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Clinical Issues™

Clinical Issues in Chronic Pain

Consensus and Controversies for Responsible Opioid Prescribing

Meeting Slides

Clinical Tools

Brief Pain Inventory (Short Form)

A multidimensional pain assessment instrument that can be used to characterize several aspects of a patient’s pain experience, the short form is also widely used for clinical trials and has been translated into multiple languages.

Opioid Risk Tool

This five-question clinical interview or patient questionnaire helps stratify patients based on their risk for opioid-related misuse and abuse.

Current Opioid Misuse Measure (COMM)®

A 17-item assessment questionnaire, the COMM focuses on current behaviors and cognition rather than character and personality traits associated with risks for substance abuse.

Pain Assessment and Documentation Tool (PADT™)

Completed via clinician-directed interview, this instrument provides a consistent and structured method to document progress with opioid therapy over time.

Guidelines

American Pain Society and American Academy of Pain Medicine: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain

Chou R, Fanciullo GJ, Fine PG, et al. J Pain. 2009;10(2):113-130.

Department of Veterans Affairs and Department of Defense: Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain

The Management of Opioid Therapy for Chronic Pain Working Group. Washington, DC: Department of Veterans Affairs, Department of Defense; 2010.

Other Resources

A Clinical Guide to Opioid Analgesia. 2nd edition

Fine PG, Portenoy RK. New York, NY: Vendome Group, LLC; 2007.

Responsible Opioid Prescribing: A Clinician’s Guide. 2nd edition, revised and expanded

Fishman SM. Washington, DC: Waterford Life Sciences; 2012.

Suggested Readings

Abuse rates and routes of administration of reformulated extended-release oxycodone: initial findings from a sentinel surveillance sample of individuals assessed for substance abuse treatment

Butler SF, Cassidy TA, Chilcoat H, et al. J Pain. 2013;14(4):351-358.

Establishing "best practices" for opioid rotation: conclusions of an expert panel

Fine PG, Portenoy RK; Ad Hoc Expert Panel on Evidence Review and Guidelines for Opioid Rotation. J Pain Symptom Manage. 2009;38(3):418-425.

Universal precautions in pain medicine: a rational approach to the treatment of chronic pain

Gourlay DL, Heit HA, Almahrezi A. Pain Med. 2005;6(2):107-112.

Urine drug testing in pain medicine

Heit HA, Gourlay DL. J Pain Symptom Manage. 2004;27(3):260-267.

Substance misuse treatment for high-risk chronic pain patients on opioid therapy: a randomized trial

Jamison RN, Ross EL, Michna E, et al. Pain. 2010;150(3):390-400.

Assessment and treatment of abuse risk in opioid prescribing for chronic pain

Jamison RN, Serraillier J, Michna E. Pain Res Treat. 2011;2011:941808.

Rates of opioid dispensing and overdose after introduction of abuse-deterrent extended-release oxycodone and withdrawal of propoxyphene

Larochelle MR, Zhang F, Ross-Degnan D, Wharam JF. JAMA Intern Med. 2015;175(6):978-987

Abuse-deterrent formulations: part 2: commercial products and proprietary technologies

Mastropietro DJ, Omidian H. Expert Opin Pharmacother. 2015;16(3):305-323.

A review of abuse-deterrent opioids for chronic nonmalignant pain

Moorman-Li R, Motycka CA, Inge LD, et al. P T. 2012;37(7):412-418.

Abuse-deterrent formulations, an evolving technology against the abuse and misuse of opioid analgesics

Schaeffer T. J Med Toxicol. 2012;8(4):400-407.

Activity
Clinical Issues in Chronic Pain

Consensus and Controversies for Responsible Opioid Prescribing

Relevant Resources

Persistent and Breakthrough Pain

Balancing the Benefits and Risk of Opioid-Based Therapy

Improving the Care of Patients With Chronic Pain

Individualized Assessment and Mechanism-Based Multimodal Treatment

Caring For Patients With Chronic Pain

Responsible Opioid Prescribing to Achieve Individualized Functional Goals

Acute Management of Migraine Attacks

Overcoming Pain and Gastrointestinal Distress to Improve Patient Outcomes

Opioid-Induced Constipation

Proactive Diagnosis and Targeted Management

Intrathecal Drug Delivery for Chronic Pain

Selecting Patients and Optimizing Long-Term Outcomes

Clinical Updates on the Management of Gout

Evidence-Based Strategies for Improved Patient Outcomes

Opioid-Induced Constipation

Proactive Diagnosis and Targeted Management

Chronic Obstructive Pulmonary Disease, Asthma, or Both

Differential Diagnosis and Comprehensive Management Strategies

Improving Outcomes in Chronic Obstructive Pulmonary Disease

Optimizing Maintenance Therapy Across Healthcare Settings

Managing Gout in Primary Care

Evolving Strategies for Diagnosis and Long-Term Management

Noninsulin Approaches to Managing Type 2 Diabetes

Best Practices in Combination Therapy

Intrathecal Drug Delivery for Chronic Pain

The Role of Nurses in Optimizing Long-term Outcomes

Hitting the Target in Type 2 Diabetes

Evolving Approaches to Insulin Based Therapy

Intrathecal Drug Therapy for Chronic Pain

Evolving Best-Practice Strategies to Maximize Efficacy and Safety

Clearing the Air

Improving Outcomes for Patients with COPD

Clinical Updates in Type 2 Diabetes

New Strategies for Insulin Replacement Therapy

How Low Do You Go?

Clinical Updates in LDL-C Management

Incretin-Based Therapies For Type 2 Diabetes

Improving Comprehensive Patient Care

Improving Outcomes in Non–24-Hour Sleep-Wake Disorder

Identifying Patients and Tailoring Therapy

Comprehensive Management of Chronic Obstructive Pulmonary Disease

Collaborative Approaches to Guideline-Concordant Patient Care

Clinical Updates in the Management of Severe Asthma

New Strategies for Individualizing Long-term Care

Comprehensive Chronic Pain Management

A Focus on Patients With Opioid-Induced Constipation

Clinical Issues in Bipolar Depression

Consensus and Controversies Across the Spectrum of Patient Presentations

Clinical Updates in Rheumatoid Arthritis

Evolving Treatment Algorithms and Expert Perspectives on Biosimilars

Best Practices in Intrathecal Therapy for Chronic Pain

Patient Selection, Treatment Initiation, and Ongoing Monitoring

Overcoming Challenges in Cancer Pain Management

Engaging With Patients About Opioid-Induced Constipation

Caring for Patients with Severe Asthma

Evolving Best Practices to Optimize Outcomes

Can You Spot Axial Spondyloarthritis?

The PCP’s Role in Timely Recognition and Referral

Clinical Issues in Chronic Pain

Debates and Discussions About Therapeutically Targeting Nerve Growth Factor Signaling

Advancing the Care of Severe Asthma

Differential Diagnosis, Multidisciplinary Management, and Patient Engagement

Updates in HCV Screening and Treatment

Key Issues Impacting OB/GYN Practice

Comprehensive Relief from Cancer Pain

Expanding the Conversation on Opioid-Induced Constipation