Pain management tips

Deciding whether to prescribe opioids for patients with chronic pain can be complex, in part because of the potential for drug dependence or misuse. Although opioids are not recommended for first-line treatment of chronic pain, there are circumstances when physicians should consider opioid therapy, for example when nonpharmacological treatments (physical therapy, home exercises, etc.) have not worked, the patient's pain significantly affects function and quality of life and therefore outweighs the risks of opioid use, or the patient cannot tolerate other treatments.

Before prescribing opioids to treat chronic pain, physicians should document the patient’s medical history, conduct a physical examination and risk assessment, and consider the following tips for evaluating whether the patient is a good candidate for opioid therapy.

1. Check your state’s prescription drug monitoring program (PDMP). If the report contains information that is troubling, or inconsistent with the patient's provided history, consider referral to a treatment program or other options for pain management.

2. If the PDMP report is negative, order a urine drug screen. If the drug screen is positive, consider referral to a treatment program or other options for pain management.

3. If the drug screen is negative, review the patient's medical records from any previous doctors. If there is a discrepancy, consider referral to a treatment program or other options for pain management.

4. If there is no discrepancy in the patient's records, prescribe opioid therapy. Have the patient review and sign a controlled substance agreement as well as a document describing your practice’s opioid medication policies, and set functional goals as part of the care plan.

5. Follow up with the patient to monitor progress, adverse effects, and problematic behaviors.

Additional resources:

• AAFP Chronic Pain Toolkit - a recently updated, comprehensive resource,
  
• Opioid Use Disorder Livestream - an AAFP live CME course, May 25-26,
• Pain Management & Opioid Misuse - a collection of AAFP resources.
  

Read the full article in FPM: “How to Monitor Opioid Use for Your Patients With Chronic Pain.”