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Updated: May 22, 2026
09:38
Determining Pain Detection and Tolerance Thresholds Using an Integrated, Multi-Modal Pain Task Battery
Published on: April 14, 2016
Managing co-occurring substance use and pain disorders
Karen Miotto1, Aaron Kaufman, Alexander Kong
1Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90095-1563, USA. kmiotto@mednet.ucla.edu
The Psychiatric Clinics of North America
|May 30, 2012
Summary
The safest pain management involves non-opioid strategies. When opioids are necessary, careful risk assessment, structured monitoring, and a strong provider-patient relationship are crucial for safe opioid treatment.
Area of Science:
- Pain Management
- Addiction Medicine
- Public Health
Background:
- Opioid addiction poses a significant public health crisis.
- Non-opioid and benzodiazepine-free approaches are the safest pain treatment strategies for at-risk individuals.
- Risk stratification is essential for managing patients requiring opioid treatment.
Purpose of the Study:
- To outline a safe and structured approach to opioid pain management.
- To emphasize risk assessment and monitoring strategies for opioid therapy.
- To highlight the importance of the provider-patient relationship in safe opioid prescribing.
Main Methods:
- Utilizing biopsychosocial assessments and opioid screening tools for risk stratification.
- Implementing structured treatment plans with single prescribers, limited supplies, and no refills.
- Employing random urine drug screens and Prescription Drug Monitoring Program (PDMP) reports.
- Reviewing risk factors such as younger age, benzodiazepine use, and comorbid conditions.
Main Results:
- High-risk individuals require maximum structure and monitoring.
- Written informed consent and treatment agreements provide a framework for safe opioid management.
- Careful monitoring of analgesic efficacy, adverse events, and functional restoration is necessary.
- Identifying and mitigating risk factors, including concurrent substance abuse, is critical.
Conclusions:
- A non-opioid and benzodiazepine-free approach is the safest strategy for pain management.
- Structured monitoring, risk assessment, and informed consent are vital for safe opioid prescribing.
- A strong provider-patient relationship and clinician training in addiction are optimal for safe opioid treatment and public health protection.
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