Trial of Opioid Therapy

PATIENT MANAGEMENT TOOL KIT OPIOID ANALGESIA

NIPC

American Pain Foundation

Trial of Opioid Therapy

Clinical Pearls
- Before initiating an opioid therapy trial
  - Review and discuss Informed Consent concepts
    - Potential opioid adverse effects
    - Definitions, descriptions of tolerance, physical dependence, addiction
    - Alternative pain treatments
    - Driving and work safety
  - Review and discuss Opioid Treatment Agreement (widely used, but not evidence based)
    - The treatment agreement may also be used as part of an overall opioid management plan to set boundaries and guidelines for opioid treatment
    - Schedule for office visits, prescription renewal policies
    - Monitoring processes (eg, pill counts, random urine drug tests, etc)
    - Safe use of opioid therapy (ie, use only as directed, storage and disposal of opioids)
    - Prohibited behaviors and grounds for tapering/discontinuation of therapy
    - Obtaining opioids from one prescriber and filling prescriptions at one pharmacy
    - Reasons, methods for discontinuation of opioid therapy (“Exit Strategy”)
  - Provide pain documentation tools to use between visits to record pain and treatment outcomes
  - Implement opioid therapy as a component of a multimodal, interdisciplinary treatment plan that may include psychological and functional restoration interventions
  - Document all therapeutic choices
Tools

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Remember: in all cases, rely on your clinical judgment and individualize treatment to each patient.