Do Pain Management Doctors Drug Test? What To Expect On My First Visit?

Do Pain Management Doctors Drug Test? What To Expect On My First Visit?


Yes. Pain management clinics may drug test you during your first appointment as it is the part of their standard operating procedures to identify potential misuse of abuse of substances.

The frequency of drug testing in pain management clinics can vary depending on several factors, including the individual patient's circumstances, the specific clinic's policies, and local regulations.

In general, pain management doctors may conduct drug testing at various points throughout the treatment process, including initial assessment, and random drug testing during the ongoing monitoring process.

This article will help you understand why pain management clinics drug test, what kind of drug test they do, and what to expect on your first visit. 

Table Of Contents:

Who Are Pain Management Doctors?

Pain management doctors, also known as pain management physicians or pain specialists, are trained medical professionals in the field of pain management.

Pain management treatment involves diagnosis, treatment, and management of chronic pain conditions. Physicians work closely with patients to develop comprehensive treatment plans that address their pain and improve their quality of life.

Some pain doctors are fellowship-trained, which means they earned further training after completing their residency. Interventional pain therapies such as injections, spinal cord stimulation with an implanted unit, or insertion of a morphine pump into the intrathecal space of the spine are often trained in pain fellowships.

Drug testing of patients seeking pain management is a proper therapeutic method for ensuring patient safety; state laws also mandate it in some instances.

What Type Of Drug Test Do Pain Management Centers Use?

Pain management centers usually go for Urine Drug Testing (UDT) for identifying potential misuse of prescription medicines. Urine drug test can detect major illicit drugs, alcohol, over-the counter medicines, and prescription medicines.

Pain centers prefer a laboratory analysis to detect abuse of illicit substances, even alcohol. They can detect opioids, benzodiazepines, stimulants, cannabinoids, and other commonly used drugs.

The laboratory based UDT (Urine Drug Testing) can clearly detect about the presence and levels of specific drugs or their metabolites in the patient's system. Meaning, there is a rare chance that the test results comes out false-positive or false-negative.

The results will help pain management doctors assess whether patients are using their prescribed medications appropriately, identify potential misuse or abuse of substances, and monitor for the presence of unauthorized drugs.

It's important to note that pain management doctors may occasionally use other types of drug tests depending on the specific circumstances.

Let us explore how pain management centers conduct UDT

Urine Drug Testing (UDT)

Qualitative UDT: It is used for outpatient pain control or drug abuse dependency monitoring and may be deemed medically appropriate for the following reasons: 

  • Baseline screening should be done before starting treatment if the following criteria are met- 
    • There is an accurate clinical evaluation of the patient's background and risk of drug abuse.
    • There is a strategy in place for how to handle the situation
    • Physicians are knowledgeable about test interpretation.
  • Treatment stabilization process with weekly qualitative screening for four weeks.
  • Treatment in the maintenance process, with tailored qualitative screening every 1 to 3 months.
  • Follow-up monitoring phase of care at a pace suitable for the patient's risk level.

Quantitative UDT: It indicates that the amount of medication used for outpatient pain control or substance abuse dependency monitoring could be deemed medically appropriate in the following situations:

  • Commercially available immunoassays for the related drug(s) are unavailable.
  • The following qualitative urine drug screen results must be present and recorded in particular circumstances when quantitative drug levels are needed for clinical decision making-
    • Optimistic for a prescription medication that the patient was not prescribed;     
    • Negative for a prescription medication that the patient has been prescribed; 
    • Tested positive for an illegal substance.

When there is a need for drug testing, it is done in the following situations:

  • Prescription of a Schedule II or III controlled drug for 90 days or more to manage chronic pain in a calendar year.
  • The situation isn't fatal.
  • The patient does not appear to be in a hospital or nursing home.

Drug testing frequency:

  • More than 30 mg/day of morphine equivalent – at least once every three months on a random basis
  • When a doctor decides the patient is suffering unduly pain, testing can be limited to once a year.
  • The patient's hardship must be recorded in his or her medical records.

UDT has several clinical advantages: 

  1. Lowering the risk of toxicity in patients who are susceptible to adverse drug effects, preventing medico-legal issues.
  2. Detecting patient noncompliance.
  3. Lowering the risk of therapeutic failure. 
  4. Avoiding or detecting drug-drug interactions. 
  5. UDT improves the physician's ability to use medications safely and reduces treatment cost and time. 

Unfortunately, UDT has been used by doctors to discharge patients from their practices. Urine drug testing should not be used solely to secure a doctor's license or a pain clinic's reputation but rather improve patient care.

It's important to note that the use of UDT is never intended to be punitive. On the contrary, a patient being discharged based on a positive UDT is a disservice to the medical profession. The presence of an illicit drug in urine indicates that the patient has a problem and, as a result, needs assistance and advice from the clinician.

Instead of dismissing the patient, assist in counselling and therapy with an addiction medicine counsellor, physician, or clinical psychologist specializing in addiction intervention and participation in a recovery program.

A basic understanding of drug metabolism is needed for the clinical analysis of test results. The patient drug's concentrations are highest right after administration, while metabolite concentrations peak later.

