Home For Providers Pain Management Online Resource Center

Pain Management Online Resource Center

Welcome to Community Health Plan of Washington’s Online Resource Center devoted to topics in pain management.  This is a resource for providers who see patients with chronic pain.  Here you will find resources that cover a variety of topics related to the treatment of chronic pain, including:

     · Standards of care and best practices, including the appropriate use of opiates 
     · Screening tools and other documents, including pain contracts
     · Relevant state law
     · A Pain Bibliography and references

We also provide references to much of the information included in the resource center, as well as links to other sites that you may find useful.

If you have a suggestion for improving this resource center, please let us know.  This includes sharing resources you would like to see added to the website.  Likewise, if you detect any inaccuracies in the information provided here or if any of the web links listed are incorrect or have become outdated, please bring those problems to our attention as well.

For any improvements you would like to suggest, just click on Contact Us and send us a note with your idea as to how we might better meet your needs.

Standards of Care/Best Practices in Pain Management:

General/multidisciplinary pain management:
American Academy of Pain Management 

     Practical Management of Chronic Pain In Primary Care

American Pain Society 

     Pain guidelines and online resource centers 

HCA:

A chronic pain contract is a way for providers and patients to agree on the ground rules as they set out to address a patient’s chronic pain.
HRSA Pain Contract 

Veterans’ Administration:

Topics in pain management

Chronic pain primer 

WA Department of Health

Medical Quality Assurance Commission guidelines 

Opiate prescribing

American Academy of Pain Management:

CARE: Confident, Appropriate, Risk-Aware, and Effective Opioid Use in Chronic Pain Management 

Collaborative Opioid Prescription Training (COPE) Guidelines

Note:  The goal of COPE is to provide physicians with essential tools for collaborative goal-setting at the outset of opioid treatment, which we believe may be an important and overlooked first step toward more humane and effective care for chronic pain. COPE is an interactive training module which models communication skill development. The program consists of didactic exercises, video tools, and quizzes and provides comprehensive background information on recent research in relevant areas of pain care.  

 COPE  

HCA Guidelines

Best Practices – Summary Checklist Tools for Documenting Medical Necessity in Clinical Notes when Prescribing Opioids 

Patient brochures available from the WA Department of Health

Opiate dosing guidelines

http://www.agencymeddirectors.wa.gov/education.asp
http://www.agencymeddirectors.wa.gov/opioiddosing.asp

WA Department of Labor and Industries guidelines:

http://www.lni.wa.gov/ClaimsIns/Files/OMD/MedTreat/Opioids.pdf

Opiate dosing calculator:

http://www.globalrph.com/narcoticonv.htm

          http://www.agencymeddirectors.wa.gov/Files/DosingCalc.xls

Drug and alcohol treatment:

ADATSA:

Directory of Certified Chemical Dependency Services in Washington (as of April 1, 2011) 

CHPW:

Directory of Chemical Dependency Professionals in the CHP network

Directory of Chemical Dependency Facilities in the CHP network

HCA:

          DSHS drug and alcohol Tool Kit 

Another tool for providers and treatment agencies is the disclosure form that allows providers to access their patient’s drug treatment and screening records.  Without disclosure, providers may be working in the dark. A model form is available at: http://maa.dshs.wa.gov/pharmacy/DisclosureForm.doc

          CHEMICAL DEPENDENCY TREATMENT 24-Hour Referral Number: 
          Washington Recovery Help Line  1-866-789-1511
          Website: http://www.crisisclinic.org/WARECOVERYHELPLINE/index.html
 
Pain screening tools and other documents:

Pain screening and intake forms:

Brief Pain Inventory (BPI)

Description:  The Brief Pain Inventory (BPI), based from a measure known as the Wisconsin Brief Pain Questionnaire, was developed by the Pain Research Group to provide information on the intensity of pain (the sensory dimension) as well as the degree to which pain interferes with function (the reactive dimension). The BPI also asks questions about pain relief, pain quality, and the patient's perception of the cause of pain.

