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

2. 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.

3. 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

4. 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.

5. 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

6. 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

7. Pain Rating Scale
Defense & Veterans Center for Integrative Pain Management

8. 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

9. 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

10. 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

11. 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

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

13. 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

14. 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

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