FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain
Written by Editor   
Monday, May 29, 2017 10:09 PM

Pain can be categorized according to its duration, underlying pathophysiology of the original insult, and whether a central sensitization component has developed. An understanding of these different categorizations can help direct therapeutic decisions.

Pain can be classified as follows:

Acute vs. chronic – Health care providers (HCPs) should be knowledgeable about the differences in the classification of pain based on how long it is expected to last.
Neuropathic vs. non-neuropathic – HCPs should be knowledgeable about the mechanisms underlying pain and the differences between nociceptive and neuropathic pain, and peripheral and central neuropathic pain.
HCPs should be knowledgeable about how to fully assess each patient when initiating a pain management program. When appropriate, standardized scales can be used to help document pain characteristics and guide management decisions throughout treatment.

Important elements of an initial assessment include the following:

1. Patient History –A complete history should be obtained. As part of the history of the pain condition, include prior evaluation such as diagnostic studies and types of past prior pharmacologic and nonpharmacologic treatment attempts and response. Any history of substance use, psychiatric history, family history of substance abuse and psychiatric disorders should be obtained and documented.

2. Screening tools should be used to evaluate known risk factors for development of chronic pain after an acute injury or disease.

3. Screening tools should be used to evaluate the known risk factors for opioid use disorder or abuse (e.g., structured interview tools).

4. Pain assessment scales/tools – The nature of pain should be fully documented.

5. Functional assessment scales – When pain or the associated disease interferes with physical or emotional function, disease specific or general quality of life scales should be used for documentation.

6. Physical Examination – A thorough physical exam should be conducted with any findings that could influence analgesic choice or underlying pain condition documented and followed.

7. Psychosocial Evaluation – This should be considered, particularly for patients with chronic pain.

8. Diagnostic Studies – Such studies should be considered to assist in determining cause of pain, particularly acute pain without clear precipitating event, or chronic pain not responding to conservative therapy.

9. Proper documentation – The overall treatment approach and plan should be well documented in the patient record. All patient interactions and treatment plans should be documented. Documentation can include written agreements/documentation and informed consent/patient provider agreements (PPAs).

A comprehensive treatment plan should be developed and customized to the needs of the individual patient. The treatment plan should include the types of therapies planned, the goals of treatment, and an explanation of the patient and prescriber roles and responsibilities. The treatment plan should also include goals related to pain interfering with life activities such as school, work, and social activities.

The goals of treatment – It is important to establish a set of goals early in the course of treatment, including expectations about the following:

• The degree of improvement in pain

• The degree of improvement in function, where relevant

• Possible constituents of the treatment plan – The HCP should be knowledgeable about which therapies can be used to manage pain and how these should be implemented.

• Nonpharmacologic therapies – includes psychological, physical rehabilitative, surgical approaches; and complementary therapies

• Pharmacologic therapies – non-opioid, opioid, and adjuvant medications

• Patient/HCP interaction – There should be a plan for patient/prescriber/health care team interaction during treatment.

HCPs should be knowledgeable about the range of available therapies, when they may be helpful, and when they should be used as part of a multidisciplinary approach to pain management.  A number of nonpharmacologic therapies are available that can play an important role in managing pain, particularly musculoskeletal pain and chronic pain.

• Psychological approaches – e.g., cognitive behavioral therapy

• Physical rehabilitative approaches – e.g., physical therapy, occupational therapy

• Surgical approaches

• Complementary therapies – e.g., acupuncture, chiropracty [sic] 

Source: https://www.fda.gov/downloads/Drugs/NewsEvents/UCM557071.pdf