Resource Center: patient monitoring

From Treatment Improvement Protocol (TIP) Series from SAMHSA, published in 2012. Title implies this is related to chronic opioid therapy for patients in recovery from substance use disorders, which it is, but it also is relevant to use of chronic opioid therapy for all patients and preventing substance use disorders.

The American Pain Society held its 27th Annual Scientific Meeting in Tampa, FL, May 6- May 7, 2008. An intensive two-day pre-conference entitled, "The Essentials of Pain Management: Principles and Practice," was a 2-day course. The target audience was 3rd or 4th year residents in Anesthesia, Neurology, Family Medicine, Emergency Medicine and Physical/Rehabilitation Medicine.

Speaker: Steven D. Passik, PhD. Discussion of aberrant behavior (including misuse). Length: 57:48

Speaker: David Walk, MD. General approach to assessing pain including assessment tools, history taking tools. Discussion of different types of pain based on stimulous and intensity. Length: 33:21

Recommendations from the American Society of Anesthesiologists to assist physicians and patients in the management of cancer pain. The guidelines include a comprehensive evaluation and assessment, longitudinal monitoring, a paradigm on management, symptoms, and the psychosocial factors of cancer-related pain.

Recommendations for the treatment of patients with a psychiatric disorder in combination with a substance abuse disorder.

Alerts physicians about the risk of addiction in pain patients, suggests ways of effectively treating or assessing the patient during a short visit, and gives alternatives to prescribing potentially addictive drugs. Authors: Johnson B, Bursztajn HJ, Paul R, Coletsos I. Issue: 24(4)

Discusses opioid diversion in the USA, UK and Australia. Talks specifically about buprenorphine diversion and provides ways to reduce diversion. Towards end, does a good job of highlighting key findings regarding diversion. Author: Bell J

Opioid analgesics must be prescribed with discernment and their appropriate use should be periodically assessed. Urine drug testing, although not designed specifically for this role, is a widely available and familiar method for monitoring opioid use in chronic pain patients. Urine drug testing can help track patient compliance and expose possible drug misuse and abuse. We sought to evaluate current attitudes and practices regarding the use of urine drug testing among chronic pain patients taking opioids. To the best of our knowledge, this is one of the first such attempts in the literature to examine and document the practice patterns of urine drug testing in this context. A total of 99 attendees at the American Congress of Pain Medicine were surveyed in 2008 about their urine testing practices for patients on opioid therapy. Surprisingly, more urine testing was motivated by a desire to detect undisclosed substances than to evaluate appropriate opioid use. Some respondents never urine-tested their opioid patients, and about two-thirds of respondents had no formal training in urine testing of patients on opioid therapy. The literature does not thoroughly address the role of urine drug testing in this patient population. Most respondents did random rather than scheduled testing; few had any urine testing protocol. The study found motivations for urine testing and testing practices varied widely, and urine testing, despite its clinical utility, is not used consistently.

Articles describing the prevalence of chronic pain, the treatment options, disease management tools, and case studies that demonstrate managing debilitating chronic pain. Author: Compton P