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.
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Strength of recommendation: I = generally perform; II = may be reasonable to perform; III = generally do not perform.
Use established criteria to evaluate inappropriate opioid use by patients who are receiving long-term opioid therapy for chronic pain. Watch for red flag behaviors (Table 10).
A chronic secondary pain syndrome initially manifests as a symptom of another disease and then continues after successful treatment of the disease.15
Your provider may suggest trying a different medicine, changing your dose or weaning you off pills. Don't take a new sleeping pill the night before an important appointment or activity because you won't know how it affects you.
Exercise universal precautions for controlled substance prescribing and limit pill count for patients at risk of having their medications diverted
Patients on a stable dose of tramadol (Schedule IV) can be seen every 6 months. Refills for up to 6 months can be authorized on Schedule IV medication prescriptions. To avoid early refills, specify the fill dates for each refill in writing on the prescription.
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Table 9 provides a checklist of items to accomplish at each visit. Obtain a history and exam to assess the effectiveness of the pain treatment plan as well as the risks and benefits associated with opioid analgesics.
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Adhere to recommended guidelines and carefully document medical decision-making when prescribing opioids.
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