Healthcare Professionals' Perspective
American Academy of Pain Medicine and the American Pain Society guideline on prescribing opioids²¹

The best way for clinicians and patients to determine the best route for pain relief is to follow the guidelines created by the American Academy of Pain Medicine (AAPM) and the American Pain Society (APS):

Patient Evaluation

Evaluation should initially include:

• pain history and assessment of the impact of pain on the patient
• directed physical examination
• review of previous diagnostic studies
• review of previous interventions
• drug history
• assessment of coexisting diseases or conditions

Treatment plan

• Treatment planning should be tailored to both the individual and the presenting problem.
• Consideration should be given to different treatment modalities, such as a formal pain rehabilitation program, the use of behavioral strategies, the use of noninvasive techniques, or the use of medications, depending upon the physical and psychosocial impairment related to the pain.
• If a trial of opioids is selected, the physician should ensure that the patient or the patient's guardian is informed of the risks and benefits of opioid use and the conditions under which opioids will be prescribed.
• Some practitioners find a written agreement specifying these conditions to be useful.

An opioid trial should not be done in the absence of a complete assessment of the pain complaint.

Consultation as needed

Consultation with a specialist in pain medicine or with a psychologist may be warranted, depending on the expertise of the practitioner and the complexity of the presenting problem. The management of pain in patients with a history of addiction or a comorbid psychiatric disorder requires special consideration, but does not necessarily contraindicate the use of opioids.

Periodic review of treatment efficacy

Review of treatment efficacy should occur periodically to assess the functional status of the patient, continued analgesia, opioid side effects, quality of life, and indications of medication misuse. Periodic reexamination is warranted to assess the nature of the pain complaint and to ensure that opioid therapy is still indicated. Attention should be given to the possibility of a decrease in global function or quality of life as a result of opioid use.

Documentation

Documentation is essential for supporting the evaluation, the reason for opioid prescribing, the overall pain management treatment plan, any consultations received, and periodic review of the status of the patient.