Managing Chronic Pain: Practical Considerations to Improve Treatment Outcomes - Episode 2
In this video segment, the expert panelists describe how they choose chronic pain candidates for opioid therapy and assess risk for misuse.
Since “one of the underlying principles of opioid pharmacotherapy is that they’re not first-line,” Christopher Gharibo, MD believes patients should not be considered for opioid treatment until they have failed to respond to acetaminophen, anti-inflammatories, antidepressants, anticonvulsants, and physical therapy.
Once a patient is deemed a reasonable candidate for opioid therapy, Vitaly Gordin, MD, uses multiple screening tools to gauge the risk of opioid misuse, including urine drug testing and the Opioid Risk Tool (ORT) that assesses history of substance abuse, pre-adolescent sexual abuse, and any untreated, ongoing psychiatry conditions. Gordin also works with a psychologist to administer the Screener and Opioid Assessment for Patients with Pain (SOAPP) risk assessment tool, which stratifies patients into 3 levels of risk: mild, moderate, and severe.
Nevertheless, Joseph Pergolizzi, MD, points out “there is no one absolute perfect risk screening tool nor biomarker that we can use,” while Gharibo adds “whatever risk your patient is presenting with, that risk is constant, dynamic, and really depends on the circumstances.”
“Things happen in life. Somebody could be very much low risk for many years, and then something catastrophic happens — their spouse dies or a loved one dies — and all of a sudden, they start to chemical cope,” Gharibo explains. “So, there needs to be ongoing surveillance … to monitor the risk level.”