Risk for violent behavior in patients with chronic pain: evaluation and management in the pain facility setting

Objective. Recent evidence indicates that physicians are at high risk for p atient-perpetrated violence. The objectives of this article, in association with case reports of patients with chronic pain (PWCP), are the following: to review the literature and determine if pain physicians could be at risk for PWCP-perpetrated violence; to review the current evaluation and manage ment procedures for potentially violent patients; and to identify some situ ations specific to PWCPs that can heighten the risk of PWCP-perpetrated vio lence. Design. Previous literature on patient-perpetrated violence against physici ans was reviewed. In addition, literature on the evaluation for risk of vio lent behavior and management of violent behavior was also reviewed. Seven p otentially violent PWCPs are described, including some who had threatened p ain physicians and institutions. PWCP-specific situations thought to be ins trumental in increasing the risk of PWCP-associated violence were identifie d. Setting. Pain facility (multidisciplinary center). Results of Review and Analysis of Case Reports. The literature on patient-p erpetrated violence against physicians indicates that, statistically, pain physicians could be at risk for this type of violence. Seven PWCP cases of threatened or potentially violent behavior are described. These case report data indicate that PWCPs with the potential for violence against physician s or institutions do present for treatment at pain facilities. Ail seven PW CPs were in a number of situations specific to chronic pain that increased the possibility of violent behavior. These situations are described. Conclusions. In the evaluation for risk of violence against physicians or i nstitutions by PWCPs, one needs to understand PWCP-specific situations. Man agement of potential violent behavior cannot be effective without this unde rstanding.