Home 5 Clinical Diagnostics Insider 5 New Guidance on the Use of Lab Testing to Monitor Pain Management Patients

New Guidance on the Use of Lab Testing to Monitor Pain Management Patients

by | Feb 2, 2018 | Clinical Diagnostics Insider, Diagnostic Testing and Emerging Technologies, Testing Trends-dtet

The American Association of Clinical Chemistry released the practice guideline, "Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients," in the January issue of the Journal of Applied Laboratory Medicine. The committee says that while urine drug testing is regarded as the standard for adherence monitoring of patients taking controlled substances to manage chronic pain, test results are read and interpreted by distinctly different sets of individuals, including laboratory scientists and clinicians. The comprehensive guideline encompasses test use (laboratory and point-of-care [POC]) and results reporting and is based on both evidence-based recommendations and consensus-based expert opinion. The guideline addresses tests for relevant over-the-counter medications, prescribed and nonprescribed drugs, and illicit substances in pain management patients. Some of the more than 30 recommendations include: The three main tiers of testing (routine monitoring, testing of high-risk patients, and clinically needed testing) and classes of drugs to be tested should be based on risk, with more frequent laboratory testing recommended for patients with a personal or family history of substance abuse, mental illness, evidence of aberrant behavior, or other high-risk characteristics. Urine is the preferred specimen type for pain management drug testing, as the evidence supporting alternative matrices (e.g., saliva, […]

The American Association of Clinical Chemistry released the practice guideline, "Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients," in the January issue of the Journal of Applied Laboratory Medicine. The committee says that while urine drug testing is regarded as the standard for adherence monitoring of patients taking controlled substances to manage chronic pain, test results are read and interpreted by distinctly different sets of individuals, including laboratory scientists and clinicians. The comprehensive guideline encompasses test use (laboratory and point-of-care [POC]) and results reporting and is based on both evidence-based recommendations and consensus-based expert opinion.

The guideline addresses tests for relevant over-the-counter medications, prescribed and nonprescribed drugs, and illicit substances in pain management patients. Some of the more than 30 recommendations include:

  • The three main tiers of testing (routine monitoring, testing of high-risk patients, and clinically needed testing) and classes of drugs to be tested should be based on risk, with more frequent laboratory testing recommended for patients with a personal or family history of substance abuse, mental illness, evidence of aberrant behavior, or other high-risk characteristics.
  • Urine is the preferred specimen type for pain management drug testing, as the evidence supporting alternative matrices (e.g., saliva, blood, plasma, serum, or hair) is currently insufficient for monitoring patient compliance.
  • Qualitative definitive tests should be used over immunoassays because they are more effective with superior sensitivity and specificity.
  • POC (oral and urine) qualitative presumptive immunoassays offer similar performance characteristics to laboratory-based immunoassays for some can detect some over-the-counter medications, prescribed and nonprescribed drugs, and illicit substances in pain management patients, but POC tests must be performed exactly according to the manufacturer's instructions.
  • Qualitative immunoassay drug testing before prescribing controlled substances can identify some illicit drug use and decrease adverse outcomes.
  • Random urine testing is recommended to assess compliance, although there is not clarity around the ideal frequency.
  • Definitive testing should be used to follow-up any unexpected results for any immunoassay (laboratory-based or POC).
  • Quantitative definitive urine testing is not more useful than qualitative definitive urine testing for detecting outcomes in pain management. Quantitative definitive urine testing should not be used to evaluate dosage or adherence to prescribed dosage regimens. However, qualitative results may be useful in complex cases to determine the use of multiple opioids, confirm spiked samples, and/or rule out other sources of exposure.
  • At a minimum specimen validity testing should include pH, temperature, creatinine, and oxidant testing on all urine drug tests for pain management patients, even not all forms of adulteration can be detected.

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