measures 1,2<br />
<strong>Pain</strong> is<br />
multidimensional<br />
Gold st<strong>and</strong>ard for pain assessment<br />
– Patient’s self-report 2<br />
Clinician must consider multiple aspects<br />
of the pain experience<br />
– Sensory, affective, cognitive 3,4<br />
1. APS. Principles of Analgesic Use in the Treatment of Acute <strong>Pain</strong> <strong>and</strong> Cancer <strong>Pain</strong>. 5th ed. Glenview, Ill: American <strong>Pain</strong> Society;<br />
2003. 2. McCaffery M, Pasero C, eds. <strong>Pain</strong>: Clinical Manual. 2nd ed. St. Louis, Mo: Mosby, Inc; 1999:36-102. 3. NPC/JCAHO.<br />
<strong>Pain</strong>: Current Underst<strong>and</strong>ing of Assessment, Management, <strong>and</strong> Treatments. December 2001. 4. Galer BS et al. Clin J <strong>Pain</strong>.<br />
2002;18:297-301. 5. Ramelet A-S et al. Aust Crit Care. 2004;17:33-45. 6. Craig KD et al. Clin Perinatol. 2002;29:445-457.<br />
7. Davis MP, Srivastava M. <strong>Drug</strong>s Aging. 2003;20:23-57.<br />
Clinical Assessment:<br />
Psychosocial History<br />
Current psychiatric symptoms<br />
History of addictive disease<br />
Medical Records <strong>and</strong> Speak to previous<br />
treating physician<br />
Change in social function<br />
– work<br />
– family <strong>and</strong> relationships<br />
– recreation<br />
Medical-legal status<br />
Grace Forde, MD<br />
<strong>Chronic</strong> <strong>Pain</strong> & the <strong>Drug</strong> <strong>Seeking</strong> Patient
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