Multimodal Approaches to Optimize Outcomes of Chronic Opioid Therapy in the Management of Chronic Pain

Objective. To review clinical strategies for long-term opioid management as well as strategies to assess and monitor patients with moderate to severe chronic pain who may be at risk for aberrant drug-related behaviors. Design. A symposium was held to disseminate a review of opioid use strategies, including use of the Universal Precautions in Pain Medicine as well as the Federation of State Medical Boards Model Policy for Prescribing Controlled Substances (FSMB model policy). These include continual reassessment of pain and risk, treatment agreements, compliance monitoring, urine drug screening, documentation, compliance with the law, and patient education. Additionally, the use of multimodal strategies to treat patients, with techniques such as cognitive-behavioral therapy, is discussed as an essential part of a comprehensive pain management plan. Setting. The review summarizes a continuing medical education (CME)-accredited symposium conducted at the American Pain Society Annual Meeting in Baltimore, Maryland, in May 2010. Results. Recommendations for the management and monitoring of long-term opioid therapy for patients with chronic noncancer pain are rooted in evidence-based clinical guidelines, which also provide guidance for the identification of aberrant behaviors or overt addiction. Conclusions. Vigilance and frequent interactions may sometimes be inadequate to prevent problematic behaviors; therefore, pharmacologic strategies designed to deter abusive behaviors are also discussed.