Activity 3: Challenging Issues in Chronic Pain Management

Two algorithms are referred to in this series. They were created by the Institute for Clinical Systems Improvement (ICSI) to accompany their guideline ‘Assessment and management of chronic pain.’ The algorithms are available from the ICSI website:

On the ICSI website you can also find these tools:

  • Brief pain inventory (short form)
  • Patient health questionnaire (PHQ-9)
  • Functional ability questionnaire
  • Personal care plan for chronic pain

Recommendation #1: Patient self report is the "most reliable indicator of the existence and intensity of pain" (National Institutes of Health) and is a key component of chronic pain assessment. Tools to assess chronic pain should:

  • Identify significant areas of impairment or disability
  • Establish specific functional outcome goals within a care plan
  • Measure the effectiveness of the care plan or treatment interventions
  • Source: http://www.guidelines.gov/summary/summary.aspx?doc_id=12998
  • Strength of evidence: C,R (C = Non-randomized trial with concurrent or historical controls, case-control study, study of sensitivity and specificity of a diagnostic test, population-based descriptive study; R: Consensus statement, consensus report, narrative review.)

Recommendation #2: Chronic pain is frequently associated with psychological problems and even comorbid psychiatric diagnoses. If psychological difficulties or psychiatric co-morbidities are found, the patient's treatment plan should include specific steps to address them.

  • Source: http://www.guidelines.gov/summary/summary.aspx?doc_id=12998
  • Strength of evidence: C,D,R (C = Non-randomized trial with concurrent or historical controls, casecontrol study, study of sensitivity and specificity of a diagnostic test, population-based descriptive study; D: Cross-sectional study, case series, case report; R: Consensus statement, consensus report, narrative review.)

Recommendation #3: A patient-centered, multi-factorial, comprehensive care plan is necessary, one that includes addressing biopsychosocial factors. It is important to have a multidisciplinary team approach coordinated by the primary care physician.

  • Source: http://www.guidelines.gov/summary/summary.aspx?doc_id=12998
  • Strength of evidence: C,M,R (C = Non-randomized trial with concurrent or historical controls, casecontrol study, study of sensitivity and specificity of a diagnostic test, population-based descriptive study; M: Meta-analysis, systematic review, decision analysis, cost-effectiveness analysis; R: Consensus statement, consensus report, narrative review.)

Download PDF with Recommendations

Approved and Off-label medications for Chronic Pain: Download PDF

The first file contains a PDA version of the lecture notes for the material covered in the first six Learning Link activities.
Download Lecture Notes: Chronic pain-AAFP learning link.zip

The second file (OpCalc) is an equianalgesic opioid calculator. This PDA tool allows easy and accurate conversion when switching from one opioid medication to another opioid and uses standard equianalgesic dosing.
Download Opiate Calculator for Palm OS, Pocket PC (Windows Mobile) and PC Windows: OpCalc.prc

Installation Instructions
RediReader for Palm OS
RediReader for Pocket PC

Presentation Slides for Challenging Issues in Chronic Pain Management

Functional MRI: Gatchel RJ et al. Pain and the Brain. Practical Pain Management. 2008; 8(5):28-40

Toombs JD, Kral LA.
Methadone treatment for pain states. American Family Physician. 2005;71(7):1353-8: http://www.aafp.org/afp/20050401/1353.html

 

Pomm HA, Pomm RM. Management of the Addicted Patient in Primary Care. NY: Springer Science, 2007.

Chronic Pain: A Primary Care Guide to Practical Management. Marcus DA. 1st Edition, HumanaPress, Totowa, NJ, 2005

Anxiety Screen: Download PDF
CAGE AID: Wisconsin Medical Journal 1995;94:135-140.
COMM tool: http://www.painedu.org/soap.asp
Documentation Charting Sheets for Treatment of Chronic Pain: Download PDF
Drug Abuse Screening Test (DAST): http://www.projectcork.org/clinical_tools/html/DAST.html
Methadone Fact Sheet: Download PDF
Opioid Risk Tool: http://www.painknowledge.org/physiciantools
Pain Agreement: Download PDF
Pain Severity Assessment Tool: Download PDF
Pain Scale Comparison: Download PDF
Patient Health Questionnaire (PHQ): www.phqscreeners.com Download PDF
Release of Information Form: Download PDF
SOAPP: http://www.inflexxion.com/offerings.aspx?id=260

Pain Scales

 

 

 

 

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