Module D: Currently on Chronic Opioid Therapy
Patient currently on opioid therapy.
Factors requiring immediate attention and possible discontinuation:
- Untreated substance use disorder
- Unstable mental health disorder
- Medical condition that acutely increases opioid risk (e.g. compromised or worsening cognitive or cardiopulmonary status)
- Other factors that acutely increase risk of overdose
- recent overdose
- current sedation
- recent motor vehicle accident
- Acutely elevated suicide risk (refer to VA/DoD Suicide CPG)
Perform a biopsychosocial assessment. The components are listed below:
- 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.
Are the following available for review?
- Prior medical records including current prescriber,
- Prior and current urine drug screens.