Module C: Tapering or Discontinuation of Opioid Therapy
Continue along this path if there is an indication to taper to a reduced dose or taper to discontinuation.
Repeat the comprehensive biopsychosocial assessment:
- Pain assessment including history, physical exam, co-morbidities, previous treatment and medications, duration of symptoms, onset and triggers, location/radiation, previous episodes, intensity and impact, patient perception of symptoms.
- Functional goals.
- Impact of pain on family, work, and life.
- Review of previous diagnostic studies.
- Additional consultations and referrals.
- Coexisting illness and treatments and effect on pain.
- Significant psychological, social, or behavioral factors that may affect treatment.
- Family history of chronic pain.
- Collateral of family involvement.
- Patient's beliefs or knowledge of: 1) cause of pain; 2) treatment preferences; 3) perceived efficacy of various treatment options.
- For patients already on opioid therapy, include assessment of psychological factors (e.g., beliefs, expectations, fears) related to continuing versus tapering opioid therapy.
- According to DSM-5, a "substance use disorder is described as a problematic pattern of using alcohol or another substance that results in impairment in daily life of noticeable distress." This use can limit a person's ability to fulfill roles in his or her professional or personal life and can have other legal, social, or physical ramifications.