Initiating opioid therapy
Before initiating opioid therapy, it is important that all patients undergo a thorough physical, psychological and functional examination, to ensure the management regimen is appropriate. This examination should be conducted in conjunction with a review of the patient's full medical history, with any additional tests conducted where appropriate.
The examination will assist physicians in:
- Selecting appropriate patients for opioid therapy, as well as identifying any potential problems that may arise (e.g. prior history of substance abuse, poor treatment compliance, etc.)
- Providing an understanding of the pain syndrome, including its aetiology and descriptors such as location, frequency and intensity, as well as duration.
- Providing an increased level of understanding about the impact of pain on psychosocial functioning and associated disability.
- Identifying the factors that exacerbate and relieve pain, as well as providing a background into what treatments have resulted in adequate pain relief in the past.
- Setting baseline measurements for both pain intensity and the patient's ability to function. The dual goals of treatment are to alleviate pain and improve the patient's ability to function normally.
Prior to prescribing opioid medications, physicians should thoroughly examine a patient’s medical records to review previous strategies and ensure that opioid therapy is an appropriate choice. This will help to establish previously prescribed managements, adherence to a particular course of therapy, the extent to which this therapy was tolerated, and any potential contraindications.
Useful questions for assessing patients before opioid management include:
- Has a realistic attempt been made to diagnose the underlying cause of pain?
- Has the patient kept a pain diary?
- What is the patient's physical and psychosocial status?
- Does the patient have a history of mental illness, or substance or alcohol abuse?
- What is the patient's current functional status?
- What improvement in functional status is desired, and how will this be measured?
- Does the patient understand and accept the goals of management?
- Does the patient understand the potential burdens of treatment?
- Have other reasonable treatments been properly tested and exhausted?