While there are evidence based screening tools validated for internal medicine settings, more research is needed to determine best screening practices in patients needing pain management. Many demographic, physical, and psychosocial factors can predict opioid misuse in patients with chronic pain. A study by Hah and colleagues suggests the importance of considering risk factors such as substance use history, current prescriptions, and sleep problems while universally screening patients with chronic pain for opioid misuse. Screening for such factors and understanding how they affect patients can help primary care clinicians identify patients in pain who may be at risk for substance misuse (Hah, Sturgeon, Zocca, Sharifzadeh, & Mackey, 2017).
To combat the opioid crisis, clinicians can take important steps to provide the best care for their pain patients. These steps include risk stratification through universal screening and psychological assessments, as well as continuous assessments using urine drug testing, medical record audits, and other techniques (Cheatle, Comer, Wunsch, Skoufalos, & Reddy, 2014).
Insights From a Doctor of Physical Medicine and Rehabilitation/Pain Medicine Specialist
Steven Stanos, DO
Medical Director, Swedish Health System, Pain Medicine and Services
Special Project: Structured Functional Restoration Program
In addition to directing pain management services for the Swedish Hospital System, Dr. Stanos leads the Structured Functional Restoration Program—a pain rehabilitation center that aims to help patients understand and manage pain with medication and nonmedication approaches, including exercise, physical and occupational therapy, psychological counseling, relaxation training, and nursing education.
Dr. Stanos offers these tips for screening pain patients for risky substance use and expert guidance on what to do if patients with pain screen positive for unhealthy substance use.
Screening Pain Patients for Substance Use Disorder: Getting Started
Getting a Positive Screen: What’s Next?
Visit NIDAMED for additional resources for you and your patients.
Propose New Topics/Contact Us
Have any questions about the content on this page or do you have another topic in mind for Science to Medicine? Contact NIDAMED Coordinator Michelle Corbin with ideas or questions about Science to Medicine content.