Universal Precautions in Pain Medicine: A Rational Approach to the Treatment of Chronic Pain


Douglas L. Gourlay, MD, MSc, FRCPC, FASAM, The Wasser Pain Management Center, Mount Sinai Hospital, Room 1160 600 University Avenue, Toronto ON M5G 1X5O. Tel: 416-535-8501; Fax: 416-595-6821; E-mail: dgourlay@cogeco.ca.


The heightened interest in pain management is making the need for appropriate boundary setting within the clinician–patient relationship even more apparent. Unfortunately, it is impossible to determine before hand, with any degree of certainty, who will become problematic users of prescription medications. With this in mind, a parallel is drawn between the chronic pain management paradigm and our past experience with problems identifying the “at-risk” individuals from an infectious disease model.

By recognizing the need to carefully assess all patients, in a biopsychosocial model, including past and present aberrant behaviors when they exist, and by applying careful and reasonably set limits in the clinician–patient relationship, it is possible to triage chronic pain patients into three categories according to risk.

This article describes a “universal precautions” approach to the assessment and ongoing management of the chronic pain patient and offers a triage scheme for estimating risk that includes recommendations for management and referral. By taking a thorough and respectful approach to patient assessment and management within chronic pain treatment, stigma can be reduced, patient care improved, and overall risk contained.