Experience with an extended-release opioid formulation designed to reduce abuse liability in a community-based pain management clinic

Figures & data

Table 1 Summary of steps used at the Pain Center of Devon for management of chronic moderate-to-severe pain and documentation of clinical decisions

Visit	Steps	Purpose
Prior to initial visit	Review past medical records.	Set baseline; determine total current daily opioid and rescue medication use; document rationale for opioid use; formulate treatment plan.
Initial visit	Review records again with patient.	Establish physician–patient relationship/partnership in pain management.
	Conduct thorough patient assessment, including physical examination.	Document/verify medical history; determine current pain intensity and locations; assess and manage opioid-associated complications.
	Determine patient’s treatment goals.	Provide opportunity to work with patient to develop reasonable, achievable goals.
	Administer UDS with confirmatory test.	Identify aberrant drug-related behaviors; appropriateness of initiating opioid therapy.
	Discuss risks/benefits of opioid therapy.	Provides patient education and awareness.
	Describe proposed new medication and provide specific instructions for use, purchase from single physician/pharmacist, and storage.	Provide patient education and awareness of expectations for opioid use in general and specific features of proposed new medication, including potential effects of ingesting tampered product.
	Have patient sign a treatment agreement.	Establish expectations, responsibilities, boundaries; reinforce physician directives for opioid use; may help increase patient compliance.
	Encourage inclusion of friend/family member in discussions.	Provides confirmation and elaboration of patient report; support for patient.
Conversion	Switch overnight to half of equianalgesic dose of MS-sNT; immediately provide newly prescribed immediate-release opioid for breakthrough pain.	Immediately addresses patient’s need for management of inadequate pain.
	Reevaluate and adjust dose every 5–7 days, if needed.	Adjust dose for inadequate pain; address occurrence of side effects.
		Assesses efficacy and AEs.
Follow-up	Monthly longitudinal monitoring for compliance.	Documents compliance, effectiveness, side effects, functional improvements, progress toward goals, and success of treatment.
	Have patient fill out PADT form. Physician completes section on potential aberrant drug-related behavior.	Provides convenient ongoing assessment and quick review of pain management over time, including, pain relief, functional changes, mood, sleep, AEs, progress towards goals, and documentation of drug-related behaviors.
	Examine confirmatory results from UDS; counsel if results are unexpected.	Determines whether to continue treatment or whether discontinuation/referral is needed.
	Reevaluate and consider nonopioid therapies when appropriate.

Abbreviations: AE, adverse event; MS-sNT, morphine sulfate and naltrexone hydrochloride extended release capsule; PADT, Pain Assessment and Documentation Tool; UDS, urine drug screen.

Appendix Figure 1 Sample model pain management agreement.³

Note: Reproduced with permission of the American Academy of Pain Management.

McCarbergBStanosSKey patient assessment tools and treatment strategies for pain managementPain Pract20088642343219000171

 PubMedGoogle Scholar