Approach to Pain Management in a Large Outpatient Clinic Population (Scientific Article: Special Issue) (Report)

Approach to Pain Management in a Large Outpatient Clinic Population (Scientific Article: Special Issue) (Report)

General approaches to chronic pain syndromes While pain management is not the intended primary focus of outpatient clinics, about one-third of the United States population experiences chronic pain, and pain is the most common reason for patient visits. (1) Providing compassionate and effective control of persistent pain while avoiding inappropriate prescribing of controlled substances remains a perplexing daily challenge, particularly in our region. From 1999 to 2004, West Virginia had the highest increase in unintentional drug overdose mortality (550%) in the United States, (2) the majority occurring with drug diversion of prescribed medications, mainly opioids. (3) This trend does not appear to be abating. The illicit drug trade also results in disruption of families, financial hardship, violence, and sometimes homicide. Our internal medicine outpatient teaching program (West Virginia University Health Sciences Center, Charleston Division/Charleston Area Medical Center) serves a relatively large population, significantly indigent. As it is our ethical obligation to address pain issues, we have sought a practical modification of known guidelines and resources (4-7) to provide more effective opioid screening and monitoring, taking into account difficult time constraints and patient complexity. We write this current communication hoping to provide some practical information, but also to help us better organize and evaluate our own program. Chronic nonmalignant pain, usually musculoskeletal or neuropathic, will be addressed primarily. In general, we attempt to use several combined approaches to treat chronic pain, initially without opioids, if possible, Table 1. These approaches will be briefly reviewed first, followed by discussion of our efforts at opioid screening and management.

Approach to Pain Management in a Large Outpatient Clinic Population (Scientific Article: Special Issue) (Report)



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