Skip to main content
. 2008 Dec;5(12):20–27.

TABLE 1.

Ten steps of universal precautions in pain medicine

Adapted from Gourley DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Medicine. 2005;6(2):107–112.
  • 1

    Make a diagnosis with appropriate differential.

  • 2

    Perform a psychological assessment including risk of addictive disorders.

  • 3

    Obtain informed consent

  • 4

    Obtain a treatment agreement (also called a medication contract).

  • 5

    Perform pre- and postintervention assessment of pain level and function.

  • 6

    Initiate appropriate trial of opioid therapy ± adjunctive medication.

  • 7

    Reassess pain score and level of function.

  • 8

    Regularly assess the “four A’s” of pain medicine:

    • a

      Analgesia

    • b

      Activity

    • c

      Adverse effects

    • d

      Aberrant behavior (Affect was later proposed as a fifth “A”).

  • 9

    Periodically review pain diagnosis and comorbid conditions, including addictive disorders.

  • 10

    Maintain complete documentation.