Module B: Trial of Opioid Therapy
Candidate for trial of Opioid Therapy with opioid treatment consent in conjunction with a comprehensive pain care plan.
Initiate opioid therapy using the following approach:
- Short duration (e.g., one-week initial prescription; no more than 3 months total)
- Use lowest effective dose, recognizing that no dose is completely safe
- A strategy of escalating dose to achieve benefit increases risk and has not been shown to improve function
- Dose escalation above 20-50 mg morphine equivalent daily dose has not been shown to improve function and such escalation increases risk
- Long-active opioids should not be prescribed for opioid naïve individuals (see CPG Recommendation #13 and refer to Appendix D - Drug Tables link displayed below).
- Consider alternatives to methadone and transdermal fentanyl (see CPG Recommendation #13 and refer to Appendix D - Drug Tables link displayed below).
- Assess patient for improvement in pain and functional status and adverse effects.
- Offer naloxone and education on how to use this rescue medication.
Is there a clinically meaningful improvement in function in the absence of significant risk factors?
Review and optimize comprehensive pain care plan (e.g., non-opioid treatments and self-management strategies)