Who Pain Ladder Management


Who Pain Ladder Management

What are the 5 A’s of pain medicine?

Table 4 – The Ten Principles of Universal Precautions for Patients with Persistent Using Chronic Opioid Therapy *

  1. Make a diagnosis with appropriate differential including the biopsychosocial-spiritual status.
  2. Psychological assessment including risk of addictive disorders. The assessment of the patient uses the biopsychosocial model with the spiritual factors included.
  3. Informed consent (verbal or written/signed). Provide patient education regarding management of pain and side effects.
  4. Treatment agreement to establish expectations of both the provider and the patient. Establish a therapeutic relationship promoting trust and honesty. This treatment agreement also includes safe storage of medications in the interest of public safety, i.e. Lock Your Meds®; as well as rationale for potential opioid discontinuation or discharge from medication treatment. See box 7 for Suggested Points for Inclusion in a Treatment Agreement.
  5. Pre/post intervention assessment of pain level and function. With the use of the bio-psychosocial-spiritual model, the assessment is included in its entirety.
  6. Appropriate trial of opioid therapy and/or adjunctive medications. Promote supportive recovery environment with family and significant other involvement. Integrate non-pharmacologic adjunctive therapies such as biofeedback, relaxation training, physical therapy, cognitive therapy and support groups.
  7. Reassessment of pain level and function. With the use of the biopsychosocial-spiritual model, the assessment is included in its entirety. Use of adherence monitoring measures are applied and include urine toxicology, screening tools for alcohol/substance use disorders, pill counts, and overall adherence with treatment plan appointments and medication use.
  8. Regularly assess the 5A’s which stand for Analgesia, Activity, Adverse Reactions, Aberrant Behavior and Affect **,
  9. Periodically review pain diagnosis and comorbid diagnoses, including addictive disorders and mental health.
  10. 10. Documentation.
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Every person for whom opioids are prescribed has the potential to abuse their medication ( Webster & Dove, 2007 ). A person’s vulnerability to prescription drug abuse is associated with many variables: the specific drug being prescribed, environmental and genetic factors, other illnesses, use of alcohol and other drugs, and the suffering associated with their persistent pain ( Savage, et al., 2008 ; Webster & Dove, 2007 ).

  1. Because it is impossible to predict who may abuse substances throughout the continuum of care, clinicians are compelled to respectfully assess every person before a prescription is written for an opioid ( Heit & Lipman, 2009 ).
  2. A systematic approach using the 10-point assessment of the Universal Precautions has been adapted using the biopsychosocial-spiritual model, and is presented in Table 4,

Risk stratification methods include the use of assessment tools to recognize patients at risk for medication adherence problems, and to evaluate problematic behaviors as they impact perceived risk and treatment planning. To assist in risk stratification there are many assessment tools on how to identify those at risk for SUDs, including opioid abuse or addiction ( Adams, Gatchel, Robinson, Polatin, Gajraj, Deschner, & Noe, 2004 ; Belgrade, Schamber, & Lindgren, 2006 ; Butler, Budman, Fernandez, & Jamison, 2004 ; Compton, et al., 1998 ; Ferrari, Cicero, Bertolini, Leone, Pasciullo, & Sternieri, 2005 ; Friedman, Li, & Mehrotra, 2003 ; Kirsh, 2007 ; Li, Katragadda, Mehrotra, Mosuro, & Friedman, 2001 ; Webster & Webster, 2005 ).

  • However, in a recent study of 428 health care providers assessing risk factors for opioid abuse, clinicians often misinterpreted initial presentation of aberrant behaviors, failing to appreciate the wide differential diagnosis ( Miller, Heit, Gourlay, Peppin, Hampton, & Miller, 2011 ).
  • If a patient takes more medication than prescribed, is this an indication of abuse, addiction, undertreatment (pseudoaddiction), anxiety, impulse, or confusion? Behaviors are frequently misunderstood and too often premature assumptions misdirect treatment.
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There is significant confusion about what it means to be adherent to an opioid regimen, and the screening tools for recognizing the risk of abuse are rarely used although readily available ( Miller, et al., 2011 ; Passik & Kirsh, 2003 ).

Why no NSAIDs after surgery?

Patients are often instructed not to take ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) before or after surgery because of increased bleeding risk. But available evidence suggests that ibuprofen does not increase the risk of bleeding after plastic surgery procedures, according to a research review in the April issue of Plastic and Reconstructive Surgery ®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

What is the most respected medical journal in the world?

The New England Journal of Medicine (NEJM) is recognized as the world’s leading medical journal and website.

What is best pain journal?

Pain & Pain Management

Publication h5-median
1. Pain 105
2. Journal of Pain and Symptom Management 101
3. Journal of Headache and Pain 89
4. Cephalalgia 77