Recommended Assessments
The following table outlines recommended assessments, tools, and frequencies for caring for patients using opioid therapy.
Suggested opioid management assessment schedule
What you are assessing | How to assess | How frequently to assess |
---|---|---|
Specific diagnosis for pain Check that the patient has a diagnosis for their pain that will benefit from opioid medication. |
Based on history, physical examination, and testing (e.g., labs, imaging, as indicated) | First acute, subacute, and chronic pain visit and then at visits according to risk level |
Progress in meeting functional goals | Pain, Enjoyment, General activity scale (PEG), documented patient-set goals (e.g., walk to the park), reports by family (though not always reliable, can be useful), evidence of performing job or life role function | Every visit when opioids are prescribed |
Potential benefits of non-opioid therapies | Diagnosis, history, patient’s perspective, evidence (See integrative medicine table and “Nonopioid Treatments for Chronic Pain” | First acute, subacute, and chronic pain opioid prescription visit and then at visits according to risk level |
Benefits and risks of continued opioid therapy | Based on history, PEG, MED, COMM, STOPBang, PDMP, UDT | A visit within 1 to 4 weeks of:
|
Potential for substance/opioid misuse, abuse, or disorder | Potential tools to use: ORT, ORT-OUD, SOAPP, COMM, DAST, TAPS, DSM-5, OUD diagnosis form using DSM-5 Note: the ORT is validated for predicting risk of aberrant drug related behaviors while the ORT-OUD is validated for risk of developing opioid use disorder. See this article for more information. |
First subacute or chronic pain visit |
Current substances used, including sedatives (e.g., benzodiazepines, carisoprodol) | UDT | First subacute or chronic pain visit and then visits according to risk level |
Current medications filled, including sedatives (e.g., benzodiazepines, carisoprodol) | PDMP | First opioid prescription, at each transition to a new pain category (acute, subacute, chronic), and then at visits according to risk level |
Informed consent | Review the patient agreement and have the patient sign it | Start of long-term opioid therapy; annually |
Morphine equivalent dosing | MED calculator | First opioid prescription and every change in opioid prescription |
Anxiety, depression | PHQ, GAD-7 | According to risk level |
PTSD | PC-PTSD | If elevated PHQ or GAD despite active treatment |
Sleep apnea | STOPBang (obstructive sleep apnea)
Epworth (central sleep apnea) |
When co-occurring risks: MED ≥ 50, Concurrent use of benzodiazepines , COPD, restrictive lung disease, including kyphosis or thoracic scoliosis, BMI > 28, snoring, fatigue, witnessed irregular breathing |
Fibromyalgia | Patient self-report tool | As appropriate if pain is widespread and co-occurring symptoms such as fatigue, poor sleep, depression, abdominal and/or urogenital pain during diagnosis |