Managing Chronic Pain: Practical Considerations to Improve Treatment Outcomes - Episode 3

Risk Stratification for Opioid Abuse

In this segment, the panelists detail their methods of stratifying chronic pain patients into low-, moderate-, and high-risk categories for opioid abuse and misuse.

Although moderater Jeffrey A. Gudin, MD, says it is important for physicians to consider patients’ prior exposure to opioid medications, Joseph Pergolizzi, MD, notes “we don’t want to be discriminatory, either … because the problem is, without an absolute biomarker, we’re never going to be sure” about their true risk for opioid abuse.

Regardless, if a primary care physician places a patient into a moderate-risk category, Pergolizzi advises consulting with a pain specialist or psychiatrist to devise the best approach to risk assessment.

“If the primary care doctors are saying, ‘I think this is an appropriate patient for opioids for all the reasons that were pointed out,’ let’s get a little bit of reassurance that there may not be other indicators that they might not be as familiar with, (which is) where I think a consultant is very helpful,” Pergolizzi explains.

However, Vitaly Gordin, MD, points out that patients can have “dual disease” consisting of anatomical pain alongside an addiction to its opioid therapy. While he does not believe it is ethical to deny them treatment, Gordin does “ask these patients to come more frequently than others, to bring their vials with pills, have regular urinary drug screens, and so forth.”