Skip to main content

Main menu

  • Home
  • Articles
    • Current Issue
    • Archives
    • Special Issue Archive
    • Ahead of Print
    • Abstracts In Press
    • Subject Collections
    • Editors' Blog
    • Email Alerts
  • Info For
    • Authors
    • Reviewers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • About
    • The JABFM
    • Editorial Board
    • Indexing
  • Classifieds
  • More
    • Email Alerts
    • Feedback
    • ABFM News
    • Folders
    • Help
  • Other Publications
    • abfm

User menu

Search

  • Advanced search
American Board of Family Medicine
  • Other Publications
    • abfm
American Board of Family Medicine

American Board of Family Medicine

Advanced Search

  • Home
  • Articles
    • Current Issue
    • Archives
    • Special Issue Archive
    • Ahead of Print
    • Abstracts In Press
    • Subject Collections
    • Editors' Blog
    • Email Alerts
  • Info For
    • Authors
    • Reviewers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • About
    • The JABFM
    • Editorial Board
    • Indexing
  • Classifieds
  • More
    • Email Alerts
    • Feedback
    • ABFM News
    • Folders
    • Help
  • JABFM On Twitter
  • JABFM On YouTube
  • JABFM On Facebook
Research ArticleOriginal Research

Structured Management of Chronic Nonmalignant Pain with Opioids in a Rural Primary Care Office

Kevin S. McCann, Shawndra Barker, Raymond Cousins, Adam Franks, Clinton McDaniel, Stephen Petrany and Eric Riley
The Journal of the American Board of Family Medicine January 2018, 31 (1) 57-63; DOI: https://doi.org/10.3122/jabfm.2018.01.170163
Kevin S. McCann
the Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Shawndra Barker
the Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Raymond Cousins
the Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Adam Franks
the Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Clinton McDaniel
the Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Stephen Petrany
the Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Eric Riley
the Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • References
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Tables

    • View popup
    Table 1.

    A Comparison of Baseline Characteristics between Those Who Remained on Opioids (A) Versus Those Who Weaned Off (B)

    Overall (N = 29)Group A (N = 17)Group B (N = 12)P Value95% CI
    Total patients2917 (59%)12 (41%)
    Mean age (years)*66.8665.8868.25.485−9.23 to 4.50
    Age range (years)48 to 8148 to 8155 to 80
    Male†20 (69%)12 (71%)8 (67%)
    Female†9 (31%)5 (29%)4 (33%)
    Mean of total number of medications*11.2411.6510.66.614−2.97 to 4.93
    Range of total number of medications2 to 212 to 213 to 19
    Mean morphine equivalents mg/day*24.9830.6117.01.0400.68 to 26.51
    Standard deviation of morphine equivalents19.0312.52
        Neck4 (14%)2 (12%)2 (17%)
        Upper back2 (7%)2 (12%)0
        Lower back17 (59%)12 (71%)5 (42%)
        Shoulder1 (3%)1 (6%)0
        Knee1 (3%)01 (8%)
        Polyarthralgia3 (10%)03 (25%)
        Peripheral neuropathy1 (3%)01 (8%)
    Comorbid conditions
        Psychiatric diagnosis† present16 (55%)10 (59%)6 (50%).221
        Current smoker†5 (17%)2 (12%)3 (25%).864
    • Group A are those who remained on opioid medication. Group B are those who weaned off opioid medication.

    • ↵* Analysis with independent T-Table test.

    • ↵† Analysis with Chi Square Test.

    • CI, confidential interval.

    • View popup
    Table 2.

    A Comparison of Beginning to End Measures for Those Who Remained on Opioid Medication During the First 18 Months of the Structured Program

    Group ABeginningEndTDfP Value95% CI
    MEDD*30.6128.840.76316.457(−3.14 to 6.67)
    MEDD (range)3.3 to 603.3 to 60
    MEDD (SD)19.0318.60
    BPI Pain Scale (0 to 10)* (mean)5.756.200.9516.356(−1.44 to 0.55)
    BPI pain (range)3 to 83.8 to 9.3
    Pain (SD)1.221.77
    BPI Quality of Life Scale (0 to 10)* (mean)5.846.110.46016.651(−1.50 to 0.96)
    BPI quality of life (range)1.7 to 9.11.7 to 9.7
    BPI quality of life (SD)2.082.21
    Zung Depression Scale (20 to 80)* (mean)40.3542.370.77216.451(−7.93 to 3.6)
    Zung (range)29 to 5725 to 53
    Zung (SD)8.27.53
    • Group A is those patients who continued opioid use and engaged the program. Morphine equivalents represents the mean MEDD in mg/day. BPI Pain Scale is the mean of pain scores for the BPI with range of 0 (no pain) to 10 (maximal pain). BPI Quality of Life is the mean score for how much pain has interfered with quality of life with range of 0 (no impairment from pain) to 10 (maximal impairment from pain). Zung Depression Scale is in raw score with a range of 20 to 80 possible, with less than 40 considered normal mood and above this with progressively worse mood.

    • ↵* Analysis is with paired t-Table test.

