In a patient presenting with acute pain provide analgesia while seeking a diagnosis.
When assessing a patient with pain take a detailed history to recognize clinical patterns (diagnostic discerning characteristics) to inform diagnosis (e.g., neuropathic, vascular, muscular, visceral pain).
In a patient presenting with pain without a clear diagnosis:
Include life-threatening conditions in your differential diagnosis
Investigate appropriately and in a timely manner
When there is a concern about drug-seeking behaviour in a patient with pain:
Maintain your therapeutic relationship (e.g., be empathic, avoid stereotyping, manage frustration)
Do not attribute the presentation to drug-seeking without first considering an appropriately broad differential diagnosis
When treating pain with narcotics:
Dose appropriately considering narcotic naïveté and renal function
Consider addiction risk
Consider variable and potentially dangerous metabolic responses (e.g., codeine, especially in pregnant and breastfeeding women; sudden removal of a painful stimulus)
In a patient whose pain is not resolving or following the anticipated course, regularly re-evaluate (e.g., diagnosis, complications, medication choices, drug diversion).
When prescribing medication for pain inform the patient not to use over-the-counter products that contain the same drug or drugs from the same class (e.g., acetaminophen, NSAIDs)
When treating a patient with pain appropriately use non-pharmacologic treatments and self-management strategies to control pain and optimize function.
In a patient where acute pain has become chronic:
Recognize the transition
Readdress the treatment plan and your patient’s expectations appropriately