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Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management

Revision Date: August 2017
Eighth Edition

Guideline Summary

In August 2017 the Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management guideline work group was asked to review acute prescribing recommendations from the Addressing the Opioid Crisis: Acute Pain Prescribing Working Group based upon their review of current literature. This working group of subject matter experts was established as the result of 15 health care organizations and health plans coming together to work on pressing issues to improve the health of Minnesota communities, beginning with opioids and mental health. The Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management guideline work group updated the following recommendations:

13.3 Special Populations: Opioids in Geriatrics

  • Geriatric patients should be assessed for risk of falls, cognitive decline, respiratory malfunction, and renal malfunction before receiving opioids.
  • If impairment or risk is detected in a geriatric patient, consider reducing the initial opioid dose by at least 50%.

13.5 Initiating Opioids for Acute Pain

  • The first opioid prescription for acute pain should be the lowest possible effective strength of a short acting opioid, not to exceed 100 MME total. Patients should be instructed that three days or less will often be sufficient.
  • For patients presenting in acute pain, already on chronic opioids, opioid tolerant or on methadone, consider prescribing an additional 100 MME maximum for this acute episode, with a plan to return to their baseline dose as soon as possible.

This guideline, Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management guideline, is a combination of ICSI’s Acute Pain Assessment/Opioid Prescribing Protocol and the Assessment and Management of Chronic Pain guidelines. Our new guideline now addresses the entire continuum for acute, sub-acute, and chronic non-cancer pain in adults.

The purpose of this guideline is to assist primary care in developing systems that support effective assessment, treatment and ongoing management of patients with pain. Updated evidence-based and best practice recommendations focus less on the pain score, and more on actively managing pain based on function and assisting patients to reach their goals.

The work group acknowledges that pain and opioids are currently intertwined, and provides the clinician with realistic approaches to the management of patients using opioids for pain. Guidance for short-term opioid treatment is included for patients when other treatments are not sufficient or urgent pain relief is indicated. In addition, recommendations and information are provided for the management of chronic opioid use.

The work group would like to acknowledge the work done by the ICSI Patient Advisory Council in reviewing this guideline, and thank them for suggestions to improve the shared decision-making opportunities throughout the document. Learn more.

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