Knowledge Library

In 2016, the CDC released a clinical practice guideline for primary care physicians prescribing opioids for chronic pain,¹ which was adopted by various entities, including Medicaid agencies and insurers.² However, according to the CDC and others, the guideline has been misinterpreted and misapplied. An example of a misapplication concern involves the management of patients with chronic pain, which are not intended to follow the same guidelines as those patients being initiated on opioids. The 2016 guidelines are in the process of being updated by the CDC. The draft guideline is available for review with an expected release in late 2022.

According to the CDC, chronic pain is a risk factor for suicidality.^1,2,3 Studies indicate several additional factors as potential predicators of increased suicide risk in chronic pain patients, including depression, anger, unemployment/disability, harmful health habits, challenging personal and family history, sleep problems, poor perceived mental health, and multiple chronic pain conditions. Newly identified psychosocial factors, including pain catastrophizing, hopelessness, and perceived burdensomeness also appear to be associated with suicidality.² On a positive note, many suicide risk factors can be addressed through an individualized chronic pain management program.²

Any patient can develop OUD and patients with OUD are at higher risk for overdose.¹ Personal history, length of therapy, and dosage play a role in the development of OUD.² A physician’s effectiveness in treating the underlying cause of a patient’s pain can be a crucial aspect of the defense in an opioid overdose case.

Although every step in test result management is important and interrelated, patient notification errors tend to result in more adverse events.¹ Communicating a critical or significantly abnormal test result requires more than simply distributing the result to the patient. The patient should understand the criticality of the result and how to follow up. Communicating the urgency of the circumstances may require an extra effort if the patient has low health literacy or cognition deficits.

A diagnosis of cancer does not always need to be directly communicated. However, special care must be used to ensure receipt of the diagnosis by the clinician in the best position to coordinate or provide treatment to the patient. The following case highlights the importance of creating a “paper trail” that proves pathology diagnoses were sent to the intended clinicians.