          https://www.lsdregistry.net/fabryregistry/hcp/partic/assess/freg_hc_p_bpi.asp

Pain Disability Questionnaire (PDQ; Gatchel et al., Univ Texas)

Description:  The Pain Disability Questionnaire (PDQ) is currently ‘the best’ evaluation study of functional status.  The PDQ focus, much like other health inventories, is primarily on disability and function. However, unlike most other measures, this instrument is designed for the full array of chronic disabling musculoskeletal disorders, rather than low back pain alone.

Opiate screening tools:

Current Opioid Misuse Measure (COMM)

Description:  The Current Opioid Misuse Measure (COMM)® is a patient self-assessment that assists clinicians in identifying current pain patients who are misusing their opioid medications.  The COMM was developed with support from Endo Pharmaceuticals and the National Institute on Drug Abuse. It primarily focuses on current behaviors and cognition rather than character and personality traits. So unlike measures that aim to identify risk potential for substance abuse (i.e. predictive validity), the COMM asks patients to describe how they are currently using their medication.
Web link:  www.inflexxionn.com
Email:  PainEDU@inflexxion.com

Opiate Risk Tool (ORT)

Description:  The ORT is a 5-item yes-or-no self-report that is designed to predict the probability of a patient’s displaying aberrant behavior when prescribed opioids for chronic pain. It consists of items on family history of substance abuse, personal history of substance abuse, age, history of preadolescent sexual abuse, and psychological disease. The items on substance abuse contain three subsections covering alcohol, illegal drugs, and prescription drugs, and the item on psychological disease has two subsections that distinguish depression from other disorders.    

Web link:  http://www.painknowledge.org/physiciantools/ORT/ORT%20Patient%20Form.pdf

Screener and Opioid Assessment for Patients with Pain – Revised (SOAPP-R)

Description:  The SOAPP is a 14-item, self-report measure that is designed to assess the appropriateness of long-term opioid therapy for chronic pain patients.(5) Each item is measured on a 5-point scale (0 = never, to 4 = very often), with a cutoff score of 8.  The SOAPP has undergone a number of iterations. It is presently briefer and perhaps less susceptible to deception than some of the more “face valid” tools.

Web link:  www.inflexxion.com
Email:  PainEDU@inflexxion.com

Drug and alcohol screening tools:

Alcohol Use Disorders Identification Test AUDIT-C

Description:  The AUDIT-C is a 3 question screen that can help identify patients with alcohol misuse. The AUDIT-C is scored on a scale of 0-12 points (scores of 0 reflect no alcohol use in the past year). In men, a score of 4 points or more is considered positive for alcohol misuse; in women, a score of 3 points or more is considered positive. Generally, the higher the AUDIT-C score, the more likely it is that the patient's drinking is affecting his/her health and safety.
 
Web link:  http://whqlibdoc.who.int/hq/2001/who_msd_msb_01.6a.pdf

CAGE 

Description:  The CAGE is a four question instrument that has been used primarily in clinical settings to identify people who have ever been alcohol dependent.

Web link: https://www.merck.healthinkonline.com/merckTools/AssessMerckSourceCAGE.asp

DSHS Drug and Alcohol screening toolkit 

Description:  This is the introduction to the DSHS Drug and Alcohol toolkit: “One out of ten adults in Washington needs treatment for a drug use disorder, and for more than half of them, the drug of choice is alcohol. This year, Washington State Legislature has authorized an unprecedented effort to expand treatment options for those who need them without waiting and, where individuals qualify, at little or no cost. But providers need to help. Studies show that when health professionals ask their patients about their alcohol/drug use and explain how misuse affects their health and well-being, people with drug use disorders are much more likely to seek help.  Get the necessary care to your patients.  Please consider using any of the tools on this site that will help you address your patient need.”