Up to 72 hours after ingestion, most medications or their metabolites can be found in the urine. If it has been 24 hours or more since the drug was last taken, it is not usual to detect only the metabolites in patients who take drugs intermittently. Medications can be identified for a much more extended period, whether they are used often or for a long time.

After the parent drug is no longer detectable, significant levels of the metabolites can remain. Knowing the relative levels of the drugs detected and the time after ingestion will help determine if the findings are consistent with normal metabolism or suggest violence.

Any adverse testing outcome must be reported to the physician, and this response must be recorded in the patient's record.

  • When a doctor suspects a patient of abusing prescription medication, the physician must refer the patient to suitable substance abuse treatment.
  • When a physician discovers a new medical problem outside his or her area of practice, refer the patient to the proper specialist.

Types of Pain Management Doctors

Anesthesiologists used to be in charge of everything from pain treatment to pain procedures. However, the specialities of anesthesiology and pain management are now separated, and it's crucial to understand the distinctions when choosing a provider.

Interventional pain management

Higher techniques and specialized pain control treatments, such as nerve blocks, spinal injections, and spine implants, are available to this class of physicians. In addition, many interventional pain management providers complete a five-year anesthesiology residency followed by a one-year pain management internship.

Medical pain management

As the name implies, these physicians deal with patients with chronic illnesses that necessitate using opioids or other long-term drugs. For example, a family medicine doctor, an internal medicine doctor, or a psychiatrist may be medical pain control specialists.

A medical pain control specialist will help you navigate the plethora of current pain medication legislation and rules. They will make sure you are getting the proper dosage for a suitable period to reduce the chances of being dependent or addicted.

When To See A Pain Specialist?

Although visiting a pain doctor does not always require a referral, most of the time, these appointments follow visits to your primary care physician (PCP) and another specialist, such as a neurosurgeon or orthopaedic surgeon.

The most important thing is to provide all relevant historical information. And evidence to the examining pain treatment specialist so that the visit is fruitful and cantered on the patient and his or her pain issue.

Spine conditions, such as herniated discs in the lumbar (back) or cervical (neck) spine, are the most common problems treated by pain specialists. For example, after a hernia repair, you can see a pain specialist for a nerve block, or a neurologist will refer you to a pain specialist.

A pain specialist will also coordinate with your other doctors to formulate a multidisciplinary treatment plan for you, which could include physical therapy, necessary drugs, injection therapy, or surgery.

Patients should seek advice from experts in four different fields:

General medical care: An internist, neurologist, family physician, or even a rheumatologist, maybe your doctor. This doctor usually has a strong understanding of a variety of medical specialities.

nterventions: This doctor is most likely from a profession like anaesthesiology, where interventions are often used to relieve pain. These doctors are specialists in anatomy and neuroanatomy, as well as physical structure.

Rehabilitation: This provider may be a physical medicine and rehabilitation (PM&R) doctor, physical therapist, occupational therapist, or chiropractor specializing in body function.

Psychology/psychiatry: The patient can also see a doctor, psychologist, or psychotherapist, depending on his or her needs.

What Do You Expect On Your First Visit?

If you suspect your pain has become unbearable and you need the assistance of a pain specialist. Inform your primary care physician of your problems and inquire whether a referral to a pain specialist is necessary. They'll be able to tell you if you're on the right track.

It's important to know what to expect during your first pain treatment consultation. Your first appointment is with a pain management nurse, who will go through your pain condition and medical history with you.

Next, a nurse, a physician assistant, and the physician will examine you. Finally, a pain management specialist can take your medical history, conduct a physical examination, and go through any test or X-ray findings with you.

So, if you've found a doctor, planning for your appointment will help you transition as smoothly as possible. Start by keeping a pain report to keep track of your symptoms.

Please note where the pain is, how it feels, how often it occurs, and whether those positions aggravate or alleviate the symptoms. Records are crucial. Bring a hard copy of every imaging you've had with you to your first meeting if the office hasn't received it yet.

Also, make a list of any drugs you're taking, whether prescribed or over-the-counter. Based on your assessment, your doctor will create a personalized pain relief plan for you. This initial evaluation is crucial for designing your customized treatment plan.

Patients are often seen on their first visit. On the other hand, most patients will be scheduled for their procedure after undergoing the required planning.

On your first visit, your doctor might ask you the following questions:

  • What is the root of your pain? (what part of the body)
  • What is the nature of your pain? (a dull, aching, tingling sensation)
  • How much pain do you feel? (How many times a day or night)
  • When do you notice the pain? (while exercising or while at rest)
  • Are you ready to set the pain? (Is it more uncomfortable to stand, sit, or lie down?)
  • What relieves your pain? (Does a particular drug help)
  • When you're in pain, have you experienced any other symptoms? (for example, a lack of bowel or bladder control)

Drug testing should never be used as a limitation but rather as a tool to improve patient care. Therefore, this testing method should be promoted to use in pain control procedures.

When the doctor and the patient work together, pain management is most effective. Therefore, understanding our roles in the patient/doctor relationship is critical; we must all work together to attain the best possible result for you when finding pain relief.

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