10
Treatment
4. Monitor
drug-related
behaviors
• Effectiveness (pain is described as less
intense, with a relationship to dose
and dosing that is expected, and the
pain reduction is associated with the
ability to sustain or improve physical
or psychological functioning
• Adverse effects
• Adherence monitoring, including
compliance with current analgesic and
nonopioid analgesic treatments, on the
basis of risk assessment
Monitoring of outcomes
is consistent with
integration of pain
management into a
palliative care model
5. Respond
to aberrant
behaviors
a. Reassess and diagnose:
Realize that aberrant drug-related
behaviors have a differential diagnosis
and that an assessment must be
performed to clarify whether behavior
indicates addiction, other psychiatric
condition associated with impulsive
drug use, family issues, desperation or
impulsivity driven by uncontrolled
pain, or some combination of these
factors. Also recognize that diversion is
possible and assess for this behavior.
b. Consider whether to continue
prescribing:
• If diversion is occurring or risks now
exceed benefit, taper and discontinue
c. If diversion is not occurring and the
assessment suggests that the benefits
of therapy will continue to outweigh
the risk if the aberrant behaviors
are stopped, restructure prescribing
to increase control and adherence
monitoring
• Avoid agents with higher abuse liability
• Prescribe small amounts at short
intervals
• Review prescription drug monitoring
data routinely
• Use pill counts
• Monitor use of substances through
urine/other toxicolog y screening
• Require use of one pharmacy
• Use written agreement
• Obtain consultation from psychiatry/
addiction specialists
Advanced illness does
not free the clinician
from the requirement of
compliance with laws and
regulations
Adapted from Portenoy and colleagues: J Clin Oncol. 32:1662-1670, 2014 & Lancet
377:2236-2247, 2011
Table 3. Universal Precautions in Chronic Cancer Pain
Management (cont'd)
