The focus in chronic pain assessment differs from the evaluation of acute pain, which assumes a specific underlying injury or disease that treatment will cure. Begin chronic pain assessment with the history and physical examination. Important components of the initial evaluation are summarized in Table 3 and are detailed below.
Since chronic pain is a disease entity rather than a symptom of an underlying disease, a new strategy is needed to assess patients with chronic pain. Assessment should result in the diagnosis of a chronic pain syndrome and determine the underlying neurobiologic mechanism to help direct specific treatment strategies.
Storage. Advise patients to store opioid medications in a secure location, preferably locked, that is away from household traffic. Opioids are a common reason for home invasion. Accidental ingestion by children and pets is also a concern.
Psychiatric comorbidities. Review the past medical history and assess the presence of psychiatric conditions that could affect the patient’s response to chronic pain, communications with the patient about chronic pain, or treatment.
When the benefits of adding an opioid to other therapy outweigh the risks, select the initial drug and dose based on the:
Principles for managing opioid use disorder in pain patients. The treatment of pain patients who exhibit evidence of opioid use disorder requires heightened monitoring, or discontinuation of opioid therapy and initiation of addiction treatment.
Substance use disorders. Obtain a substance use history in all patients with chronic pain, including the use of alcohol, illicit drugs, tobacco, and caffeine. When the etiology of pain is unclear, this history can help assess the risk for substance use disorder prior to considering treatment with opioids. Obtain a family history of substance use disorders as part of a comprehensive risk assessment. Consider use of a standardized screening tool, such as the drug abuse screening test (DAST-10) or the Michigan opioid risk assessment (MORA).
Remember the facts: Smoking can kill you. And think about how much better you’ll feel once smoking is out of your life.
Be familiar with transdermal and buccal buprenorphine. Sublingual buprenorphine should be initiated only by prescribers trained in its use. It can provoke acute copyright online pharamcy opioid withdrawal if not done correctly.
Many patients with chronic pain have long and sometimes complex treatment histories. Obtain a full history, including:
The hallmark of acute pain is tissue inflammation. Acute pain can be nociceptive or neuropathic. Accordingly, measures to reduce inflammation are helpful when developing a treatment plan for acute pain conditions. Some treatments to consider for acute pain include those listed in the table below:
Some evidence exists for methadone use in this population as well. However, it is less promising than buprenorphine.
These drugs act by blocking the effects of nicotine on the brain or changing brain chemicals involved in addiction. Always consult a doctor before taking medicine.
The goal of physical therapy is to improve function. Therapeutic exercise, other modalities, manual techniques, and patient education are part of a comprehensive treatment program to accomplish this goal.