Healthcare Providers:
This section addresses the challenges associated with treating acute and chronic pain and provides best practice information and associated resources for healthcare networks, hospitals and clinicians. This section is closely connected with the sections related to opioid dependence, and addiction.
Content will be in various forms including articles, infographs, interviews, links to other websites, video and other media forms.
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Introduction to the challenge of acute and chronic pain for the healthcare system
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The pain opioid ecosystem
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Care for pain in the community
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Care for pain in the hospital
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Resources for achieving optimal pain management
Goals and outcomes
The right treatment
for the right patient at the right setting at the right time and the right cost.
Safe Opioid Prescribing/Tapering
With the nation in the midst of an epidemic of prescription medication overuse, abuse, and diversion, the DoD and VHA are committed to ensuring that their providers understand how to appropriately, safely, and effectively prescribe opioids. This video utilizes the latest guidelines from the Centers for Disease Control and Prevention, clinical practice, guidelines, and medical evidence to provide an overview for opioid prescribing and tapering.
Care Provided in the Community (Including dental and podiatry)
Primary Care
Overview
Education
Checklist
Resources
Specialty Care
Overview
Education
Checklist
Resources
Pain Centers
Overview
Education
Checklist
Resources
Intgrated Care
Overview
Education
Checklist
Resources
Care Provided in the Hospital
Surgery
Overview
Education
Checklist
Resources
Inpatient Care
Overview
Education
Checklist
Resources
Behavioral Health
Overview
Education
Checklist
Resources
PCSS-MAT Mentor Program is designed to offer general information to clinicians about evidence-based clinical practices in prescribing medications for opioid addiction.
• PCSS-MAT Mentors comprise a national network of trained providers with expertise in medication-assisted treatment, addictions and clinical education.
• Our 3-tiered mentoring approach allows every mentor/mentee relationship to be unique and catered to the specific needs of both parties.
• The mentoring program is available, at no cost to providers.
For more information on requesting or becoming a mentor visit: pcssmat.org/mentoring
ECRI: Pain Relief: How to Keep Opioid Administration Safe .
Medical Professonal Checklist
CHECKLIST: When considering long-term opioid therapy
Checklist for prescribing opioids for chronic pain For primary care providers treating adults (18+) with chronic pain ≥ 3 months, excluding cancer, palliative, and end-of-life care
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain, 2016. JAMA. doi:10.1001/jama.2016.1464.
When CONSIDERING long-term opioid therapy
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Set realistic goals for pain and function based on diagnosis (eg, walk around the block). Check that non-opioid therapies tried and optimized.
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Discuss benefits and risks (eg, addiction, overdose) with patient. Evaluate risk of harm or misuse.
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Discuss risk factors with patient.
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Check PDMP
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Check urine drug screen.
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Set criteria for stopping or continuing opioids. Assess baseline pain and function (eg, PEG scale).
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Schedule initial reassessment within 1– 4 weeks.
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Prescribe short-acting opioids using lowest dosage on product labeling; match duration to scheduled reassessment.
If RENEWING without patient visit
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Check that return visit is scheduled ≤ 3 months from last visit.
When REASSESSING at return visit
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Continue opioids only after confirming clinically meaningful improvements in pain and function without significant risks or harm.
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Assess pain and function (eg, PEG); compare results to baseline.
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Evaluate risk of harm or misuse: (Addiction Behaviors Checklist (ABC) (Google DOC )
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Designed to track behaviors characteristic of addiction related to prescription opioid medications in chronic pain patients. Items are focused on observable behaviors noted both during and between visits. ABC is focused on longitudinal assessment and tracking of problematic behaviors.
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Observe patient for signs of over-sedation or overdose risk. – If yes: Taper dose.
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Check PDMP.
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Check for opioid use disorder if indicated (eg, difficulty controlling use).
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If yes: Refer for treatment.
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If you suspect your patient has a substance abuse issue, refer them to SAMHSA’s National Helpline at 1-800-662-HELP (4357) or SAMHSA’s Behavioral Health Treatment Services Locator.
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Check that non-opioid therapies optimized.
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Determine whether to continue, adjust, taper, or stop opioids.
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Calculate opioid dosage morphine milligram equivalent (MME).
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If ≥ 50 MME /day total (≥ 50 mg hydrocodone; ≥ 33 mg oxycodone),
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increase frequency of follow-up;
consider offering naloxone.
Avoid ≥ 90 MME /day total (≥ 90 mg hydrocodone; ≥ 60 mg oxycodone), or carefully justify;
consider specialist referral.
Schedule reassessment at regular intervals (≤ 3 months).
Common Elements in Guidelines for Prescribing Opioids for Chronic Pain
The Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control, along with the National Institute on Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Office of the National Coordinator for Health Information Technology (ONC), reviewed eight guidelines to identify common recommendations (see accompanying Table). Guidelines on chronic pain that had been issued on or before January 2013 and developed by professional societies, states, or Federal agencies for general practitioners were considered. Guidelines for specific conditions or subpopulations were excluded, as were those specific to pain specialists.
Prescription-monitoring programs have tremendous potential that is not fully realized in most states. One solution is PMP Interconnect, an effort of the National Association of Boards of Pharmacy to link these programs (www.nabp.net/programs/pmp-interconnect/nabp-pmp-interconnect). There are currently 28 states participating in PMP Interconnect, with more enrolling. Another important challenge for prescription-monitoring programs is the reluctance of physicians to use these programs. The ultimate solution will be multifactorial, but integrated prescription-monitoring programs could develop into an effective tool to reduce doctor-shopping.
http://www.radars.org/home2/events/annual-meeting
International Pre-Symposium: Emerging Global Trends in Prescription Drug Misuse
American Pain Society
American Academy of Pain Medicine
Physicians for Responsible Opioid Prescribing
How Doctors Helped Drive the Addiction Crisis Richard Friedman NY TImes November 7th, 2105
Responsible Opioid Prescribing: A Clinician's Guide
Responsible Opioid Prescribing: A Clinician's Guide offers clinicians effective strategies for reducing the risk of addiction, abuse and diversion of opioids that they prescribe for their patients in pain. Written by pain medicine specialist Scott M. M.D., this new edition, updated in September 2014, includes new information on Model Guidelines, FDA labeling, and preventing opioid overdose that was not available when the first edition was published in 2007. The update is especially important given the rise of opioid abuse and related deaths in the United States as well as the ongoing need for legitimate patient access to pain medications.
Federation of State Medical Boards: State board guidelines
Pain Policies and Online Educational Activities
In 2012, the FSMB in collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA) met to begin the process of revising FSMB’s responsible opioid prescribing and office-based opioid treatment policies. FSMB’s Workgroup on Pain Policy and the Workgroup on Office-Based Opioid Treatment met periodically and after receiving comments from FSMB's member boards and other key stakeholder organizations, the final policy documents of Model Policy on the Use of Opioid Analgesics in the Treatment of Chronic Pain and Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office were adopted in 2013.
In accordance with a contract awarded by SAMHSA, FSMB created learning activities to educate the state medical boards and the physicians and other health care providers they license on the recently revised pain policies. These learning activities serve as a valuable resource to physicians seeking education related to opioid addiction as well as the appropriate use of opioid analgesics in the treatment of pain. These courses are available free of charge to the learner and may be taken for continuing medical education credit.
Continuing Medical Education (CME) Activities
Model Policy for the Use of Opioid Analgesics in the Treatment of Chronic Pain
Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office