Module A: 
Determination of Appropriateness for Opioid for Chronic Pain

Note: Non-pharmacologic and non-opioid pharmacologic treatments are preferred for chronic pain​
Patient with Chronic Pain
​(greater than 90 days duration)
Obtain Pain and Biopsychosocial Assessment.    
​​The components are listed below.
  • Conduct a pain assessment (e.g., information about the onset of pain, location, duration, exacerbating factors, relieving factors, whether there is radiation [location of the radiation and what triggers the radiation], 24 hour pain pattern, quality of pain)
  • Assess history of previous treatments and effect on pain
  • Assess impact of pain on daily functioning and quality of life (e.g., pain interference, family, education, work, community, social activities, sleep quality)
  • Assess patient’s functional goals
  • Evaluate psychological/behavioral factors, including suicide risk, that may affect treatment (e.g., pain avoidance, pain catastrophizing)
  • Evaluate social factors that may affect treatment (e.g., employment, homelessness) · Assess current and past co-occurring conditions (medical and behavioral health comorbidities)
  • Conduct physical exam
  • Confirm diagnosis (review previous diagnostic studies)
  • Consider consultations and referrals
  • Patient beliefs and understanding of:
    • The cause of their pain
    • Their treatment preferences
    • The perceived efficacy of various treatment options
Is the patient currently on opioids for chronic pain?
Educate/re-educate on, implement, and optimize non-opioid treatments for chronic pain:
  • Rehabilitation and manipulative therapies (e.g., provided by physical therapists, occupational therapists, chiropractors)
  • Pharmacologic therapy (e.g., over-the-counter medications, non-opioid prescription pain medications)
  • Interventional procedures (e.g., trigger point injections, joint injections, acupuncture)
  • Psychological and behavioral interventions (e.g., motivational interviewing, CBT)
  • Complementary and integrative treatments (e.g., yoga, tai chi) 
Including:
  • Self-management to promote health and wellness
  • Non-opioid pharmacologic pain treatments
  • Non-pharmacologic paint treatments
  • Behavioral therapies (e.g., cognitive behavioral therapy)
  • Physical/movement-based therapies (e.g., physical therapy)
  • Manipulative therapies (e.g., chiropractic care)
  • Complementary and integrative health treatments (e.g., acupuncture)
  • Interventional pain care (e.g., joint injection, radiofrequency ablation)
  • Realistic expectations and limitations of medical treatment
  • Click links below for Low Back Pain (LBP), Osteoarthritis (OA), and Headache CPG, as appropriate for further condition-specific guidance.