1. Managing Pain Patients: Assessing the chronic pain patient for opioid abuse potential

Video length: 2:16

Transcript

Doctor: And you are no longer doing the physical therapy?

Patient: No, I do not think it was doing me much good. So, can I get another script? I ran out this morning and my back is killing me.

Doctor: Sure, I can write a new prescription. First I would like to go over some information with you and ask you a few questions. I do not know if your previous doctor discussed this with you, but the use of opioid medication may lead to dependence and addiction. Are you aware of this?

Patient: He mentioned something about it, I am not addicted to anything, I am just in pain.

Doctor: I understand. However, it is my responsibility as your doctor to do everything I can to make sure that you use the medication safely and effectively. It is standard practice for all patients taking opioid medications.

Patient: Okay, well, sure. Ask me whatever questions you want.

Doctor: Answer each question based on a 5-point continuum according to how often you have used each substance over the past year: Never, once or twice, monthly, weekly, daily or almost daily.

Patient: Okay.

Doctor: On average, how often did you drink alcoholic beverages over the past year: never, once or twice, monthly, weekly, daily or almost daily?

Patient: Well, if you count wine or beer during dinner, I would have to say almost every day.

Doctor: And how many drinks did you typically have each day?

Patient: Oh, 1 or 2 on average.

Doctor: How often have you used tobacco products over the past year: never, once or twice, monthly, weekly, daily or almost daily?

Patient: Well I quit smoking 12 years ago when I got married, but do not tell my wife, I occasionally sneak a cigarette or 2 when I am out with my friends.

Doctor: How often is that?

Patient: I do not know, maybe once a month.

Doctor: Have you used any prescription drugs over the past year for non-medical reasons?

Patient: For non-medical reasons? No.

Doctor: What about illegal drugs? Over the past year have you used illegal drugs: never, once or twice, monthly, weekly, daily or almost daily?

Patient: Over the past year, never. In fact, over the past 20 years never. I used to smoke weed in high school, but never tried anything stronger.

Doctor: Okay, thank you for your candor. I would also like to ask you some additional questions about your medical history. According to your chart, you had an appendectomy back in 1989 and had—