Table 1.

Documented Items Required to Determine the Level of Appropriateness for Opioid Prescribing Preintervention and Postintervention among Patients with Chronic Noncancer Pain

ItemPreintervention (N = 177)Postintervention (N = 96)P ValueFurther Definitions
Overall level of appropriateness score, mean (SD)5.54 (1.23)6.29 (1.26)<.001Opioid appropriateness score (out of nine) was calculated based on the number of documented items described below.
Documented items required:
    (1) Use of nonpharmacologic methods, N (%)129 (72.9)82 (85.4).023Utilized either physical therapy or osteopathic manipulative treatment.
    (2) Specialist consultation, N (%)126 (71.2)66 (68.8).680Specialist consultation warranted if on methadone, >120 morphine equivalents, or >2 psychiatric conditions.
    (3) Imaging/EMG/labs to identify pain generator, N (%)137 (77.4)80 (83.3).275For the purpose of identifying CNCP being treated with opioids.
    (4) Use of nonopioid medications, N (%)172 (97.2)95 (99.0).669For the purpose of identifying CNCP being treated with opioids.
    (5) Visit to discuss CNCP at least every 6 months, N (%)160 (90.4)90 (93.8)0.494
    (6) Pain level/therapeutic/functional goals discussions, N (%)56 (31.6)66 (68.8)<.001Discussed during the last patient's medical encounter for CNCP.
    (7) UDS within last year, N (%)29 (16.4)24 (25.0).109
    (8) Pain contract/agreement within past year, N (%)9 (5.1)12 (12.5).034
    (9) Documented details on drug use, substance abuse or detox, N (%)162 (91.5)89 (92.7).819At any time prior to or at the reviewed medical encounter.
  • EMG, electromyogram; CNCP, chronic noncancer pain; SD, standard deviation; UDS, urine drug screen.