Q&A · Vol. 6, No. 01
Summary
Pain management in primary care requires balancing effective treatment with patient safety. This article examines practical strategies for improving pain care through shared functional objectives, drawing on insights from healthcare experts. These approaches help providers address chronic pain while minimizing risks associated with traditional pain management methods.
Alan SilberbergAlan SilberbergPresident, MD, Greater Austin Pain Center
Managing long-term pain while preserving quality of life and reducing reliance on opioids starts with setting realistic, collaborative goals early in treatment. The focus shifts away from completely eliminating pain and toward improving function, mobility, sleep, and daily activity. That mindset helps patients feel empowered rather than discouraged when pain fluctuates.
One of the most effective approaches is combining multiple strategies instead of relying on a single solution. This can include physical therapy, lifestyle changes, interventional treatments, behavioral health support, exercise, and non-opioid pain management options. Patients tend to do better long term when treatment addresses both the physical and emotional aspects of chronic pain.
From a relationship standpoint, communication is extremely important because chronic pain can affect mood, energy levels, and family dynamics over time. One conversation approach that works particularly well is focusing on shared goals and safety instead of framing the discussion around restriction or denial of medication.
For example, rather than saying, "We need to reduce opioids," the conversation becomes, "How do we help you function better, stay safe, and maintain the life and relationships that matter to you?" That subtle shift changes the tone from confrontation to collaboration.
When patients feel heard and included in the decision-making process, they are usually more open to broader treatment plans and more realistic expectations. In many cases, that improves trust, reduces fear around treatment changes, and leads to better long-term outcomes overall.
Standardized risk assessments help decide if starting or continuing an opioid is safe. Validated tools can screen for misuse risk, mood disorders, and other red flags. A structured review of function, treatment history, and clear pain goals guides the plan.
Results should be recorded in the chart and explained to the patient in plain words. Repeat the assessment on a schedule to track change and support dose or taper choices. Make standardized risk assessment a required step at every pain visit starting today.
Checking the prescription monitoring program at each controlled-substance visit improves safety. The report can reveal multiple prescribers, early refills, or risky dose levels. Add EHR prompts and rooming steps so the check happens fast and every time.
Discuss any findings with the patient in a calm, open, and nonjudgmental way. Know state rules on access and documentation to protect privacy and meet the law. Adopt a clinic policy to review and document the PDMP at every controlled-substance visit now.
Avoiding concurrent opioids and benzodiazepines lowers the risk of respiratory depression and death. The mix also raises the chance of falls, confusion, and car crashes, especially for older adults. If both are already prescribed, create a slow taper plan and coordinate with all prescribers.
Offer safer options for anxiety or sleep, and add counseling or sleep training when possible. Use informed consent and PDMP checks to reinforce safety and track change. Set a firm clinic rule to avoid this drug combination and begin safer substitutions now.
Co-prescribing naloxone reduces the chance that an overdose becomes a death. Risk is higher with big opioid doses, sedative use, lung disease, or a past overdose. Give a brief teach-back on overdose signs and how to use the nasal spray in an emergency.
Normalize naloxone as a safety tool so patients and families feel ready to carry it. Use standing orders and pharmacy partners to make access and billing simple. Add naloxone coprescribing and brief training to your routine for at-risk patients today.
Nonopioid therapies and physical rehabilitation can reduce pain while protecting health. Simple medicines, guided exercise, and skills training can raise function with fewer harms. Set clear, realistic goals that focus on walking, work, and sleep rather than only pain scores.
Use staged care with regular follow ups to adjust the plan based on progress. Address cost and access by linking patients to coverage help and community programs. Put nonopioid care at the front of every plan and start that shift today.
