When treating a chronic pain patient, it is important to provide an individualized treatment plan.
Basic principles:
(1) avoid opioid therapy, if possible, especially long-term use
(2) emphasize interventions with the lowest risk
(3) make non-pharmacologic interventions a necessary component
(4) base therapy on the underlying diagnoses and the mechanisms of pain
(5) identify barriers
Specific actions:
(1) use shared decision making
(2) define the patient's goals and specify measurable outcomes
(3) identify comorbidities and how they may influence management
(4) identify psychosocial factors
(5) educate the patient and facilitate self-management
(6) implement lifestyle changes
(7) use targeted therapies
(8) consider procedural interventions (injections, etc)
(9) consider referral to appropriate specialists
(10) obtain informed consent
(11) educate patient about how to use various treatments
(12) weigh the benefits and risks of various therapies
If an opioid is used:
(1) avoid alcohol
(2) avoid benzodiazepines and sedatives
(3) educate women of child-bearing age about neonatal abstinence syndrome
(4) sign drug agreement
(5) take into account whether the patient is opioid naive or tolerant
(6) identify patients who should have a naloxone prescription
(7) if a patient is not meeting functional goals while on opioids then consider discontinuation
