Pain Management: Opioid Prescribing and De-prescribing for Patients with Chronic Pain

In 2018, the Residency Program Collaborative focused on non-opioid pain management, specifically low back pain and osteoarthritis because they are very common in primary care.

Overall, our objectives are:

  • to understand pain better and what it looks like;
  • do a better job diagnosing pain and monitoring patients;
  • and create appropriate treatment plans that consider all appropriate therapies, including opioids and non-opioids.

The overall goal is developing appropriate treatment plans for patients with pain.The curriculum focused on expanding primary care physician skill sets specific to diagnosing pain, monitoring patients, screening for social determinants of health and communicating with patients to inform the development of appropriate treatment plans for patients with pain. There was a focus on moving patients to non-opioid therapies when appropriate and doing so with respect and compassion for the patient. Attendees developed plans to operationalize those skill sets into practice during the PDSA sessions.

There are quality measures related to pain, opioids, and low back pain, but none that faculty and staff felt practices could easily and accurately report. As a surrogate quality measure, practices have identified patients with low back pain and have a prescription for opioids. Practices will put their new skills to work and report on actions taken at those patients’ next appointments.

Status: Practices are implementing PDSAs from the final project learning session in October and doing some data collection.

The official title of this project is “Clinical Advances in Optimal Approaches for the Management of Osteoarthritis and Low Back Pain” and it’s one part of a large national project. NJAFP partnered with Medscape on this project, which is supported by an independent educational grant funded by Pfizer Inc., in partnership with Lilly USA, LLC.