Page 121 Complete Your CE Test Online - Click Here Page 121 Checklist for prescribing opioids for chronic pain EVIDENCE ABOUT OPIOID THERAPY • Benefits of long-term opioid therapy for chronic pain not well supported by evidence. • Short-term benefits small to moderate for pain; inconsistent for function. • Insufficient evidence for long-term benefits in low back pain, headache, and fibromyalgia. NON-OPIOID THERAPIES Use alone or combined with opioids, as indicated: • Non-opioid medications (eg, NSAIDs, TCAs, SNRIs, anti-convulsants). • Physical treatments (eg, exercise therapy, weight loss). • Behavioral treatment (eg, CBT). • Procedures (eg, intra-articular corticosteroids). EVALUATING RISK OF HARM OR MISUSE Known risk factors include: • Illegal drug use; prescription drug use for nonmedical reasons. • History of substance use disorder or overdose. • Mental health conditions (eg, depression, anxiety). • Sleep-disordered breathing. • Concurrent benzodiazepine use. Urine drug testing: Check to confirm presence of prescribed substances and for undisclosed prescription drug or illicit substance use. Prescription drug monitoring program (PDMP): Check for opioids or benzodiazepines from other sources. ASSESSING PAIN & FUNCTION USING PEG SCALE PEG score = average 3 individual question scores (30% improvement from baseline is clinically meaningful) Q1: What number from 0 –10 best describes your pain in the past week? 0=“no pain” , 10=“worst you can imagine” Q2: What number from 0 –10 describes how, during the past week, pain has interfered with your enjoyment of life? 0=“not at all” , 10=“complete interference” Q3: What number from 0 –10 describes how, during the past week, pain has interfered with your general activity? 0=“not at all” , 10=“complete interference” TO LEARN MORE | /prescribing /guideline When CONSIDERING long-term opioid therapy Set realistic goals for pain and function based on diagnosis (eg, walk around the block). Check that non-opioid therapies tried and optimized. Discuss benefits and risks (eg, addiction, overdose) with patient. Evaluate risk of harm or misuse. • Discuss risk factors with patient. • Check prescription drug monitoring program (PDMP) data. • Check urine drug screen. Set criteria for stopping or continuing opioids. Assess baseline pain and function (eg, PEG scale). Schedule initial reassessment within 1– 4 weeks. Prescribe short-acting opioids using lowest dosage on product labeling; match duration to scheduled reassessment. If RENEWING without patient visit Check that return visit is scheduled ≤3 months from last visit. When REASSESSING at return visit Continue opioids only after confirming clinically meaningful improvements in pain and function without significant risks or harm. Assess pain and function (eg, PEG); compare results to baseline. Evaluate risk of harm or misuse: • Observe patient for signs of over-sedation or overdose risk. – If yes: Taper dose. • Check PDMP. • Check for opioid use disorder if indicated (eg, difficulty controlling use). – If yes: Refer for treatment. Check that non-opioid therapies optimized. Determine whether to continue, adjust, taper, or stop opioids. Calculate opioid dosage morphine milligram equivalent (MME). • If ≥50 MME/day total (≥50 mg hydrocodone; ≥33 mg oxycodone), increase frequency of follow-up; consider offering naloxone. • Avoid ≥90 MME/day total (≥90 mg hydrocodone; ≥60 mg oxycodone), or carefully justify; consider specialist referral. Schedule reassessment at regular intervals (≤3 months). For primary care providers treating adults (18+) with chronic pain ≥3 months, excluding cancer, palliative, and end-of-life care CS273808A CHECKLIST REFERENCE