Universal Precautions and the Five Pillars of Pain Management

Douglas L. Gourlay, MD, MSc, FRCPC, FASAM

The Wasser Pain Management Center
Mount Sinai Hospital
Toronto, Ontario, Canada

Initially adapted from the field of infectious disease, the Universal Precautions approach to pain management posits that all patients with chronic pain who are being considered for long-term opioid therapy pose some risk of opioid misuse and abuse. Therefore, every patient should undergo a structured assessment for common risk factors, including personal and family history of substance abuse and relevant psychiatric pathology. Failure to identify patients who may be at higher risk and structure therapy appropriately if opioids are prescribed can lead to significant harm to patients, practitioners, and the general public. As originally proposed, the Universal Precautions approach includes 10 recommendations that support a nonadversarial and patient-centered pain management plan. These concepts have been further incorporated into the 5 pillars of pain management, which highlight the importance of an appropriate diagnosis, an assessment of risk, a therapeutic trial, an evaluation of outcomes, and an emphasis on patient self-efficacy.

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