Keywords

Chronic pain, opioid

Abstract

Chronic pain is an ever present issue in the United States, with more people suffering from it than heart disease, cancer, and diabetes combined. Chronic pain is the most frequent complaint in primary care, and it poses significant challenges to both primary care providers (PCPs) and their patients. At the root of many of these challenges is the prescription and management of opioid prescription drugs used to treat chronic pain. Opiate misuse, abuse, and diversion are serious risks of opiate prescribing. Risk assessment tools are available to aid the PCP in determining the severity of risk for potential patient abuse, and include the Revised Screener and Opioid Assessment for Patients with Pain (SOAPP-R), the Opioid Risk Tool (ORT), and the Brief Risk Questionnaire (BRQ). Patients who score “high” on these scales should be referred to pain specialty clinics; however, it is often necessary to manage these patients in the primary care setting. The CDC Guidelines for Prescribing Opioids for Chronic Pain—United States, 2016 serves as a protocol for prescribing opiate medications for chronic pain. Inherit in these guidelines is the utilization of urine drug testing and patient provider agreements, which although underutilized, have shown to improve patient and PCP outcomes. Such outcomes for the PCP include improved efficiency and time-management in the clinic, more accurate detection of medication adherence and possible diversion, and improved objectivity with prescribing decision-making. The outcomes for patients include reduced aberrant drug behaviors, which results in improved patient safety. This paper will address evidence-based strategies for PCPs to aid them in appropriate referral processes and provide guidelines for safe and effective prescription of opioid medication for patients with chronic pain.