Algorithm

Module A is about determination of appropriateness for opioid therapy. Note: Non-pharmacologic and non-opioid pharmacologic therapies are preferred for chronic pain. If a patient is with chronic pain and has been on daily OT for pain for more than 3 months, then proceed to module D. If a patient is with chronic pain and has not been on daily OT for pain for more than 3 months, then obtain biopsychosocial assessment. Then educate or re-educate on non-opioid management, self-management to improve function and quality of life, realistic expectations and limitations of medical treatment. Then implement and optimize non-opioid treatments for chronic pain (e.g., physical, psychological, and complementary and integrative treatments). If the treatments are effective in managing pain and optimizing function, then exit algorithm; manage with non-opioid modalities. If the treatments are not effective in managing pain and optimizing function, then complete opioid risk assessment and see if patient risks outweigh benefits by considering strength and number of risk factors and patient preference. If patient risk outweighs benefits, then see whether referral/consultation for evaluation and treatment is indicated (e.g., mental health, SUD, more intensive interdisciplinary care). If referral/consultation for evaluation and treatment is indicated, then refer/consult with appropriate interdisciplinary treatments. Then after referral/consultation with appropriate interdisciplinary treatments, see if the patient is willing to engage in a comprehensive pain care plan. If referral/consultation for evaluation and treatment is not indicated, then see if the patient is willing to engage in a comprehensive pain care plan. If the patient is not willing to engage in a comprehensive pain care plan, then exit algorithm; manage with non-opioid modalities. If the patient is willing to engage in a comprehensive pain care plan, then educate the patient and family about treatment options, including education on known risks and unknown long-term benefits of OT, risks of SUD and overdose, need for risk mitigation strategies, naloxone rescue. Then see if adding OT to comprehensive pain therapy is indicated at this time. If adding OT to comprehensive pain therapy is indicated at this time, then see if the patient is prepared to accept responsibilities and the provider is prepared to implement risk mitigation strategies. If adding OT to comprehensive pain therapy is not indicated at this time, then exit algorithm; manage with non-opioid modalities. If the patient is prepared to accept responsibilities and the provider is prepared to implement risk mitigation strategies, then discuss and complete written informed consent with patient and family, determine and document treatment plan, and proceed to module B. If the patient is not prepared to accept responsibilities or the provider is not prepared to implement risk mitigation strategies, then exit algorithm; manage with non-opioid modalities.

Question: What is Module A about?
Answer: determination of appropriateness for opioid therapy

Question: What therapies are preferred for chronic pain?
Answer: Non-pharmacologic and non-opioid pharmacologic

Question: What to do if a patient is with chronic pain and has been on daily OT for pain for more than 3 months?
Answer: proceed to module D

Question: What to do if a patient is with chronic pain and has not been on daily OT for pain for more than 3 months?
Answer: obtain biopsychosocial assessment. Then educate or re-educate on non-opioid management, self-management to improve function and quality of life, realistic expectations and limitations of medical treatment. Then implement and optimize non-opioid treatments for chronic pain (e.g., physical, psychological, and complementary and integrative treatments).

Question: For patients who are in chronic pain and have not been on daily OT for pain for more than 3 months, which topics to consider for educating or re-educating them?
Answer: non-opioid management, self-management to improve function and quality of life, realistic expectations and limitations of medical treatment

Question: What to implement and optimize for patients who are in chronic pain and have not been on daily OT for pain for more than 3 months?
Answer: non-opioid treatments for chronic pain

Question: What to do if the treatments are effective in managing pain and optimizing function?
Answer: exit algorithm; manage with non-opioid modalities

Question: What to do if the treatments are not effective in managing pain and optimizing function?
Answer: complete opioid risk assessment and see if patient risks outweigh benefits by considering strength and number of risk factors and patient preference

Question: How to determine whether patient risks outweigh benefits?
Answer: by considering strength and number of risk factors and patient preference

Question: What to do if patient risk outweighs benefits?
Answer: see whether referral/consultation for evaluation and treatment is indicated (e.g., mental health, SUD, more intensive interdisciplinary care)

Question: What to do if referral/consultation for evaluation and treatment is indicated?
Answer: refer/consult with appropriate interdisciplinary treatments. Then after referral/consultation with appropriate interdisciplinary treatments, see if the patient is willing to engage in a comprehensive pain care plan.

Question: What to do if referral/consultation for evaluation and treatment is not indicated?
Answer: see if the patient is willing to engage in a comprehensive pain care plan

Question: What to do if the patient is not willing to engage in a comprehensive pain care plan?
Answer: exit algorithm; manage with non-opioid modalities

Question: What to do if the patient is willing to engage in a comprehensive pain care plan?
Answer: educate the patient and family about treatment options, including education on known risks and unknown long-term benefits of OT, risks of SUD and overdose, need for risk mitigation strategies, naloxone rescue. Then see if adding OT to comprehensive pain therapy is indicated at this time.

Question: When the patient is willing to engage in a comprehensive pain care plan, what to educate the patient and family about?
Answer: treatment options, including education on known risks and unknown long-term benefits of OT, risks of SUD and overdose, need for risk mitigation strategies, naloxone rescue

Question: What to do if adding OT to comprehensive pain therapy is indicated at this time?
Answer: see if the patient is prepared to accept responsibilities and the provider is prepared to implement risk mitigation strategies

Question: What to do if adding OT to comprehensive pain therapy is not indicated at this time?
Answer: exit algorithm; manage with non-opioid modalities

Question: What to do if the patient is prepared to accept responsibilities?
Answer: discuss and complete written informed consent with patient and family, determine and document treatment plan, and proceed to module B

Question: What to do if the patient is not prepared to accept responsibilities or the provider is not prepared to implement risk mitigation strategies?
Answer: exit algorithm; manage with non-opioid modalities