Clinical Cases Podcast Series-FREE NO CME-Recommended Screening Tools for Pain and Opioid Risk Management

Recommended Screening Tools for Pain and Opioid Risk Management
Pdf Summary
The document is a “Compass Opioid Prescribing Treatment Guidance Toolkit” reference sheet listing recommended screening tools for pain and opioid risk management across different clinical situations.

For <strong>acute pain (short-term opioid use) at the initial visit</strong>, it recommends assessing pain and function with the <strong>PEG-3</strong> (Pain, Enjoyment, General Function), asking interview questions about <strong>personal and family history of substance use disorders</strong>, using the screening portion of <strong>SBIRT</strong> (Screening, Brief Intervention, and Referral to Treatment), and checking the <strong>state online Prescription Drug Monitoring Program (PDMP)</strong>.

For <strong>chronic pain (long-term opioid use) at initial visit(s)</strong>, it again recommends <strong>PEG-3</strong> and <strong>SBIRT</strong>, plus substance use screening tools tailored by substance: <strong>Fagerström Test</strong> (tobacco), <strong>AUDIT</strong> (alcohol), <strong>CUDIT-R</strong> (cannabis), and <strong>DAST-10</strong> (other drugs). Additional recommended interview/screening areas include substance use history, <strong>psychiatric or mood history</strong>, trauma via the <strong>ACE questionnaire</strong>, depression and anxiety screening with <strong>PHQ-2</strong> (followed by <strong>PHQ-9</strong> if positive) and <strong>GAD-7</strong> (if anxiety indicated), and sleep apnea risk using <strong>STOP-BANG</strong>. It also recommends PDMP review and <strong>definitive drug testing</strong> (GC/MS or LC/MS-MS). For opioid-specific misuse risk, it suggests <strong>SOAPP-R</strong>, with alternatives including <strong>RIOSORD</strong> and the <strong>Opioid Risk Tool (ORT)</strong>.

For <strong>chronic pain follow-up visits</strong>, it advises monitoring using the <strong>Five A’s</strong> (Activities/function, Analgesia, Affect/mood, Adverse effects, Aberrancies), repeating <strong>PEG-3</strong>, and using the <strong>Current Opioid Misuse Measure (COMM)</strong>, alongside PHQ/GAD screening as indicated, PDMP checks, and urine drug screening (immunoassay with definitive confirmation when needed).

It also lists optional tools for other conditions when suggested by history: <strong>PCL-C</strong> (PTSD), <strong>MDQ</strong> (bipolar disorder), <strong>ASRS</strong> (adult ADHD), <strong>PS</strong> (psychosis), <strong>SCI</strong> (insomnia), and <strong>PSS-3</strong> (suicidality). The document includes a CMS/HHS disclaimer and notes collaboration with Stader Opioid Consultants.
Keywords
opioid prescribing
pain management
PEG-3
SBIRT
PDMP
AUDIT
DAST-10
COMM
SOAPP-R
urine drug testing