Web link:  http://maa.dshs.wa.gov/pharmacy/ToolKit.htm

GAIN-SS

Description:  “The GAIN-Short Screener (GAIN-SS) is designed for use in general populations to quickly and accurately identify people who would be flagged on the full GAIN as having a drug dependency or mental health disorder.”  (GAIN administration manual, p. 1-2)     

Web links:  www.chestnut.org/li/gain

http://www.gaincc.org/gain_ss/index.asp -- This website provides a demonstration of the Global Appraisal of 
Individual Needs (GAIN) Short Screener (GAIN-SS) software application.  
Email:  gaininfo@chestnut.org

Depression screening tools:

Center for Epidemiologic Studies Depression Scale (CES-D):

Description:  The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales.

Web links:  http://www.chcr.brown.edu/pcoc/cesdscale.pdf

WA DOH:  http://counsellingresource.com/lib/quizzes/depression-testing/cesd/

Patient Health Questionnaire (PHQ-9)

Description:  The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day).

Web link:  http://www.phqscreeners.com

Relevant State Law:

House Bill 2876:

PWAC 246-919-850 through WAC 246-919-863 (physicians) and WAC 246-918-800 through WAC 246-918-813 (physician assistants). 
WAC link: 

WA Department of Health summary of HB2876 can be found here:
http://www.doh.wa.gov/hsqa/Professions/PainManagement/Default.htm

Patient Restriction Program (MRIP):

Patient Review and Coordination (PRC):

Description:  Patient review and coordination (PRC) program, formerly known as the patient review and restriction (PRR) program, coordinates care and ensures that clients selected for enrollment in PRC use services appropriately and in accordance with department rules and policies.

Member Review and Intervention Program (MRIP):

Description:  MRIP is CHP’s version of the state’s PRC.  Members at risk for excessive or inappropriate health care use can be referred for review and possible restriction by using the link below.

References:

Alcohol Use Disorders Identification Test (AUDIT-C):

Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA.  The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test.  Arch Intern Med. 1998 Sep 14;158(16):1789-95.
http://www.ncbi.nlm.nih.gov/pubmed/9738608

Brief Pain Inventory (BPI):

Cleeland CS, Ryan KM.  Pain assessment: global use of the Brief Pain Inventory.  Ann Acad Med Singapore, 1994 Mar; 23(2):129-38.
http://www.ncbi.nlm.nih.gov/sites/entrez/8080219?dopt=Abstract&holding=f1000,f1000m,isrctn

Keller, S. et al.  Validity of the Brief Pain Inventory for Use in Documenting the Outcomes of Patients With Noncancer Pain.  Clinical Journal of Pain, 2004 September/October; 20 (5): 309-318.
http://journals.lww.com/clinicalpain/Abstract/2004/09000/Validity_of_the_Brief_Pain_Inventory_for_Use_in.5.aspx

Tan, G, Jensen, M, Thornby, J & Shanti, B.  Validation of the brief pain inventory for chronic nonmalignant pain.   The Journal of Pain, 2004 Mar; 5(2): 133-137.
http://www.sciencedirect.com/science/article/pii/S1526590004000124

CAGE alcohol assessment: 

Ewing JA.  Detecting alcoholism:  The CAGE questionnaire.  JAMA:  Journal of the American Medical Association, 1984; 252:1905-1907.

Center for Epidemiologic Studies Depression Scale (CES-D):
Radloff LS.  The CES-D Scale: A Self-Report Depression Scale for Research in the General Population.  Applied Psychological Measurement, June 1977;1(3): 385-401.
http://apm.sagepub.com/content/1/3/385.abstract

Controlled substance use guidelines:
Canadian Pharmacists Association. Compendium of Pharmaceuticals and Specialties, online version (e-CPS).  http://www.e-therapeutics.ca  (Accessed August 9, 2007).

