Article Figures & Data
Tables
- 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 Value 95% CI Total patients 29 17 (59%) 12 (41%) Mean age (years)* 66.86 65.88 68.25 .485 −9.23 to 4.50 Age range (years) 48 to 81 48 to 81 55 to 80 Male† 20 (69%) 12 (71%) 8 (67%) Female† 9 (31%) 5 (29%) 4 (33%) Mean of total number of medications* 11.24 11.65 10.66 .614 −2.97 to 4.93 Range of total number of medications 2 to 21 2 to 21 3 to 19 Mean morphine equivalents mg/day* 24.98 30.61 17.01 .040 0.68 to 26.51 Standard deviation of morphine equivalents 19.03 12.52 Neck 4 (14%) 2 (12%) 2 (17%) Upper back 2 (7%) 2 (12%) 0 Lower back 17 (59%) 12 (71%) 5 (42%) Shoulder 1 (3%) 1 (6%) 0 Knee 1 (3%) 0 1 (8%) Polyarthralgia 3 (10%) 0 3 (25%) Peripheral neuropathy 1 (3%) 0 1 (8%) Comorbid conditions Psychiatric diagnosis† present 16 (55%) 10 (59%) 6 (50%) .221 Current smoker† 5 (17%) 2 (12%) 3 (25%) .864 - 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 A Beginning End T Df P Value 95% CI MEDD* 30.61 28.84 0.763 16 .457 (−3.14 to 6.67) MEDD (range) 3.3 to 60 3.3 to 60 MEDD (SD) 19.03 18.60 BPI Pain Scale (0 to 10)* (mean) 5.75 6.20 0.95 16 .356 (−1.44 to 0.55) BPI pain (range) 3 to 8 3.8 to 9.3 Pain (SD) 1.22 1.77 BPI Quality of Life Scale (0 to 10)* (mean) 5.84 6.11 0.460 16 .651 (−1.50 to 0.96) BPI quality of life (range) 1.7 to 9.1 1.7 to 9.7 BPI quality of life (SD) 2.08 2.21 Zung Depression Scale (20 to 80)* (mean) 40.35 42.37 0.772 16 .451 (−7.93 to 3.6) Zung (range) 29 to 57 25 to 53 Zung (SD) 8.2 7.53 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.
- 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 problems YES/NO Recent thoughts of suicide YES/NO Adequate sleep YES/NO Paralysis or loss of function YES/NO Incontinence YES/NO Fever YES/NO Change in weight YES/NO Previous history of cancer YES/NO Impairment to vision YES/NO Dry mouth YES/NO Syncope YES/NO Witnessed apnea YES/NO Constipation YES/NO Itching YES/NO Changes in sexual function YES/NO Past medical history: see below Past surgical history: see below Family history Suicide YES/NO Alcohol or drug abuse YES/NO Social history Smoking currently YES/NO Alcohol use ever YES/NO Illegal drug use YES/NO Marijuana use YES/NO Currently abused YES/NO Currently working YES/NO Living situation changes YES/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.
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