After regular follow-up and treatment optimization, has the treatment plan been effective in managing pain and optimizing function?
Complete opioid risk assessment; refer for interdisciplinary pain and specialty consultations, as appropriate
Examples of contraindications to initiating opioids for chronic pain:
- SUD, not in remission
- Elevated suicide risk
- Concomitant use of benzodiazepines If patient is already on prescribed opioids, is there evidence of OUD, such as:
- Self-escalating dose
- Early refills
- Difficulty tapering
- Cravings
- Continued use despite medical or psychological consequences
- Interpersonal or social problems related to opioid use
- Screening tools and predictive models (repeat as clinically indicated). Examples include: · RIOSORD · STORM (within VA network)
At this point, do potential benefits outweigh risks? (Consider strength and number of risk factors and patient preference)
Refer or consult for appropriate interdisciplinary treatment treatments.
Is the patient able and willing to engage in a comprehensive pain care plan?
Educate patient and family about treatment options, including education on:
- Known risks and unknown long-term benefits of opioids
- Risks of Substance Use Disorder and overdose
- Need for risk mitigation strategies
- Naloxone rescue
Is adding opioids to comprehensive pain therapy indicated at this time?
Consider:
- Risks do not outweigh potential functional benefits
- Patient has a condition that is:
- Causing severe chronic pain
- Interfering with function and quality of life
- Failing to adequately respond to indicated non-pharmacologic and non-opioid pharmacologic therapy
- Clear and measurable functional goals are established
- Patient is willing and able to access adequate follow-up for prescribed opioids
- PDMP and Urine Drug Testing are concordant with expectations (no aberrant behavior)
- Patient is fully informed and consents to treatment with opioids
Is adding opioids to comprehensive pain therapy indicated at this time? - continued
