More than 100 million Americans are affected by chronic noncancer pain, accounting for an estimated $635 billion in health care costs and lost productivity annually.1 Once the mainstay of chronic pain treatment, opioids have many serious side effects, including addiction, and often their use leads to failed pain relief in chronic situations. Thus, the standard of care has been to move away from opioid prescribing.
With this shift from long-term opioid care has come increased patient safety, but that has been offset for many by withdrawal and negative health consequences including hospitalization, overdose, and suicide.2 Despite clinical guidelines, health care workers and patients often remain uncertain about how to formulate individualized pain management plans. Moreover, the Centers for Disease Control and Prevention did not include pain guidelines in their updated 2022 recommendations.3 Instead, they focus now on best practices such as shared decision-making, overdose prevention, and patient education about the risks of long-term opioid use. Nevertheless, tools are necessary to standardize, guide, and achieve these aims.
Michael A. Incze, MD, MSEd, who published an article in February on redesigning opioid pain agreements, makes arguments for drawing up just such a plan.4 Although it may not be applicable in all settings, it does represent guidelines to help patients and clinicians by sharing responsibilities and offering substantial education. The author hopes that with implementation, these guidelines can lead to a stronger therapeutic alliance, greater efficiency for practitioners, improved patient experience, and safer, more evidence-based care.
The pain agreement begins with a template for a baseline pain assessment and elicits a set of patient values and functional goals. Current evidence and knowledge gaps pertaining to benefits and harms of long-term opioid treatment are emphasized, facilitating discussion between clinician and patient, and allowing a shared understanding of what successful treatment could be expected. The agreement outlines treatment options (including ongoing opioid treatment) and a monitoring plan to ensure safety and efficacy.
A possible universal pain agreement template that promotes patient-centered care and integrates current chronic opioid-prescribing guidelines is shown in Figure 1.
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