    • BPI, Brief Pain Inventory Short Form; CI, confidential interval; MEDD, morphine-equivalent daily dose; SD, standard deviation.

    • View popup
    Appendix.

    Template for Chronic Pain Management Structured Subjective Objective Assessment Plan (SOAP) Note

    Chief complaint: chronic pain management visit
    Controlled substance database last reviewed
    Urine drug screen last obtained
    Pain contract signed
    History of present illness (one or more chronic pain disorders)
        Location
        Intensity
        Quality
        Duration
        Frequency
        Associated symptoms
        Modifying factors
        Previous treatments that helped
        Previous treatments that did not help
    Review of systems
        Mental health problemsYES/NO
        Recent thoughts of suicideYES/NO
        Adequate sleepYES/NO
        Paralysis or loss of functionYES/NO
        IncontinenceYES/NO
        FeverYES/NO
        Change in weightYES/NO
        Previous history of cancerYES/NO
        Impairment to visionYES/NO
        Dry mouthYES/NO
        SyncopeYES/NO
        Witnessed apneaYES/NO
        ConstipationYES/NO
        ItchingYES/NO
        Changes in sexual functionYES/NO
    Past medical history: see below
    Past surgical history: see below
    Family history
        SuicideYES/NO
        Alcohol or drug abuseYES/NO
    Social history
        Smoking currentlyYES/NO
        Alcohol use everYES/NO
        Illegal drug useYES/NO
        Marijuana useYES/NO
        Currently abusedYES/NO
        Currently workingYES/NO
        Living situation changesYES/NO
    Brief Pain Inventory Short Form scores
    Roland Disability score
    SOAPP-R score
    Zung Depression raw score
    Physical examination
        Patient is alert and in no apparent distress
        Gait is
        Strength is /5 with flexion and extension at
        Deformity not present
    Assessment
        Is patient meeting previous goal markers for pain control?
        What are patient's new goals markers for pain control?
        Is there evidence for improvement in function?
        What will be planned goal for improvement in function next visit?
        Are there signs of diversion?
        Are there adverse effects of medication?
        Does the risk versus benefit ratio favor continuing narcotic pain medication?
        Has patient tried safer options for pain control (NSAID, ACET, Tramadol, Lidocaine, topical NSAID, or PT)?
    Plan
        Patient given handout on prescription drug abuse
        Patient given handout on safe medication disposal
        Does patient require more extensive monitoring? Pill counts, urine drug screens.
    • NSAID, Nonsteroidal Anti-Inflammatory Drugs; ACET, Acetaminophen; PT, Physical Therapy.

PreviousNext
Back to top

In this issue

The Journal of the American Board of Family     Medicine: 31 (1)
The Journal of the American Board of Family Medicine
Vol. 31, Issue 1
January-February 2018
  • Table of Contents
  • Table of Contents (PDF)
  • Cover (PDF)
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Board of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Structured Management of Chronic Nonmalignant Pain with Opioids in a Rural Primary Care Office
(Your Name) has sent you a message from American Board of Family Medicine
(Your Name) thought you would like to see the American Board of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
4 + 10 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Structured Management of Chronic Nonmalignant Pain with Opioids in a Rural Primary Care Office
Kevin S. McCann, Shawndra Barker, Raymond Cousins, Adam Franks, Clinton McDaniel, Stephen Petrany, Eric Riley
The Journal of the American Board of Family Medicine Jan 2018, 31 (1) 57-63; DOI: 10.3122/jabfm.2018.01.170163

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Structured Management of Chronic Nonmalignant Pain with Opioids in a Rural Primary Care Office
Kevin S. McCann, Shawndra Barker, Raymond Cousins, Adam Franks, Clinton McDaniel, Stephen Petrany, Eric Riley
The Journal of the American Board of Family Medicine Jan 2018, 31 (1) 57-63; DOI: 10.3122/jabfm.2018.01.170163
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Methods
    • Results
    • Discussion
    • Conclusion
    • Acknowledgments
    • Appendix
    • Notes
    • References
  • Figures & Data
  • Info & Metrics
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Interventions Must Be Realistic to Be Useful and Completed in Family Medicine
  • Google Scholar

More in this TOC Section

  • A Systematic Review and Meta-Analysis of Food Insecurity and Dyslipidemia
  • A Review of 50 Years of International Literature on the External Environment of Building Practice-Based Research Networks (PBRNs)
  • A Longitudinal Effectiveness Study of a Child Obesity Electronic Health Record Tool
Show more Original Research

Similar Articles

Keywords

  • Chronic Pain
  • Controlled Substances
  • Opioid Analgesics
  • Patient Compliance
  • Pharmacy
  • Primary Care Physicians
  • Retrospective Studies

Navigate

  • Home
  • Current Issue
  • Past Issues

Authors & Reviewers

  • Info For Authors
  • Info For Reviewers
  • Submit A Manuscript/Review

Other Services

  • Get Email Alerts
  • Classifieds
  • Reprints and Permissions

Other Resources

  • Forms
  • Contact Us

© 2022 American Board of Family Medicine

Powered by HighWire