Pain Management Assessment Beyond the Physician Encounter

The long-term use of opioids in the treatment of chronic pain patients has increased dramatically over the last two decades. With this increase has come abuse, misuse, diversion, and overdose deaths, resulting in tremendous media attention. Further, there has been an increase in regulatory scrutiny of the prescribing practices of healthcare professionals. Monitoring patient compliance with chronic opioid therapy has become very important. Urine drug monitoring and patient agreements are part of this monitoring effort. However, interpreting test results can be challenging and applying these results to patient care can be complex. Metabolites, interfering substances, and false-positives and false-negative results all need to be considered when interpreting test results. Test results should not be considered sacrosanct and should always be an opportunity for discussion with a patient.