Universal precautions in pain medicine: a rational approach to the treatment of chronic pain

Pain Med. Mar-Apr 2005;6(2):107-12. doi: 10.1111/j.1526-4637.2005.05031.x.


The heightened interest in pain management is making the need for appropriate boundary setting within the clinician-patient relationship even more apparent. Unfortunately, it is impossible to determine before hand, with any degree of certainty, who will become problematic users of prescription medications. With this in mind, a parallel is drawn between the chronic pain management paradigm and our past experience with problems identifying the "at-risk" individuals from an infectious disease model. By recognizing the need to carefully assess all patients, in a biopsychosocial model, including past and present aberrant behaviors when they exist, and by applying careful and reasonably set limits in the clinician-patient relationship, it is possible to triage chronic pain patients into three categories according to risk. This article describes a "universal precautions" approach to the assessment and ongoing management of the chronic pain patient and offers a triage scheme for estimating risk that includes recommendations for management and referral. By taking a thorough and respectful approach to patient assessment and management within chronic pain treatment, stigma can be reduced, patient care improved, and overall risk contained.

MeSH terms

  • Analgesics / adverse effects*
  • Analgesics / therapeutic use*
  • Chronic Disease
  • Humans
  • Pain / complications
  • Pain / diagnosis*
  • Pain / drug therapy*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • Risk Assessment / methods*
  • Risk Factors
  • Substance-Related Disorders / etiology*
  • Substance-Related Disorders / prevention & control*
  • Treatment Outcome


  • Analgesics