[Value of "medication screening" in therapy for chronic pain]

Drug therapy plays often an important role in the treatment of chronic pain. Former studies and also experiences of clinical practice have given evidence, that insufficient patient compliance is a widespread event. Therefore drug screening becomes a significant tool for quality assurance. In the following the methodical and practical aspects of drug screening are described and recommendations for its use in clinical practice are suggested.

This tool can be used to check the intake of prescribed drugs, to detect hidden taken drugs, to decide whether side effects result of the prescribed medication or not and to support a withdrawal therapy.

Drug screening presupposes an informed patient, who consents to the investigation. Otherwise confidence is risked and the handling with unexpected results is not possible any more. Testing of urine has the advantage of a non invasive procedure and makes use of the reservoir of the bladder. A close co-operation and good communication between therapist and laboratory prevents misinterpretations, which might result from inaccurate formulated questions or methodical limitations, for instance because of cross reacting substances or a too insensitive detection level for the respective drug. The finding must primary bee used to value the therapy and improve the compliance but can not prove the patient himself.

Even if the value of drug screening is not prospectively investigated until now, clinical experiences reveals it is as powerful tool for monitoring effectiveness and side effects of pharmacotherapy of pain and also of patient compliance which the prescribed drug regimes.