Complications
Poorly controlled chronic pain is characteristically associated with significant disability, with disruptions in activities of daily living, social relationships, and employed work. All patients with chronic pain should be asked directly about pain impact at each visit, with appropriate referrals to occupational therapy and pain psychology, as needed.
Poorly controlled chronic pain is characteristically associated with significant psychological distress.[114] All patients with chronic pain should be asked directly about pain impact at each visit, with appropriate referrals to occupational therapy and pain psychology, as needed.
Medication use disorders occur in 25% to 30% of patients with chronic pain treated with opioids. Patient characteristics do not accurately predict who will develop medication use disorders. Consequently, all patients treated with opioids must be routinely evaluated to determine medication compliance by monitoring prescription refills and random urine drug screens.[42] Reducing and stopping opioids is appropriate in patients whose functional goals are not met.[42]
Long-term efficacy may be lacking with high doses of opioids due to the combination of lowering of the pain threshold and medication tolerance.[42][115]
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