Clinical Guidelines
Guidelines for Prescribing
- Washington State Agency Medical Directors’ Group: Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain: An educational aid to improve care and safety with opioid therapy. 2010 Update.
- APS/AAPM Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain Reprinted from the Journal of Pain, Vol 10, Issue 2, Chou R et al., Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain, Pages 113-130. Copyright 2009, with permission from Elsevier.
- Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. The Canadian Guideline is presented in two separate documents: Part A (Executive Summary and Background) and Part B (Recommendations for Practice).
- Oregon Pain Guidance The Oregon Pain Guidance group (OPG) offers HCPs and community partners opioid guidelines and other information, including best practices for managing complex, chronic pain, to bring them into standardized, general use in Southern Oregon.
- Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain. Utah Department of Health 2009.
- Cautious, Evidence-Based Opioid Prescribing. Physicians for Responsible Opioid Prescribing (PROP). 2011. or visit: www.responsibleopioidprescribing.org
- Information on Opioid Medications U.S. Food and Drug Administration.
Tools for Opioid Dosing and Risk Mitigation
- AMDG Opioid Dose Calculator (in Excel)
The AMDG Opioid Dose Calculator was developed by the Washington State Agency Medical Directors’ Group to be used in conjunction with the Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain. - Opioid Risk Tool (ORT) – Physician Interview Form
The ORT has certain strengths and weaknesses. ORT strengths include that it is brief, free, offers face validity, and provides high and low scores proven to predict outcome. Its weaknesses are that it is one small validation study; significant risk factors are omitted (such as PTSD, sexual abuse of males, smoking). In addition, intermediate scores not predictive of outcomes. - Tapering or Weaning Patients off of Chronic Opioid Therapy. In the Chronic Opioid Therapy (COT) Safety Guideline For Patients With Chronic Non-Cancer Pain. Group Health Cooperative. Copyright 2010–2012. This safety guideline offer indications and recommended taper schedules along with a referral matrix to aid in tapering or weaning patients off of long-term opioid therapy.
- Urine Drug Screening for Safety in Patients on Chronic Opioid Therapy. Group Health Cooperative. Copyright 2010–2012. This screening information and guidance can be used in routine opioid management.
Patient Counseling
Shared Decision Making and Communication
- Center for Shared Decision Making at Dartmouth-Hitchcock
www.patients.dartmouth-hitchcock.org/shared_decision_making.html - COPE: Toolkit of Phrases for Tough Situations. University of Washington. COPE. 2007.
- Informed Medical Decisions Foundation
www.informedmedicaldecisions.org - Patient-Clinician Communication: Basic Principles and Expectations. Institute of Medicine. (IOM). 2011.
- REMS Patient Counseling Document on Extended-Release/Long-Acting Opioid Analgesics. Section of FDA REMS. Extended-Release (ER) and Long-Acting (LA) Opioid Analgesics Risk Evaluation and Mitigation Strategy (REMS). Modified August 2012.
Medication Information
- FDA Blueprint for Prescriber Education for Extended-Release and Long-Acting Opioid Analgesics 7/9/2012. General Drug Information for ER/LA Opioid Analgesic Products (Section V of FDA REMS) “Drug Information Common to the Class of Extended-Release and Long-Acting Opioid Analgesics (ER/LA opioid analgesics)”
- List of Extended-Release and Long-Acting Opioid Products, FDA. 2014.
www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass - NIH Medication Guidelines available at NIH DailyMed (US National Institute of Health’s DailyMed page)
www.dailymed.nim.nih.gov/dailymed/about.chm - "Selected Important Safety Information: Abuse Potential and Risk of Life-threatening Respiratory Depression." FDA REMS. 2012.
Resources for Patients
Opioid Storage and Disposal
- Proper Prescription Drug Disposal. Drug Medication Recommended by FDA for Disposal for Flushing
Chronic Pain and Health Services
- American Chronic Pain Association http://theacpa.org/
- American Pain Society www.americanpainsociety.org
- Centers for Disease Control and Prevention (CDC). www.cdc.gov See especially “Policy Impact: Prescription Painkiller Overdoses." November 2011. Available at: www.cdc.gov/homeandrecreationalsafety/pdf/PolicyImpact-PrescriptionPainkillerOD.pdf
- Institute of Medicine. Relieving Pain in America. A Blueprint for Transforming Prevention, Care, Education, and Research. The National Academies Press. 2011. www.iom.edu/relievingpain
- National Institute on Drug Abuse (NIDA) www.drugabuse.gov See, for example: www.drugabuse.gov/publications/topics-in-brief/prescription-drug-abuse
- NODCP (White House Office of National Drug Control Policy) www.whitehouse.gov/ondcpSee especially “Epidemic: Responding to America’s Prescription Drug Crisis.” April 2011. Available at: http://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/rx_abuse_plan.pdf
Recommended Reading
Books on Managing Chronic Pain
- Cowan, Penney. From Patient to Person: First Steps. The American Chronic Pain Association. 2004.
- Caudill, Margaret. Managing Pain Before It Manages You (Revised Edition). 3rd ed. Guilford Press, 2009.
- Cowan, Penney. Staying Well: Advanced Pain management for ACPA Members. The American Chronic Pain Association. 2007.
- Otis, JD. Managing Chronic Pain. A Cognitive-Behavioral Therapy Approach. New York: Oxford University Press, 2007.
- Turk DC, Winter, F. The Pain Survival Guide: How to Reclaim Your Life. Washington, DC: APA Press, 2006.
Articles
- Efficacy of opioids for chronic pain: A review of the evidence. Ballantyne JC, Shin NS. Clin Jour Pain. 2008 July/Aug; (24)6: 469-478. doi: 10.1097/AJP.0b013e31816b2f26.
- Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. Chou R, Fanciullo GJ, Fine PG, et al. American Pain Society- American Academy of Pain Medicine Opioids Guidelines Panel. J Pain. 2009;10:113-130. doi: 10.1016/j.jpain.2008.10.008.
- Reported lifetime aberrant drug-taking behaviors are predictive of current substance use and mental health problems in primary care patients. Fleming MF, Davis J, Passik SD. Pain Med. 2008 Nov;9(8):1098-106.doi: 10.1111/j.1526-4637.2008.00491.x. Epub 2008 Aug 18.
- Protect your patients, protect your practice: Practical risk assessment in the structuring of opioid therapy in chronic pain. Fine PG, Finnegan T, Portenoy RK. J Fam Pract. 2010 Sep;59 (9 Suppl 2):S1-16. PMID: 20824240
- Risks for possible and probable opioid misuse among recipients of chronic opioid therapy in commercial and medicaid insurance plans: The TROUP Study. Sullivan MD, Edlund MJ, Fan MY, Devries A, Brennan Braden J, Martin BC. PAIN. Aug. 2010;150(2):332-9. doi: 10.1016/j.pain.2010.05.020.
- What are we treating with long-term opioid therapy? Sullivan MD, Ballantyne J. Arch Intern Med. 2012; 172(5): 433-434.doi: 10.1001/archinternmed.2011.2156.
- Treatment of chronic non-cancer pain. Turk DC, Wilson HD, Cahana A. The Lancet. 2011 (Jun25); 377:2226-2235. doi: 10.1016/S0140-6736(11)60402-9.
- Assessment of Chronic Pain in Epidemiological and Health Research: Empirical Bases and New Directions. Von Korff M. In: Turk D.C., Melzack, R. eds. Handbook of Pain Assessment. 3rd ed. New York, NY: Guilford Press; 2011: 455-473.