VA/DoD CLINICAL PRACTICE GUIDELINE FOR OPIOID THERAPY FOR CHRONIC PAIN

VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain
2010
Recommendation
Location 18 2010 Recommendation Text 19
Module
Section
Number
• Need for periodic re-evaluation of treatment
• Reasons for stopping opioid therapy
• Consequences of non-adherence with the treatment agreement.
2 H 4 Patient’s refusal to sign an agreement as part of the initial and ongoing assessments of
the patient’s ability to adhere to the treatment plan and the level of risk for adverse
outcomes (see Table 2, Annotation F). The prescription of therapy, in such cases, should
be based on the individual patient and the benefits versus harm involved with therapy.
The rationale for prescribing opioids without a signed agreement should be
documented.
2 I 1 The treatment plan should be individually tailored to the patient’s circumstances and to
the characteristics of the patient’s pain.
2 I 2 Consider the use of other treatment approaches (such as supervised therapeutic
exercise, biofeedback, or cognitive behavior approaches), which should be coordinated
with the opioid therapy.
2010 Grade 20
2016
Recommendation (if
Category 21 applicable) 22
None Not reviewed,
Deleted
None Not reviewed,
Deleted
None Reviewed,
New-replaced
2 I 3 Consider establishing a referral and interdisciplinary team approach, if indicated. None Not reviewed,
Deleted
2 I 4 Establish a follow-up schedule to monitor treatment and patient progress. None Not reviewed,
Deleted
2 I 5 The treatment plan and patient preferences should be documented in the medical
record.
3 K1 1 Chronic pain is often a complex biopsychosocial condition. Clinicians who prescribe OT
should routinely integrate psychotherapeutic interventions, functional optimization,
interdisciplinary therapy, and other adjunctive non-opioid pain therapies.
3 K1 2 Provide written and verbal education to the patient about the specific medication,
anticipated adverse effects, dosing and administration, possible excessive sedation and
symptoms of opioid withdrawal.
3 K1 3 With patient consent, obtain a urine drug test (UDT) prior to initiating an OT trial and
randomly at follow-up visits to confirm the appropriate use of opioids. A patient can
refuse urine drug testing. The provider should take into consideration a patient’s refusal
to undergo urine drug testing as part of the ongoing assessment of the patient’s ability
to adhere to the treatment plan and the level of risk for adverse outcomes (see
None Not reviewed,
Deleted
None Not reviewed,
Deleted
None Not reviewed,
Deleted
None Reviewed,
Deleted
Recommendation 1
February 2017 Page 139 of 192