In the face of limited data on long-term safety and efficacy of opioids for chronic pain, expert consensus has arrived at the following broad paradigm: clinicians should conduct frequent re-assessments to weigh benefit and harm of ongoing opioid treatment and continue therapy only if benefit is outweighing harm. This general approach has been promoted by the VA since 2003's "VA/DoD Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain;" 2010-updated guidelines do not diverge from this main principle. However, specific guidance on assessing harm and benefit are lacking. The specific aims outlined in this project are designed to improve assessment, specifically, PCPs' ability to identify patients on opioids who may need a change in medication regimen either because the current regimen is unsafe, ineffective or because of medication misuse.
This project fills an important void in the clinical armamentarium by creating a brief instrument that fulfills the need for patient reassessment advocated in current guidelines on the use of opioids in patients with chronic pain.
Specific Aim #1: To perform a systematic review of the published literature describing clinical features and validated patient-reportable items related to opioid safety, efficacy and misuse during opioid treatment and to create an item pool to be subject to expert consensus review in Aim #2.
Specific Aim #2: To use the Delphi method to achieve expert consensus on the patient-reportable items from Aim #1 that are indications for opioid reassessment (IOR) in primary care patients with chronic pain.
Specific Aim #3: To develop and assess preliminary validity and reliability of an instrument to screen patients for IORs using items identified in Aim #2: the Patient-Reported Indications for Opioid Reassessment (PRIOR).
Specific Aim #4a: To design a Computerized Patient Record System (CPRS) progress note to transmit results of the PRIOR to the treating clinician and assess the feasibility of implementing it in primary care.
Specific Aim #4b: To conduct a pilot trial of the PRIOR to obtain data required to design a randomized clinical trial
Not yet available.
We have made step-wise progress in developing a brief instrument (the PRIOR) that will identify patient-reported indications for opioid reassessment in primary care. We hypothesize that once developed and incorporated into CPRS, this instrument will address a key clinician gap and improve clinical outcomes related to opioid safety, one of the most pressing Veteran health issues.
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- Edelman EJ, Gordon K, Goulet J, Tate J, Becker W, Bryant K, Crothers C, Gaither J, Gibert C, Gordon AJ, Rodriguez-Barradas M, Samet JH, Justice AC, Fiellin DA. Is unhealthy alcohol use associated with CD4 cell count among HIV-infected patients on and off combination antiretroviral therapy. Poster session presented at: Research Society on Alcoholism Annual Scientific Meeting; 2014 Jun 22; Bellevue, WA.
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- Becker WC. Recent trends and regional variation in opioid analgesic exposure in the Veterans Health Administration. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2014 Apr 26; San Diego, CA.
- Becker WC. Trends in and correlates of opioid receipt among Veterans with and without HIV. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2013 Apr 26; Denver, CO.