Weighing the benefits and risks of opioid treatment can help ensure appropriate use
Established guidelines and tools can be used to determine which patients are appropriate candidates for opioids
There are a number of challenges in making sure patients receive treatment that is both safe and effective. It is imperative to take an individualized approach to therapy, weighing the potential risks posed by opioids against the clinical benefits on a case-by-case basis. This includes evaluating when to initiate or continue opioids, and when to prescribe preferred therapies.1-4
Nonpharmacologic and nonopioid pharmacologic treatments have been shown to be effective in managing chronic pain before initiating opioids. These may include4-5:
- Cyclooxygenase-2 (COX-2) inhibitors
- Physical treatments (eg, exercise therapy and weight loss)
- Procedures (eg, intraarticular corticosteroids)
- Selected antidepressants such as tricyclics and serotonin and norepinephrine reuptake inhibitors (SNRIs)
However, opioids may be the appropriate therapeutic option for select patients with an inadequate response to alternative treatments.4 Ensuring safe use in these patients is a continuous process that involves multiple checkpoints and preventative measures1,4-7:
Safe Opioid Use
Adapted from J. Gudin, MD
A number of tools have been developed (as listed below) to help guide your treatment strategies. Understanding the important considerations addressed in these tools can help you balance the benefits and risks of therapy for each of your patients.
Patient assessment resources:
American Pain Society (APS) and American Academy of Pain Medicine (AAPM) Opioid Treatment Guidelines
- Provides recommendations for opioid prescribing and the assessment and management of risks associated with opioid abuse, addiction, and diversion1
Visit www.jpain.org and search with key terms “clinical guidelines for opioid therapy.”
American Society of Interventional Pain Physicians (ASIPP) Guidelines for Responsible Opioid Prescribing in Chronic Non-Cancer Pain
- Offers comprehensive, evidence-based guidelines for interventional techniques in the diagnosis and treatment of chronic pain2
Visit www.asipp.org and click on “ASIPP GUIDELINES.”
Federation of State Medication Boards Model Policy on the Use of Opioid Analgesics in the Treatment of Chronic Pain
- Provides state medical boards’ guidelines for pain management, appropriate opioid use, and applicable state and federal laws and regulations3
Visit www.fsmb.org and search with key terms “pain policy.”
Centers for Disease Control and Prevention (CDC) Guidelines, Fact Sheet, and Checklist for Prescribing Opioids for Chronic Pain
- Establishes recommendations for initiation of opioids, determination of dosage, duration, and discontinuation, and risk assessment of opioid use4-6
Visit www.cdc.gov and search with key terms “opioid guidelines,” “opioid fact sheet,” and “opioid checklist.”
Patient self-assessments & questionnaires:
Brief Pain Inventory (BPI)
- Evaluates the analgesic effect of patients’ current treatments and the impact of pain on quality of life8
Visit www.opioidrisk.com and search with key terms “Brief Pain Inventory.”
Drug Abuse Screening Test (DAST-10)
- Assesses drug use and abuse potential to help select appropriate treatment9
Visit www.drugabuse.gov and search with key term “DAST.”
Screening Instrument for Substance Abuse Potential (SISAP)
- Helps determine whether a patient is at high risk for opioid dependency or abuse10
Search online with key terms “Screening Instrument for Substance Abuse Potential (SISAP) pdf.”
Pain Medication Questionnaire (PMQ)
- Helps identify patients at risk for opioid misuse in a 26-question assessment11
Visit www.opioidrisk.com and search with key terms “PMQ: Pain Medication Questionnaire.”
Patient Agreement Form
- Helps ensure that patients understand their role in responsible opioid treatment and facilitates communication among patients and healthcare professionals7
Visit www.drugabuse.gov and search with key terms “Patient Agreement Forms.”
Journal of Pain and Symptom Management
- Publishes emerging research and relevant articles about treating chronic pain12
Appropriate opioid use begins with weighing the benefits and risks.
Take advantage of available resources to help provide effective, safe, and responsible treatment for your chronic pain patients.
1. Chou R, Fanciullo GJ, Fine PG, et al. Opioid treatment guidelines: clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113-130.
2. Manchikanti L, Abdi S, Atluri S, et al. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: part 2-guidance. Pain Physician. 2012;15(special issue):S67-S116.
3. Federation of State Medical Boards. Model policy on the use of opioid analgesics in the treatment of chronic pain. http://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/pain_policy_july2013.pdf. Accessed June 27, 2016.
4. Centers for Disease Control and Prevention. CDC guideline for prescribing opioids for chronic pain—United States, 2016. http://www.cdc.gov/drugoverdose/prescribing/guideline.html. Published March 18, 2016. Accessed June 13, 2016.
5. Centers for Disease Control and Prevention. Checklist for prescribing opioids for chronic pain. http://www.cdc.gov/drugoverdose/pdf/pdo_checklist-a.pdf. Published March 2016. Accessed June 13, 2016.
6. Centers for Disease Control and Prevention. Guideline for prescribing opioids for chronic pain. http://www.cdc.gov/drugoverdose/pdf/guidelines_factsheet-a.pdf. Accessed June 13, 2016.
7. National Institute on Drug Abuse. Sample patient agreement forms. https://www.drugabuse.gov/sites/default/files/files/SamplePatientAgreementForms.pdf. Accessed June 27, 2016.
8. Cleeland CS, Syrjala KL. How to assess cancer pain. In: Turk DC, Melzack R, eds. Handbook of Pain Assessment. New York, NY. The Guilford Press; 1992:378-384.
9. National Institute on Drug Abuse. DAST-10. https://www.drugabuse.gov/sites/default/files/files/DAST-10.pdf. Accessed June 13, 2016.
10. Coambs RB, Jarry JL, Santhiapillai AC, Abrahamsohn RV, Atance CM. The SISAP: a new screening instrument for identifying potential opioid abusers in the management of chronic nonmalignant pain within general medical practice. Pain Res Manag. 1996;1(3):155-162.
11. Holmes CP, Gatchel RJ, Adams LL, et al. An opioid screening instrument: long-term evaluation of the utility of the pain medication questionnaire. Pain Prac. 2006;6(2):74-88.
12. Journal of Pain and Symptom Management. http://www.jpsmjournal.com/. Accessed June 13, 2016.