Federation of State Medical Boards of the United States, Inc.  Model Guidelines for the Use of Controlled Substances for the Treatment of Pain.  Euless, TX: F.S.M.B., 2004.

Isaacson J, Hopper J, Alford D, Parran T.  Prescription Drug Use and Abuse: Risk Factors, Red Flags, and Prevention Strategies.  Postgraduate Medicine, 118(1), July 2005.
http://www.postgradmed.com/issues/2005/07_05/isaacson.htm

Current Opioid Misuse Measure (COMM):
Butler SF et al.  Development and Validation of the Current Opioid Misuse Measure.  Pain, 2007 July; 130(1-2): 144–156.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1950245/

Opiate use guidelines for pain management:
Anderson R, Saiers JH, Abram S, Schlicht C.  Accuracy in equianalgesic dosing. Conversion dilemmas. J Pain Symptom Manage 2001;21:397- 406.

Antoin H.  Opioids for Chronic Noncancer Pain: Tailoring Therapy to Fit the Patient and the Pain.  Postgraduate Medicine, 116(3). September 2004.  http://www.postgradmed.com/issues/2004/09_04/antoin.htm
Ballantyne JC, Mao J. Opioid therapy for chronic pain. N Engl J Med 2003;349:1943-53.

Toombs J., Kral L. Methadone Treatment for Pain States. American Family Physician, 71(7): 1353-8. April 1, 2005.  http://www.aafp.org/afp/20050401/1353.html

Pereira J, Lawlor P, Vigano A, et al. Equianalgesic dose ratios for opioids. a critical review and proposals for long-term dosing. J Pain Symptom Manage 2001;22:672-87.

Washington State Pharmacy and Therapeutics Committee.  Opioid Analgesic Dosing Guidelines.

Opiate Risk Tool (ORT):

Webster LR & Webster RM.  Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool.  Pain Medicine, 2005; 6(6):432-442.

Pain Disability Questionnaire (PDQ):

Anagnostis C, Gatchel R, & Mayer, T.  The Pain Disability Questionnaire: A New Psychometrically Sound Measure for Chronic Musculoskeletal Disorders.  Spine, 2004 October; 29 (20): 2290-2302.
http://journals.lww.com/spinejournal/Abstract/2004/10150/The_Pain_Disability_Questionnaire__A_New.18.aspx

Gatchel RJ, Mayer, TG & Theodore, BR.  The Pain Disability Questionnaire: Relationship to One-Year Functional and Psychosocial Rehabilitation Outcomes.  Journal of Occupational Rehabilitation; 16(1): 72-91.
http://www.springerlink.com/content/d438326832672045/

Pain management guidelines:

American Board of Family Practice, Opioid Analgesics for Chronic Noncancer Pain in Primary Care Guidelines,  J Am Board Fam Pract 12(4):293-306, 1999.

Gureje O, Von Korff M, Simon GE, Gater R.  Persistent pain and well being – a World Health Organization Study in Primary Care.  JAMA 1998; 280: 147-51.

Moss A. End-of-life care including pain management. Therapeutic Research Center, Pharmacist’s Letter/Prescriber’s Letter 2003;CE 03006.

National Cancer Institute. Basic Principles of Cancer Pain Management. NCI website. http://www.cancer.gov/cancertopics/pdq/supportivecare/pain/healthprofessional . (Accessed August 12, 2004).

Patient Health Questionnaire (PHQ-9):

Kroenke K, Spitzer RL, Williams JBW.  The PHQ-9:  Validity of a Brief Depression Severity Measure.  J Gen Intern Med. 2001 September; 16(9): 606–613.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495268/

Screener and Opioid Assessment for Patients with Pain – Revised (SOAPP-R): 

Butler SF, Budman SH, Fernandez K & Jamison RN. (2004). Validation of a screener and opioid assessment measure for patients with chronic pain. Pain, 2004; 112: 65-75.
http://www.painedu.org/soapp-development.asp