Box 3.3 Requirements for prescribing opioids for chronic pain
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Prescribe only for documented patients
– Never prescribe for patients before a full evaluation is completed
– Never prescribe for non-patients (yourself, relatives, employees,
friends)
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Document evaluation and specific pain diagnosis
– Prescribe opioids only for patients with a clear pain diagnosis
– Never prescribe for the undiagnosed patient to “improve ability to
cooperate with testing,” unless the patient is acutely ill
Document reason for choosing opioid analgesic
– For example, failure or inability to tolerate non-opioid analgesics
Catalogue specific treatment goals
– Minimize gastric/renal toxicity from non-opioid analgesics
– Improve functional ability
– Improve ability to participate in rehabilitative pain therapy
Document regular follow-up with identification of treatment efficacy and
tolerability
– Specify target goals that have been met or improved
– Document side effects, e.g., change in bowel habits or cognition
Document treatment plan at each visit
– Continue therapy due to demonstrated efficacy/goal attainment
– Modify therapy due to failed goal attainment
– Medication discontinuation for non-efficacy or non-compliance
D. Marcus, Chronic Pain: A Primary Care Guide to Practical Management,
© Humana Press, a part of Springer Science + Business Media, LLC 2009
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