tailieunhanh - Universal Precautions in Pain Medicine: A Rational Approach to the Treatment of Chronic Pain

This paper is intended as an overview of recent developments and trends. It wishes to pro- vide a short survey of the principal families of approaches, their use and limitations. Algo- rithms generic or specific to particular imaging modalities are not given here (see for exam- ple (10)). Section 2 presents the analysis pipeline, which accepts as input raw data and provides some form of processing or interpretation. Two basic processing paradigms are summarized in section 3, namely linear (or pseudo-linear) and morphological. Section 4 develops the prob- lem of features extraction by means of image segmentation techniques. Analysis of multi- slice and volume data, and matching, between. | PAIN MEDICINE Volume 6 Number 2 2005 COMMENTARY Universal Precautions in Pain Medicine A Rational Approach to the Treatment of Chronic Pain Douglas L. Gourlay MD MSc FRCPC FASAM Howard A. Heit MD FACP FASAM and Abdulaziz Almahrezi mD CcFp The Wasser Pain Management Center Mount Sinai Hospital Toronto Ontario Canada Assistant Clinical Professor of Medicine Georgetown University School of Medicine Washington DC Clinical Fellow Center for Addiction and Mental Health Toronto Ontario Canada A B S T R A C T------------------------------------------------------------------------------------ The heightened interest in pain management is making the need for appropriate boundary setting within the clinician-patient relationship even more apparent. Unfortunately it is impossible to determine before hand with any degree of certainty who will become problematic users of prescription medications. With this in mind a parallel is drawn between the chronic pain management paradigm and our past experience with problems identifying the at-risk individuals from an infectious disease model. By recognizing the need to carefully assess all patients in a biopsychosocial model including past and present aberrant behaviors when they exist and by applying careful and reasonably set limits in the clinician-patient relationship it is possible to triage chronic pain patients into three categories according to risk. This article describes a universal precautions approach to the assessment and ongoing management of the chronic pain patient and offers a triage scheme for estimating risk that includes recommendations for management and referral. By taking a thorough and respectful approach to patient assessment and management within chronic pain treatment stigma can be reduced patient care improved and overall risk contained. Key Words. Pain Addiction Universal Precautions Prescription Abuse Misuse Urine Drug Testing Introduction The term universal precautions as it applies to infectious disease .