Table 3 Ten steps of universal precautions

1.

Make a diagnosis with appropriate differential.

2.

Perform a psychological assessment, including risk of addictive disorders.

3.

Obtain informed consent.

4.

Use a treatment agreement.

5.

Conduct assessment of pain level and function before and after the intervention.

6.

Begin an appropriate trial of opioid therapy with or without adjunctive medications and therapies.

7.

Reassess pain score and level of function.

8.

Regularly assess the 4 “As” of pain medication: Analgesia, Activity, Adverse effects, and Aberrant behavior.

9.

Periodically review pain diagnosis and co-occurring conditions, including addictive disorders.

10.

Document initial evaluation and follow visits.