Colorado Physician Ebook Continuing Education

identified risks, the prescriber should proceed with caution, ensuring safeguards, as detailed below, are in place prior to the initiation of opioid therapy. See Appendix A.1 for additional resources related to assessment, including resources for alcohol and substance use screening and guidelines for treating patients with risk factors. 3. Assess Pain Prescriber should assess the patient’s pain prior to treatment. This assessment should also be completed periodically during continuation of opioid therapy and before increasing dosage, changing formulation or the addition of other medications in order to document the trajectory of the treatment. An appropriate pain assessment should include an evaluation of the patient’s pain for the: ● Nature and intensity; ● Type; ● Pattern/frequency; ● Duration; ● Past and current treatments; ● Underlying or co-morbid disorders or conditions; and ● Impact on physical and psychological functioning. 4. Assess Function Functional assessment is critical in the management of pain. Functional ability has been found to be a more reliable measure in the evaluation of treatment Consider Alternatives to Opioid Therapy Not all pain conditions require opioid treatment. The first step in reducing the misuse and abuse of opioids is to avoid prescribing opioids when non-pharmacologic or non-opioid pharmacologic treatments are effective in addressing the patient’s pain and function. This applies not only to chronic, non-cancer pain, but also, acute pain. Studies have shown that opioid treatment for acute pain has been associated with long-term opioid use 5 and that physical dependence on opioids is an expected physiological response for patients using opioids for more than a few days.6 The decision to prescribe or dispense opioids should be made only after careful consideration of the benefits and risks of all treatment options. Other treatment options may include, but are not limited to, the following: Collaborate with the Healthcare Team Prescribers and dispensers should collaborate with members of the healthcare team, including mental and behavioral health providers and addiction and Patient Education A decision to initiate opioid therapy should be a shared decision between the patient and the prescriber. Prescribers should educate patients regarding all treatment options for the management of pain, ensuring the patient is provided with, and

and is essential for establishing agreed upon functional goals. Prescribers should assess the patient’s functional ability prior to treatment. This assessment should also be completed periodically during opioid therapy and before increasing dosage, changing formulation or the addition of other medications. See Appendix A.1 for Functional Assessment Tools. 5. Psychological Assessment In instances where the risk assessment identifies a mental health or psychological condition, the prescriber should consider referring the patient to a mental health provider for a psychological or cognitive behavioral assessment. 6. Review PDMP Prescribers and dispensers should access the PDMP and review the patient profile prior to making a determination regarding the initiation of opioid therapy. Prescribers and dispensers should also review the patient’s PDMP profile prior to each instance in which opioids are prescribed, refilled or dispensed. Prescribers and Dispensers may want to consider reviewing the patient’s pet or animal profile if there is a concern for diversion of veterinary prescriptions. Further, prescribers and dispensers must follow the statutory mandates of Senate Bill 18-022, Clinical Practice for Opioid Prescribing, which requires prescribers to check the PDMP prior to a second fill of any opioid in certain circumstances. ● Non-opioid Pharmacologics such as acetaminophen, alpha-acting agents, anticonvulsants, antidepressants, nonsteroidal anti-inflammatory drugs (NSAIDS), muscle relaxants, or topical lidocaine; and ● Non-pharmacologic treatments such as acupuncture, complementary alternative medicine, cognitive behavioral therapy, dry needling, exercise therapy, massage therapy, physical therapy, occupational therapy, osteopathic manipulation, regenerative therapy, trigger point or interventional/targeted injections, electrical stimulation, biofeedback, radio frequency ablation or interventional pain management procedures. If opioids are used, they should be combined with non-pharmacologic therapy and non-opioid pharmacologic therapy, as appropriate.

pain management specialists, to prevent under- prescribing, over-prescribing, misuse and abuse of opioids. See the Appendix for additional resources.

understands, the necessary information to make informed decisions. Prescribers should provide this information in a format suited to the particular patient, taking into account the patient’s learning

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Book Code: MDCO1025

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