Pain Assessment and Management, 2nd Edition _ _________________________________________________
GUIDELINES TO COMPLETE EVALUATION
Biological components
• Medical history, review of systems, and physical examination of targeted pain condition • A review of current medications, including over-the-counter drugs and natural remedies • A description of the nature and intensity of the pain • Underlying or coexisting diseases or conditions, including those that could complicate treatment (e.g., obesity, renal disease, sleep apnea, chronic obstructive pulmonary disease) • Effect of pain on physical functioning • Urine, blood, or other types of biological samples and diagnostic markers
Psychological components
• Effect of pain on psychological functioning • Personal and family history of substance use disorder • History of behavioral health disorders
Interventional components • Current and past treatments, including interventional treatments, with response to each treatment • Medical indication(s) for use of opioids • Review of the prescription drug monitoring program results • Consultation with other clinicians when applicable Source: Adapted from Workgroup on the Model Policy for the Use of Opioid Analgesics in the Treatment of Chronic Pain (2024) Table 5
Based on information gathered during the evaluation, the client and clinician together develop a treatment plan and goals. Goals focus on improvement in function and decreasing other symptoms related to pain. It is important to recognize how social determinants of health impact access to therapies and identify strategies or options to help these individuals obtain treatment. Pharmacologic and nonpharmacologic interventions, including other diagnostic tests, consultations, or therapies (cognitive-behavioral, massage, exercise), are pos- sible options (Workgroup, 2024). The guidelines recommend the use of an informed consent and treatment agreement to be used with clients who have long- term chronic use of opioids in the plan of care (Workgroup, 2024). The informed consent discusses all the risks, prescribing policies, reasons for discontinuation, and education around expectations. The treatment agreement outlines the responsi- bilities of all involved (Workgroup, 2024). • Treatment goals in terms of pain management, restoration of function, and safety • Patient’s responsibility for safe medication use • Secure storage and safe disposal • Patient’s responsibility to obtain prescribed opioids from only one clinician or practice • Patient’s responsibility to get the prescriptions filled at only one pharmacy • Patient’s agreement to periodic drug testing • Clinician’s responsibility to be available or to have a covering clinician available to care for unforeseen problems and to prescribe scheduled refills.
Although this agreement is often between the physician and the client, the practitioner should be aware of its contents in order to support the client. For example, the practitioner may be the one who hears that the client has lost their prescription or is filling a prescription at a different pharmacy. Although these behaviors may be perfectly innocent, they could poten- tially put therapeutic relationships at risk. Common complaints that may give rise to lower patient satisfac- tion and potential litigation include inadequate pain control during treatment (Kollas & Kollas, 2024). Clients with chronic pain can experience stigma not only from their healthcare providers but also from family, friends, and coworkers, who may doubt the legitimacy of their pain experience. These people may consider the pain to be “all in the head” or the result of “hysteria” or a low pain tolerance. Pain diagnoses associated with stigma include low back pain, fibromyalgia, and migraines. Stigma about pain can lead to undertreatment (Collier, 2018). A study by Dassieu et al. (2021) found that people who use prescription opioids experience three primary impacts of the opioid overdose epidemic. These were worries about the dan- gers of opioids, stigma related to use of opioids during conversa- tions with others, and stigma management. To address these issues, individuals would often conceal their use from others. It is important to also recognize stigma not just from family, friends, and coworkers. Practitioners need to recognize that their own biases, both conscious and unconscious, may affect access to treatment (Steenhof & Ng, 2024). These biases could be related to the client’s personal life choices, culture, appear- ance, or substance use history (Cooke et al., 2023). Overall,
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