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

VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain
alternative, and medication therapies are often combined to create a multimodal pain care plan. The goals
of the Stepped Care Model for Pain Management include functional rehabilitation, improvement in quality
of life, and prevention of the pain becoming chronic and associated deterioration in function (Figure 2).
Figure 2. Stepped Care Model for Pain Management*
*Adapted from the Interagency Pain Research Coordinating Committee’s National Pain Strategy (2016) [26]
Abbreviations: BPS: biopsychosocial; CAM: complementary and alternative medicine; CARF: Commission on
Accreditation of Rehabilitation Facilities; MH-PC: Primary Care-Mental Health; OEF: Operation Enduring Freedom;
OIF: Operation Iraqi Freedom; PACT: Patient Aligned Care Team; SUD: substance use disorders
J. Transfer of Care
As the entire medical community is moving toward a greater understanding of the need for opioid safety,
it is possible that a provider may receive, as a result of a transfer of care, a patient on a high-risk opioid
regimen that raises concerns related to the provider’s and patient’s current understanding of opioid risks.
Some universal approaches should be used in the management of care for the patient regardless of the
location from which that patient is transferred.
• Clinicians should provide each new patient with a full evaluation, understanding that chronic
pain is a complex process that requires a comprehensive assessment of the whole individual as
well as their social circumstances. The general goals of the interview with the patient are to do
more than just gather information. This process should build a therapeutic relationship as well
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