Universal Precautions in Pain Management

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.

1. Make a diagnosis with appropriate differential. Identify treatable causes for pain and instigate therapy.
2. Conduct a psychological assessment, including risk of addictive disorders.
3. Obtain informed patient consent.
4. Enter a verbal or written treatment agreement outlining the expectations and obligations of both the clinician and patient.
5. Assess pain level and function pre- and post-intervention.
6. Try an appropriate course of opioid therapy with or without adjunctive medication.
7. Regularly reassess patient's pain score and level of function.
8. Routinely assess the four As of pain medicine: analgesia, activity, adverse reactions, aberrant behavior.
9. Reevaluate pain diagnosis and comorbid conditions.
10. Document medical and pain management.

Source: Pain Med 2005;6:107-112.