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VHA Pain Management

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Opioid Safety

man & dog - with text VA commited to finding better ways to manage pain while limiting risk of long-term opioid therapy.

VA/DoD Clinical Practice Guidelines:
Management of Opioid Therapy (OT) for Chronic Pain (2017)

Image of VA_DOD Practice Guidelines

There is a mounting body of research detailing the lack of benefit and potentially severe harm of long-term opioid therapy.  Since the publication of the Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain in 2010, there has been a growing epidemic of opioid misuse and opioid use disorder in America. The 2017 updated guideline is based on a systematic review of both the clinical and epidemiological evidence available as of December, 2016.

The guideline was developed by a multidisciplinary panel of experts who rated both the quality of the evidence and the strength of each recommendation. This guideline is intended to provide healthcare providers with a framework by which to evaluate, treat, and manage the individual needs and preferences of patients with chronic pain, who are currently on or are being considered for long-term opioid therapy (LOT). web link  Link to the VA/DoD Clinical Practice Guideline 

About the CPG  Guideline Links  Patient-Provider Tools  Related Guidelines 
The guideline is formatted as a single algorithm with annotations. OT Full Guideline (2017) - (PDF) OT Patient Summary (2017) - (PDF) Substance Use Disorder (SUD) - site
>Submit - questions about the OT Guideline OT Provider Summary (2017) - (PDF) Managing Side Effects Fact Sheet (2017) - (PDF)  
  OOT Pocket Card (2017) - (PDF) Patient Information Guide (2017) - (PDF)  

Opioid Safety Overview

The prescription opioid epidemic has required the VA to find better ways to manage pain in veterans while limiting the risks of opioids. A recent article, “Addressing the Opioid Epidemic in the United States: Lessons from the Department of Veterans Affairs” describes the system-wide strategies the VA has been employing since the launch of the Opioid Safety Initiative in 2013.  Click here to read the article on line - web link  http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2608540*

Collaborative Opioid Tapering

Guidelines are very clear about when patients should be tapered or weaned but are much less helpful with suggestions about how this will occur.  This video was produced by the VA and DoD to make this process a little easier for providers and a lot more helpful for patients. Common and challenging clinical interactions are depicted along with analyses of provider responses that facilitate collaboration, patient safety, and improved pain care.

Click on this link to watch the video * web link  

Opioid Safety Initiative (OSI) & Toolkit

The VHA recognizes the clinical challenges to successfully managing pain and prescribing safely for our Veterans while implementing the Opioid Safety Initiative (OSI) Directive and the Informed Consent Directive.  Get more information about Opioid Safety Initiative (OSI) & Toolkit. web link

Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients

A recent VA study comparing opioid and non-opioid therapy for pain demonstrated that opioids were not superior to non-opioid approaches in terms of efficacy but were associated with significant side effects. This is important information for clinicians to help with decisions related to pain care. It is also important information for patients who can be reassured that safer options for pain care may be equally effective and in some situations more effective.  Read more about this study.

Centers for Disease Control and Prevention (CDC) - Opioid

The web link CDC Opioid Overdose site contains useful information on opioids.

National Library of Medicine (NLM) - Opioid Addiction and Treatment Portal

NLM has released a new web portal on opioid addiction and treatment. It is available at: web link  www.sis.nlm.nih.gov/enviro/addiction.html *

Opioids - Resource Topics

 Clinical Tools  Provider Education Veteran Public Education  Other Resources Opiod Safety 

Literature Alerts for VA Staff

The VA Library Network will provide VA staff an index of recent articles related to opioids and many other areas of interest right to your work mailbox. If you are interested in subscribing to this alert click here.

Disclaimer: *Links will take you outside of the Department of Veterans Affairs Website. VA does not endorse and is not responsible for the content of the linked websites.