Universal Precautions Revisited: Managing the Inherited Pain Patient

Authors

  • Douglas L. Gourlay MD, MSc, FRCPC, FASAM,

    Corresponding author
    1. The Wasser Pain Management Centre, Mount Sinai Hospital; Center for Addiction and Mental Health, Toronto, Ontario, Canada;
      Douglas L. Gourlay, MD, MSc, FRCPC, FASAM, The Wasser Pain Management Centre, Mount Sinai Hospital, Room 1160, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada. Tel: 416-535-8501 ext. 6754; Fax: 416-595-6821; E-mail: dgourlay@cogeco.ca.
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  • Howard A. Heit MD, FACP, FASAM

    1. Georgetown University School of Medicine, Washington, District of Columbia, USA
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Douglas L. Gourlay, MD, MSc, FRCPC, FASAM, The Wasser Pain Management Centre, Mount Sinai Hospital, Room 1160, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada. Tel: 416-535-8501 ext. 6754; Fax: 416-595-6821; E-mail: dgourlay@cogeco.ca.

ABSTRACT

“Universal Precautions in Pain Medicine: A Rational Approach to the Treatment of Chronic Pain” was published in 2005. In it, a unified 10-step approach to the assessment and management of patients suffering from chronic pain was proposed. As well, a triage scheme of risk stratification was offered. By placing patients into risk categories of low, medium, or high (Groups I, II, and III), it became possible to recommend to primary care practitioners those patients whom they might confidently manage on their own, comanage with specialty support, or refer to specialty clinics with more experience and resources to tackle these often challenging cases.

It is important to note that Universal Precautions is not simply about opioid prescribing, although the use of opioids does highlight the value inherent in managing risk in all patients. Moreover, it should serve to remind health care professionals that the presence of significant psychiatric comorbidities, including substance-use disorders, may represent treatable conditions that must be addressed in order to optimize outcomes.

Universal Precautions as a concept should be based upon mutual trust and respect between patient and practitioner, both of whom should be committed to setting and achieving realistic goals in both cancer and noncancer pain patients.

The goal of this article is to explore the application of a Universal Precautions approach to manage the care of patients with chronic pain who no longer have an appropriate source of the medications upon which they have become physically dependent—so-called inherited pain patients.

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