Drug Testing in Pain Management

This is a 6-page series of videos which explain the details of Urine Drug Testing (UDT) to Primary Care Practitioners.  I’ve posted the link to each video and the corresponding text below:

Drug Testing in Pain Management  – from Practical Pain Management


Chronic pain is a leading reason why people visit their primary care physician (PCP) or family healthcare practitioner.  

Primary care physicians are on the forefront of care, and many of their patients have chronic pain.  Whether you are a PCP or in family practice—Drug Testing in Pain Management—can benefit your patients, the public, and your practice.

PCP Perspective on UDT in Patients with Chronic Pain

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Drug Testing: Balancing Need to Test With Need to Treat

Compliance in Pain Patients: Balancing Need to Test With Need to Treat

Legislators, medical boards, and physicians groups continue to try to balance the need to maintain access to pain medication for patients with chronic pain with the need to protect the public from abuse and diversion.

Pain patients who do not respond to the analgesic properties of the most commonly used opioids (common with EDS) have a significant chance of being genetically incapable of generating the clinically-active metabolite of these medications. See Non-responsive Pain Patients with CYP-2D6 Defect

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Medical Marijuana Could Help Patients Reduce Opiate Use

UCSF Study Finds Medical Marijuana Could Help Patients Reduce Pain with Opiates | ucsf.edu

A UCSF study suggests patients with chronic pain may experience greater relief if their doctors add cannabinoids – the main ingredient in cannabis or medical marijuana – to an opiates-only treatment. The findings, from a small-scale study, also suggest that a combined therapy could result in reduced opiate dosages.

In a paper published this month in Clinical Pharmacology & Therapeutics, researchers examined the interaction between cannabinoids and opiates in the first human study of its kind. They found the combination of the two components reduced pain more than using opiates alone, similar to results previously found in animal studies

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Cannabis and Pain

Cannabis and Pain

Exploring the use of cannabis in pain management, Donald Abrams, MD, chief of hematology-oncology at San Francisco General Hospital and professor of clinical medicine at the University of California San Francisco, walked those in attendance at this AAPM session through the plant’s introduction into medical treatment, its benefits, and how it works in pain management.

“Cannabis has traditionally been promoted for putative analgesic, sedative, anti-inflammatory, antispasmodic, and anticonvulsant properties,” said Dr. Abrams, “and analgesic effects of cannabis are not blocked by opioid receptors, [which allows for co-administration].” Cannabis can be effective for pain management of neuropathic pain and cancer pain, and has also shown efficacy in control of nausea and vomiting, and appetite stimulation.

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Debunking five myths that make it hard to understand pain

Five everyday myths that make it hard to understand pain

Surprisingly for such a universal experience, pain is profoundly misrepresented by common myths about what it is and what it means.

These are rooted in dualistic models: the body as a simple machine and the mind, distinct, receiving input from and sending orders to the machine. But pain emerges from recursive interaction of the brain and the body and constant adjustment of the system according to the organism’s priorities.

Below, facts that debunk 5 common myths about pain:

1. Pain is not a sensation

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The downside of opiod agreements and pain contracts

The downside of opioid agreements and pain contracts:

What’s trust got to do with it? Revisiting opioid contracts — Buchman and Ho — Journal of Medical Ethics

Prescription opioid abuse (POA) is an escalating clinical and public health problem. Physician worries about iatrogenic addiction and whether patients are ‘drug seeking’, ‘abusing’ and ‘diverting’ prescription opioids exist against a backdrop of professional and legal consequences of prescribing that have created a climate of distrust in chronic pain management.

One attempt to circumvent these worries is the use of opioid contracts that outline conditions patients must agree to in order to receive opioids.

Assuming the patient is untrustworthy may wrongfully undermine the credibility of the patient’s testimony, which may exacerbate certain vulnerabilities of the person in pain.

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Example of a Pain Treatment Agreement – Pain Contract

Example of a Pain Treatment Agreement

If your doctor asks you to sign a pain treatment agreement, discuss any concerns you may have with the doctor before signing the agreement. Questions you may want to ask include:

  • What medications does the agreement include?
  • How does the agreement affect emergency care?
  • What if I fail to follow the agreement?

A pain management agreement may include statements such as those listed in the sample document below.

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State-by-State Opioid Prescribing Policies

State-by-State Opioid Prescribing Policies

Physicians and others involved with prescribing controlled substances must be well-versed in the legal requirements including knowledge of both federal and state law. The Controlled Substances Act (CSA) is the federal law that regulates such substances

The Drug Enforcement Administration (DEA) publishes a guide for prescribers entitled “Practitioner’s Manual, an Informational Outline of the Controlled Substances Act.” This resource provides a comprehensive overview of the Controlled Substances Act and the federal requirements for prescribing controlled substances.

Additionally, all states have further regulations involving controlled substances.

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Practicioner’s Manual for Controlled Substances

Practicioner’s Manual - an Informational Outline of the Controlled Substances Act

This manual has been prepared by the Drug Enforcement Administration, Office of Diversion Control, to assist practitioners (physicians, dentists, veterinarians, and other registrants authorized to prescribe, dispense, and administer controlled substances) in their understanding of the Federal Controlled Substances Act and its implementing regulations as they pertain to the practitioner’s profession.

Download Practitioner’s Manual PDF

Table of Contents

  1. Section I – Introduction
  2. Section II – General Requirements –  includes Schedules of Controlled Substances
  3. Section III – Security Requirements
  4. Section IV – Recordkeeping Requirements
  5. Section V – Valid Prescription Requirements.
  6. Section VI – Opioid (Narcotic) Addiction Treatment Programs


Proof that the AMA has a sense of humor

From within the AMA web site comes this:

How Many of us Does It Take to Change a Light Bulb?

A Code of Ethical Behavior for Patients

Do not expect your doctor to share your discomfort. Involvement with the patient’s suffering might cause loss of valuable scientific objectivity.

Be cheerful at all times. Your doctor leads a busy and trying life and requires as much gentleness and reassurance as possible.

Try to suffer from the disease for which you are being treated. Remember that your doctor has a professional reputation to uphold.

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