MDM //

CHRONIC PAIN MDM “I discussed the patient's recurrent pain issues with @him@. This is the *** time @name@ has been evaluated in the emergency department for pain-related issues in the last ***. I emphasized that my training was in the treatment of acute pain, that @his@ physical exam here is quite reassuring, and that definitive treatment of chronic pain is not the role of the emergency department. “@He@ exhibited the following behaviors known to be associated with addiction and pseudoaddiction: ***- inability to restrict medications or take them on an agreed-upon schedule ***- taking multiple medications together ***- doctor shopping ***- the use of nonprescribed psychoactive drugs in addition to prescribed medications ***- noncompliance with recommended nonopioid treatments or evaluations ***- a preoccupation with opioids ***- insistence on rapid-onset formulations and routes of administration ***- reports of allergy or no relief whatsoever by any nonopioid treatments I compassionately explained to @name@ that I felt providing opiate medications from the emergency department was counterproductive in that this may cause or exacerbate tolerance, acute overdose, physiological or psychological dependence, or withdrawal. We discussed that opiate use in the management of chronic pain is best managed by a single practitioner, such as a primary care provider or a pain specialist. We discussed adjunctive therapies such as heat, ice, and exercise, as well as non-opiate medications such as acetaminophen, NSAIDs, antidepressants, gabapentin, and pregabalin. I reiterated to @name@ that the most effective management of @his@ chronic pain involves a multimodal approach coordinated by @his@ primary care provider and often includes physical therapy, cognitive behavioral therapy, and referrals to practitioners such as anesthesiologists trained in chronic pain management.



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