June 2012: Volume 38, Number 6
Universal Precautions in Pain Management
In 2005, pain medicine specialists Douglas Gourlay, MD, MSc, and Howard Heit, MD, put forth the concept of universal precautions in pain management, as a standardized approach to the assessment and ongoing management of all chronic pain patients. Borrowing from the field of infectious diseases, this 10-step approach assumes that it is impossible to predict which long-term pain patients will develop problems with prescription medications.
- Make a diagnosis with appropriate differential. Identify treatable causes for pain and instigate therapy.
- Conduct a psychological assessment, including risk of addictive disorders.
- Obtain informed patient consent.
- Enter a verbal or written treatment agreement outlining the expectations and obligations of both the clinician and patient.
- Assess pain level and function pre- and post-intervention.
- Try an appropriate course of opioid therapy with or without adjunctive medication.
- Regularly reassess patient’s pain score and level of function.
- Routinely assess the four As of pain medicine: analgesia, activity, adverse reactions, aberrant behavior.
- Reevaluate pain diagnosis and comorbid conditions.
- Document medical and pain management.
Source: Pain Med 2005;6:107-112.