The following table outlines recommended assessments, tools, and frequencies for caring for patients using opioid therapy.
|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
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|
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|