Essentials of Good Pain Care: A Team-Based Approach Organize your practice to safely manage acute and chronic pain

Pain-related concerns account for up to 20% of all outpatient visits in the United States. Overall, 66.5 opioid prescriptions were written for every 100 persons.

What is chronic pain and the risks of long-term opioid use? Chronic pain: pain that lasts for greater than 3 months, or beyond the time of normal tissue healing Long term use of opioids can result in tolerance, dependence, addiction, and opioid use disorder Limiting exposure to opioids for acute pain is an important strategy to minimize the development of opioid use disorder

Six steps to improve the safety of pain treatment in your practice Engage the team Engage the patient Assess the patient Use non-pharmacologic and non-opioid therapies first Initiate opioids safely Monitor 5. 6.

Step 1 | Engage the team Practice Perspective: Patient Perspective: It is important to ensure the entire practice is committed to safety as a primary concern when treating acute or chronic pain Practices should develop policies that allow for standardization Patient Perspective: Patients want to feel they are being heard Have a care team work together Appreciate physicians educating them about benefits and risks associated with opioids and alternative approaches

Step 2 | Engage the patient Emphasis placed on making sure the patient feels heard Communicating with patients includes: Listening to their stories Acknowledging their pain Educating them about the nature of chronic pain Establish realistic treatment goals with the patient in terms of pain and function Ask patients what their functional goals are

Pain Rating Scale Defense & Veterans Center for Integrative Pain Management

Step 3 | Assess the patient Using opioids to eliminate all pain can worsen other aspects of quality of life for patients Incorporate systematic approaches to identify patients in need of pain assessment Every patient prescribed opioids should be assessed for risk of opioid misuse before initiating treatment Level and frequency of opioid monitoring depends on the patient’s initial risk evaluation Determine whether the benefits of treatment outweigh the risks It is important to screen patients for depression before implementing opioids

Step 4 | Use non-pharmacologic and non-opioid treatments first Non-opioid and non-pharmacologic therapies are the preferred treatments for many cases of mild to moderate acute pain

Step 5 | Initiate opioids safely The decision to use opioids to treat pain is one that requires careful deliberation and detailed conversations between the physician and patient A checklist is helpful for the initial evaluation of patients with chronic pain Components of that checklist include: Setting realistic goals for pain and function Discussing the benefits and risks of long term opioids Evaluating the risk for opioid misuse Having an exit strategy in place for discontinuing opioid therapy

Step 6 | Monitor Regular follow up visits are appropriate for patients on chronic opioid therapy These visits are used to assess for adverse events and changes in risk as well as progress towards treatment goals Risk mitigation strategies can include: Regular clinic visits Toxicology testing (generally urine) Prescription drug monitoring program checks

AMA Pearl The treatment of chronic pain should be focused on maximizing overall quality of life and emotional and functional well- being for patients

How is it working at other practices? Philadelphia, Pennsylvania Steps in Practice Summary = Location Featured Here Summarize the description of the steps in practice section in a bulleted format Keep it concise and straight to the point Think about what information would be helpful to a practice manager that is presenting this information Review other module pitch decks for examples

Associate Medical Director “ It is important for the clinic to deliver more consistent messaging about risks of opioids, as well as support implementation of counseling, risk mitigation strategies, alternative therapies, and tapering. ” Associate Medical Director embed video

For additional resources, frequently asked questions and implementation support, visit stepsforward.org