VHA Pain Management
Opioid Safety Initiative (OSI)
Management of Opioid Therapy (OT) for Chronic Pain (2017) - VA/DoD Clinical 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 panel of multidisciplinary experts and it provides a clear explanation of the logical relationships between various care options and health outcomes while rating both the quality of the evidence and the strength of the 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).
Opioid Safety Initiative 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. The National Pain Management Program office convened a national task force comprised of multidisciplinary pain exerts to create an OSI Toolkit (evidence-based to the extent possible) to help guide the field.
The resulting Toolkit contains documents and presentations that can aid in your clinical decisions about starting, continuing, or tapering opioid therapy, and other challenges related to safe opioid prescribing. We trust you will find these tools useful for your clinical teams caring for Veterans with chronic pain.
Opioid Safety Initiative Toolkit Material
- Acute Pain Provider Guide - Acute Pain Management Opioid Safety VA Educational Guide (2017) (PDF)
- Chronic Pain Provider Guide - Transforming the Treatment of Chronic Pain Moving Beyond OpioidsA VA Clinician’s Guide (2017) (PDF)
- Pain Quick Reference Guide - Transforming the Treatment of Pain A Quick Reference Guide (2017) (PDF)
- Effective Treatments for PTSD: Consider Cognitive Behavioral Therapy (CBT) as First Line Treatment - for Clinicians (PDF)
- PTSD Overview – for Patients (PDF)
- Effective Treatments for PTSD: Helping Patients Taper from Benzodiazepines – for Clinicians (PDF)
- Benzodiazepines Overview - for Patients (PDF)
- Cognitive Behavioral Therapy for Chronic Pain - Therapist Manual (PDF)
- Consent Form for Long-Term Opioid Therapy for Pain (PDF)
- TAKING OPIOIDS RESPONSIBLY - Patient Information Guide on Long-Term Opioid Therapy for Chronic Pain (PDF)
If you have any questions or suggestions, please contact: Your VISN or facility Pain Point-of-Contact (POC) through, email Pamela Cremo - Pamela.Cremo@va.gov
Opioid Therapy Risk Report (OTRR)
OTRR is a patient-focused, actionable and provider-specific report that is available to Primary Care Providers (PCP), Primary Care Managers, PAC Teams, Clinical Pharmacists and others who need to identify patients receiving long-term Opioid Therapy (OT). Data are gathered Nationwide and updated daily so that the most recent information is available, regardless of where care was delivered. Data presented includes key variables that influence patient risk, such as PTSD, Substance Use Disorder (SUD) and Obstructive Sleep Apnea (OSA) as well as the most recent patient interaction with health providers such as Last PCP visit date, Last Pain Clinic visit date and last Mental Health visit date. Dates and status of the signed iMedConsentTM for Opioid Therapy are included. The Patient Details page contains results from the latest Urine Drug Test (UDT), Patient Pain Scores as well as patient Opioid and Benzodiazepine medication history tables listing the prescriber, dispensing location, strength, number of days supply and Morphine Equivalents.
National Library of Medicine (NLM) Opiate Addiction and Treatment Portal
NLM has released a new web portal on opiate addiction and treatment. Link to the site www.sis.nlm.nih.gov/enviro/addiction.html *
PCP and PAC Teams: Access the report using CPRS - Tools - PC Almanac
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